Prognostic Potential of Serum VEGF Expression in Breast Cancer: A Study from Egypt

Abstract

Introduction: Basal Vascular Endothelial Growth Factor (VEGF) levels are elevated in the serum of Breast Cancer (BC) patients. Positive correlation has been reported between VEGF expression and microvessel density in primary BC sections. The relapse-free survival rate of patients with VEGF-poor tumours was significantly higher than that of VEGF-rich tumours, suggesting that expression of VEGF may be associated with poor BC prognosis. Aim: To evaluate the role of VEGF as a prognostic factor in breast cancer patients. Materials and Methods: This case-control study was conducted on BC patients admitted to the Oncology Unit or the Outpatient Clinics, Main Alexandria University Hospitals, Faculty of Medicine, Egypt. Clinically diagnosed 75 BC patients were divided into Group IA: 45 patients diagnosed with early BC Stage I and II; and Group IB: 30 patients diagnosed with advanced BC Stage III and IV. Apparently, healthy 60 females (relatives/companions) were recruited as the control group (Group II). Serum VEGF levels were measured by Enzyme-linked immunosorbent assay (ELISA). Serum VEGF data were expressed as median (minmax). Qualitative data were analysed using Chi-square test and Fisher’s-Exact test or Monte Carlo correction. Quantitative data were analysed using Mann Whitney (Z) test and Kruskal Wallis (H) tests. Spearman’s coefficient (rs ) was performed to determine correlation of serum VEGF with age, tumour size and grade. Binary logistic regression was done to predict the probability of several clinical parameters with respect to the VEGF measurement. Significance level was set at 5%. Results: The median VEGF serum levels showed significant difference between the three studied groups (p<0.001). Serum VEGF was significantly increased in both Groups IA/IB patients compared to healthy controls (p<0.001); and were significantly higher in advanced than early BC patients (p<0.001). Serum VEGF was significantly associated with tumour size, tumour grade, Oestrogen Receptor (ER), Progesterone Receptor (PR), luminal tumour, and triple negative BC. BC cases who developed metastasis expressed significantly higher serum VEGF (Group IA: p≤0.001; Group IB: p=0.024). Conclusion: Serum VEGF may serve as an independent prognostic biomarker in BC patients that merits prospective validation.

Keywords

• biological markers
• cancer work-up
• enzyme-linked immunosorbent assay
• tumour staging