The Diagnostic Value Of Vascular Endothelial Growth Factor In Malignant Ascites/pleural Effusions

Objective Studies clearly indicate a correlation between tumor neovascularization and aggressiveness of tumor growth and metastasis. One of the key factors capable of stimulating tumor angiogenesis is vascular endothelial growth factor (VEGF). Using an immunoassay for VEGF, we assessed the levels of soluble VEGF in the sera and effusions of patients with malignant and nonmalignant disease as well as in the sera of healthy controls. Methods Using a sandwich enzyme-linked immunoadsorbent assay, the concentration of VEGF was measured in serum specimens (n=108) and effusions (n=68) collected from a total of 38 patients with various types of cancer, 30 patients with nonmalignant disease, and 40 healthy individuals. Results Low and rather stable levels of VEGF were detected in the serum of healthy individuals (median, 76 pg/mL; range, 16-209 pg/mL; 95th percentile, 162 pg/mL). Compared with healthy individuals, serum levels in patients with acute infections were elevated (P<0.05), whereas patients with chronic cirrhosis had lower serum VEGF levels. In patients with various types of neoplasia, serum VEGF levels in patients with malignant effusions were significantly higher than in healthy individuals. Effusion VEGF levels in malignancy were significantly higher than in nonmalignancy. Maximum serum concentrations of VEGF (median, 396pg/mL; range, 102-1372pg/mL) were found in patients with ovarian carcinoma. Median VEGF levels (and ranges) in malignant effusions were up to 8-fold higher than in matched serum samples: 2806 pg/mL (287-18376 pg/mL) in ovarian carcinoma, 898pg/mL (84-3230 pg/mL) in lung carcinoma, and 674 pg/mL (128-2473 pg/mL) in gastrointestinal carcinoma. In contrast, effusions from patients with acute infections contained 243 pg/mL(59-463pg/mL) and ascitic fluid from patients with cirrhosis contained only 62 pg/mL (16-212 pg/mL) of VEGF, corresponding to the low serum levels in this group of patient. Compared with healthy individuals' upper limit (95th percentile, 162 pg/mL), sensitivities and specificities of serum VEGF level for the diagnosis of malignant effusions were 57.89% and 73.33% respectively and those of effusion VEGF level were 89.47% and 63.33% respectively. Conclusions 1. Serum VEGF levels in healthy individuals were low and rather stable. Serum VEGF levels in patients with either infections or malignant effusions were significantly elevated, whereas patients with chronic cirrhosis were the converse case.2. Serum and effusion VEGF levels in malignancy were significantly higher than in nonmalignancy.3. Variation of sera and effusions VEGF levels may be connected with clinical course in patients with malignant effusions.4. Detection of VEGF in sera and effusions is helpful for diagnosing and differentiating between natural of ascites/pleural effusions.5. Detection of VEGF in sera and effusions could conduce to observing treated effect and evaluating prognosis on patients with malignant ascites/pleural effusions.