Abstract:

Objective To analyze the predictive value of serum transforming growth factor-β1 （TGF-β1） and vascular endothelial growth factor （VEGF） in patients with non-small cell lung cancer （NSCLC） after single-port thoracoscopic radical resection. Methods A total of 50 patients with NSCLC who underwent single-port thoracoscopic radical resection in Affiliated Hospital of Xuzhou Medical University from May 2018 to May 2020 were selected as the observation objects. Serum TGF-β1， VEGF levels and Karnofsky functional status （KPS） scores before and after surgery were compared， and the total incidence of complications was calculated. All subjects were followed up for 3 years， and serum levels of TGF-β1， VEGF and KPS scores were compared between relapsed group and non-relapsed group， survival group and death group. Pearson correlation analysis was used to explore the correlation between TGF-β1， VEGF and KPS scores. The receiver operator characteristic （ROC） curve was plotted and the area under the curve （AUC） was calculated to evaluate the predictive value of serum TGF-β1 and VEGF alone and combined detection in patients with NSCLC after single-port thoracoscopic radical resection. Results The serum levels of TGF-β1 and VEGF were （7.16±1.94） μg/L and （42.26±5.04） ng/L in 50 patients with NSCLC one month after single-port thoracoscopic radical resection， which were lower than those before surgery [（13.62±3.52） μg/L and （136.52±20.66） ng/L， t=11.37， P<0.001； t=31.34， P<0.001]. The KPS score one month after surgery was 66.57±8.11， which was higher than that before surgery （53.62±5.62， t=9.28， P<0.001）. Postoperative wound healing was delayed in 1 of the 50 patients， pulmonary infection in 1 patient， and no pulmonary embolism and other complications occurred. The total incidence of complications was 4.00%. The serum levels of TGF-β1 and VEGF in patients in the relapsed group （n=6） were （12.95±4.26） μg/L and （72.46±6.05） ng/L respectively， which were higher than those in the non-relapsed group （n=44） [（6.37±1.25） μg/L and （38.14±5.37） ng/L； t=8.34， P<0.001； t=29.99， P<0.001]. The KPS score in the relapsed group was 52.16±8.16， which was lower than that in the non-relapsed group （67.55±12.67， t=2.88， P=0.006）. Serum levels of TGF-β1 and VEGF in the death group （n=5） were （13.99±6.82） μg/L and （75.95±9.05） ng/L， which were higher than those in the survival group （n=45） [（6.41±3.06） μg/L and （38.52±8.37） ng/L； t=4.56，P<0.001； t=21.47， P<0.001]. The KPS score in the death group was 1.25±0.34， which was lower than that in the survival group （65.11±12.94， t=10.93， P<0.001）. Pearson correlation analysis showed that serum levels of TGF-β1 （r=-0.45， P<0.001） and VEGF （r=-0.48， P<0.001） were negatively correlated with KPS scores. ROC curve analysis showed that when the optimal cut-off value of TGF-β1 was 8.14 µg/L， the AUC for predicting recurrence after single-port thoracoscopic radical resection was 0.516 （95%CI：0.446-0.676）， the sensitivity was 71.85%， and the specificity was 80.69%. When the optimal cut-off value of VEGF was 142 ng/L， the AUC was 0.659 （95%CI：0.534-0.761）， the sensitivity was 76.04%， and the specificity was 82.52%. The AUC of the combined detection was 0.828 （95%CI：0.786-0.951）， the sensitivity was 91.86%， and the specificity was 87.52%. The AUC of combined detection was higher than that of serum TGF-β1 （Z=2.63，P=0.007）， VEGF（Z=2.32，P=0.013） single detection. Conclusion The serum levels of TGF-β1 and VEGF are significantly decreased in NSCLC patients after one month of single-port thoracoscopic radical resection， and the combined detection of the two has predictive value for recurrence after single-port thoracoscopic radical resection.

Key words: Transforming growth factor beta1, Vascular endothelial growth factors, Carcinoma, non-small-cell lung, Treatment outcome, Single-port thoracoscopic radical surgery