The relationship between serum vascular endothelial growth factor, persistent disease, and survival at second-look laparotomy in ovarian cancer.
OBJECTIVE
To assess if the angiogenic factors vascular endothelial growth factor (VEGF) and D-dimer are predictive of persistent disease, early relapse, and survival in patients with ovarian cancer who achieve a complete clinical remission after first-line chemotherapy.


METHODS
Serum levels of VEGF and D-dimer were assessed by ELISA in 62 patients who completed first-line chemotherapy and underwent second-look laparotomy at Duke University Medical Center. Cox Proportional Hazards Modeling was utilized to determine if VEGF and/or D-dimer levels could predict disease-free and overall survival. The Kaplan-Meier method was used to estimate median survival. The Wilcoxon test was used to determine if a significant difference existed in median VEGF and D-dimer levels between patients with positive and negative second-look operations.


RESULTS
Forty (65%) of the 62 women who underwent second-look laparotomy had persistent disease. The median VEGF levels were 264 pg/ml (range 109-896 pg/ml) in the group with negative second looks compared to 390 pg/ml (range 99-1011 pg/ml) in those with positive second-looks (P = 0.1). High levels of VEGF were marginally associated with the presence of persistent (P = 0.10) and gross (P = 0.07) disease at the time of second look laparotomy. After adjusting for CA125, women with high VEGF serum levels had a worse overall survival (P = 0.004).


CONCLUSIONS
This study suggests that serum VEGF may be a clinically important marker for persistent disease and is predictive of survival in ovarian cancer patients after first-line chemotherapy.
Alvarez Secord
Angeles
A
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA. secor002@mc.duke.edu
Sayer
Robyn
R
Snyder
Stacey A
SA
Broadwater
Gloria
G
Rodriguez
Gustavo C
GC
Berchuck
Andrew
A
Blackwell
Kimberly
K
D000328:Adult; D000368:Aged; D018394:CA-125 Antigen / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D007813:Laparotomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D024162:Second-Look Surgery; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
D018394:CA-125 Antigen; D005338:Fibrin Fibrinogen Degradation Products; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C036309:fibrin fragment D