Clinical Value Of Serum VEGF,IL-6 And CRP In Patients With Advanced NSCLC

backgroundNon-small cell lung cancer（NSCLC）is a common malignant tumor,and its incidence is increasing year by year worldwide.The clinical symptoms are not obvious in the early stage,and the metastasis often occurs in the advanced stage,which misses the best time for treatment.Serious threat to the patient’s life and health.Increasing evidence shows that the tumor microenvironment（TME）plays an important role in the development,invasion and metastasis of non-small cell lung cancer in multiple stages,and a variety of cytokines are involved in the regulation of the tumor microenvironment.Serum markers are widely used due to the advantages of less trauma,convenient sampling,reproducibility and high specificity,which are convenient for tumor diagnosis and prognosis evaluation.However,single serum markers lack sufficient sensitivity and specificity,and they are usually combined.use.Therefore,this topic from the perspective of the relationship between tumor microenvironment and non-small cell lung cancer,to explore Vascular endothelial growth factor（VEGF）,interleukin-6（IL-6）and the expression of C-reactive protein（CRP）in NSCLC provides a valuable basis for the early diagnosis and prognosis evaluation of NSCLC.ObjectiveThis paper mainly studies the expression levels and significance of VEGF,IL-6 and CRP in the serum of patients with advanced NSCLC,and explores their relationship with different clinical features,diagnosis,treatment efficacy and prognosis of advanced NSCLC,so as to provide valuable reference for clinical application.MethodsIn this study,80 newly diagnosed lung cancer patients admitted to the Third Affiliated Hospital of Xinxiang Medical College from November 2017 to March 2021 were collected as the observation group,including 42 males and 38 females with an average age of（67.39±11.21）years old,all the patients were patients with definite pathological diagnosis.They were all diagnosed with non-small cell lung cancer for the first time in the Third Affiliated Hospital of Xinxiang Medical College,and were newly treated patients.According to the Union for International Cancer Control（UICC）TNM staging standard^[1],has not received anti-tumor therapy such as radiotherapy,chemotherapy,surgery,immunotherapy,targeted therapy.According to the 8th edition of the international TNM staging criteria for lung cancer,there were 0 cases in stage I,13 cases in stage II,31 cases in stage III,and 36 cases in stage IV.Pathological types:53 cases of adenocarcinoma and27 cases of squamous cell carcinoma.Degree of differentiation:34 cases were moderately and highly differentiated,and 46 were poorly differentiated.During the same period,50healthy subjects in our hospital were selected as the control group,including 23 males and27 females,with an average age of（69.72±10.50）years.4ml of fasting venous blood was collected from all subjects in the morning and sent to the laboratory department of our hospital.The blood was collected by the relevant instruments and reagents of the laboratory department.VEGF was detected by chemiluminescence method,and IL-6 was detected by electrochemiluminescence method.Immunoturbidimetry was used to detect CRP,and the relevant data results were recorded.The expression levels of peripheral serum VEGF,IL-6,and CRP in the two groups of subjects were compared,and the relationship between the levels of VEGF,IL-6,and CRP with different clinical characteristics was analyzed,and the sensitivity,specificity and accuracy of the three independent detection and combined detection were calculated.,to analyze the diagnostic value of the expression levels of VEGF,IL-6 and CRP in the diagnosis of middle and advanced non-small cell lung cancer,and to analyze the relationship between the levels of serum VEGF,IL-6 and CRP and the curative effect.Results1.Comparison of the expression levels of VEGF,IL-6 and CRP in the observation group and the control group:The expression levels of VEGF,IL-6 and CRP in the observation group were（259.83±131.73）pg/ml、（15.54±11.37）pg/ml、（13.55±12.41）pg/ml,respectively.The expression levels in the control group were（104.50±51.08）pg/ml、（5.84±1.91）pg/ml、（2.37±2.19）pg/ml,respectively.The expression levels of VEGF,IL-6and CRP in NSCLC patients were significantly higher than those in the control group（P<0.05）.2.Comparison of the expression levels of VEGF,IL-6 and CRP with different clinical features in the observation group:the expression levels of VEGF,IL-6 and CRP in NSCLC were correlated with smoking history,lymph node metastasis,degree of differentiation and TNM stage（P<0.05）,and the expression level of VEGF is also related to the pathological type;3.Comparison of sensitivity,specificity and accuracy:The sensitivity of VEGF,IL-6and CRP were 82.5%、62.8%、86.3%、85.0%、87.5%、86.3%and 90.0%,respectively.The specificity was 85.0%、94.5%、87.5%、87.5%、85.0%、92.5%、96.2%,respectively.The areas under ROC curve were 0.877（95%CI:0.816-0.938）、0.785（95%CI:0.704-0.866）、0.876（95%CI:0.814-0.939）、0.913（95%CI:0.862-0.965）、0.933（95%CI:0.889-0.977）、0.922（95%CI:0.875-0.968）and 0.945（95%CI:0.905-0.985）,respectively.The sensitivity,specificity and accuracy of the combined detection of VEGF,IL-6 and CRP were higher than those of the single detection and the paired detection.4.Comparative analysis of VEGF,IL-6 and CRP expression levels in NSCLC patients before and after chemotherapy:The expression levels of VEGF,IL-6 and CRP in NSCLC patients before chemotherapy were（239.28±105.46）pg/ml、（15.13±11.31）pg/ml、（13.32±12.79）pg/ml,and after chemotherapy were（216.19±83.68）pg/ml、（10.48±7.38）pg/ml、（9.52±6.47）pg/ml,the expression levels of VEGF,IL-6 and CRP in patients after chemotherapy were significantly lower than those before chemotherapy,the difference was statistically significant（P<0.05）.5.The observation group was divided into CR+PR+SD group and PD group according to RECIST,and the expression levels of VEGF,IL-6 and CRP in CR+PR+SD group were significantly lower than that in PD group.The difference was statistically significant（P<0.05）.6.Single factor analysis:Smoking history,lymph node metastasis,TNM stage,degree of differentiation and expression level of VEGF were related risk factors affecting the short-term efficacy of first-line chemotherapy in NSCLC patients,while smoking history,age,lymph node metastasis,TNM stage,degree of differentiation,expression level of VEGF,IL-6 and CRP were related risk factors affecting the prognosis of NSCLC patients.7.Multivariate analysis:smoking history,lymph node metastasis,TNM stage and VEGF expression level were independent risk factors affecting short-term efficacy of first-line chemotherapy in NSCLC patients,while differentiation degree and VEGF expression level were independent risk factors affecting prognosis of NSCLC patients.Conclusions1.The expression levels of VEGF,IL-6 and CRP in serum of NSCLC patients were significantly higher than those of healthy subjects;2.The expression levels of VEGF,IL-6 and CRP were correlated with smoking history,lymph node metastasis,differentiation degree and TNM stage;3.Compared with any one of VEGF,IL-6 and CRP and the combined detection of the three,the combined detection of the three has the highest diagnostic value;4.The expression levels of VEGF,IL-6,and CRP in serum of NSCLC patients can be used to evaluate the efficacy of first-line chemotherapy regimens.The higher the expression levels,the worse the short-term efficacy;5.The expression levels of VEGF,IL-6 and CRP are related to the prognosis of NSCLC patients,and the higher the expression level is,the worse the prognosis is.