Vascular endothelial growth factor as prognostic factor in renal cell carcinoma

Purpose: Vascular endothelial growth factor (VEGF) has been recognized as an important constituent of vascularization and growth of solid tumors. Serum VEGF levels were evaluated and correlated to clinicopathologic findings and clinical outcome in patients with renal cell carcinoma (RCC). Materials and Methods: Serum samples were collected before surgery in 164 patients with RCC. Levels of VEGF(165) protein in sera were measured using a quantitative ELISA. Univariate and multivariate analyses were performed. Results: The VEGF(165) level in serum was significantly increased (p = 0.0001) in patients with RCC (median 343.4 pg./ml.) compared with the control patients (median 103.8 pg./ml.). The level of VEGF(165) in serum correlated to clinical stage nd histopathological grade. Patients with VEGF(165) levels below median value had significantly longer survival time than patients with higher levels (p = 0.0001). This was also shown when VEGF(165) was analyzed in univariate Cox regression (p = 0.0001). The impact of VEGF(165) on survival was especially shown in patients having tumors with vein invasion (pT3b-c NO MO) and in patients with clinical stages I - III (p = 0.0240 and p = 0.0023, respectively). When using multivariate analysis, only tumor stage and grade remained as independent prognostic variables. Conclusions: In RCC, serum VEGF(165) level was significantly correlated to tumor stage and grade. Increased levels were correlated to adverse survival. Although, VEGF did not remain as an independent prognostic factor in multivariate analysis the levels of VEGF(165) in serum was found useful for the identification of patients with potentially progressive disease especially for those with vein invasion.