The crucial role of blood VEGF kinetics in patients with locally advanced esophageal squamous cell carcinoma receiving curative concurrent chemoradiotherapy

Background: To evaluate the role of blood vascular endothelial growth factor (VEGF) kinetics in patients with locally advanced esophageal squamous cell carcinoma (ESCC) receiving curative concurrent chemoradiotherapy (CCRT). Methods: A total of 97 locally advanced ESCC patients were enrolled. All the patients had their blood drawn at three time points to determine their levels of VEGF, including pre-chemotherapy (day 0), post-chemotherapy (day 5), and pre-cycle 2 chemotherapy (day 28). The VEGF levels were evaluated according to the day 0 value, day 5 value, day 28 value, day 5/day 0 ratio, day 28/day 0 ratio, and day 28/day 5 ratio. A VEGF cut-off level of 80pg/mL was applied. Results: In the analysis of progression-free survival (PFS), the patients less than 60years old had significantly superior PFS compared to those more than 60years old. Patients who had VEGF <80pg/mL at day 28 and a day 28/day 5 ratio<1 had better PFS than those with VEGF >80pg/mL and a day 28/day 5 ratio>1, respectively. In the analysis of overall survival (OS), patients with N0-1 status had significantly superior OS compared to those with N2-3 status. Furthermore, patients who had VEGF <80pg/mL at day 28, a day 5/day 0 ratio<1, and a day 28/day 5 ratio<1 had superior OS compared to those patients with VEGF >80pg/mL, a day 5/day 0 ratio>1, and a day 28/day 5 ratio>1, respectively. In the multivariate analysis, only VEGF <80pg/mL at day 28 and a day 28/day 5 ratio<1 represented independent prognostic factors of superior PFS and OS. Conclusions: Our study suggests that VEGF kinetics is a prognostic factor for locally advanced ESCC patients receiving curative CCRT. For these patients, lower post-treatment VEGF levels and decreasing levels of VEGF during CCRT are significantly associated with better clinical outcomes.