title: Predictive significance of preoperative serum VEGF-C and VEGF-D, independently and combined with Ca19-9, for the presence of malignancy and lymph node metastasis in patients with gastric cancer.
abstract: BACKGROUND
  Cumulative evidence demonstrate that lymphangiogenic vascular endothelial growth factors (VEGF)-C and -D are over-expressed and associated to lymph node metastasis (LNM) in gastric cancer. The aim of this study is to investigate whether preoperative serum levels of VEGF-C and VEGF-D could be useful tumor markers in patients with operable gastric adenocarcinoma.
  
  
  METHODS
  We prospectively examined serum samples from 40 patients and 40 non-cancer controls using enzyme-linked immunosorbent assay (ELISA). Logistic regression analysis was implemented. VEGF-C and VEGF-D were studied independently and in combination with Ca19-9.
  
  
  RESULTS
  In gastric cancer patients, preoperative VEGF-C was significantly lower as compared to controls and to postoperative VEGF-C (P < 0.001); preoperative VEGF-D was significantly higher as compared to controls and to postoperative VEGF-D (P < 0.001). ROC curve analysis identified a VEGF-C/VEGF-D cut-off value of < 2.7 for the presence of gastric cancer, with 83% sensitivity and 75% specificity (P < 0.001). Backward stepwise selection modeling including sex, age, VEGF-D and Ca19-9, predicted the presence of LNM with 86% sensitivity and 82% specificity (P < 0.001).
  
  
  CONCLUSIONS
  Circulating levels of VEGF-C and VEGF-D could play a role as biomarkers for serological detection and staging in gastric cancer.
authors.affiliation: 3rd Department of Surgery, General Hospital of Athens G. Gennimatas, Athens, Greece. theodoros.tsirlis@nuth.nhs.uk
authors.forename: Theodoros D
authors.initials: TD
authors.lastname: Tsirlis
authors.forename: Alkiviadis
authors.initials: A
authors.lastname: Kostakis
authors.forename: George
authors.initials: G
authors.lastname: Papastratis
authors.forename: Kiriaki
authors.initials: K
authors.lastname: Masselou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Vlachos
authors.forename: Antonios
authors.initials: A
authors.lastname: Papachristodoulou
authors.forename: Nikolaos I
authors.initials: NI
authors.lastname: Nikiteas
mesh_terms: D000230:Adenocarcinoma / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011379:Prognosis; D013274:Stomach Neoplasms / Q000097:blood* / Q000473:pathology*; D042582:Vascular Endothelial Growth Factor C / Q000097:blood*; D042643:Vascular Endothelial Growth Factor D / Q000097:blood*
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D042582:Vascular Endothelial Growth Factor C; D042643:Vascular Endothelial Growth Factor D