Prognostic significance of VEGF after twenty year follow-up in a randomized trial of fenretinide in non-muscle invasive bladder cancer
Menée à partir de données portant sur 99 patients atteints d'un cancer de la vessie de stade Ta/T1 et inclus dans un essai évaluant le fenrétinide (durée médiane de suivi : 20,5 ans), cette étude évalue l'association entre les niveaux sériques du facteur VEGF et la survie des patients
Non-muscle invasive bladder cancer (NMIBC) may progress to muscle-invasive disease, but no effective preventive treatments are available. In addition, no reliable prognostic biomarkers have been identified. We assessed the long-term effect of the oral retinoid fenretinide and the prognostic value of circulating VEGF levels. We updated through the Tumor Registry the vital status of 99 patients with resected Ta/T1 bladder tumors who were recruited in a randomized trial of 2 years of fenretinide or no treatment in 1993-94. Serum VEGF levels measured at baseline and 12 months were available in a subgroup of 62 patients. After a median of 20.5 years, 54 subjects deceased, 35 for any cancer and 14 for bladder cancer. Neither overall survival (OS), nor cancer survival (CS) or bladder cancer survival (BCS) were affected by fenretinide (log-rank p{greater than or equal to}.2). DNA aneuploidy in bladder washing was associated with shorter OS (p=.02), CS (p=.05) and BCS (p=.09). Subjects with baseline VEGF levels in the top quintile ({greater than or equal to}350 pg/mL) had a significantly shorter OS (p=.01), CS (p=.02) and BCS (p=.008). Trend across quintiles of VEGF was significant for BCS (p=.007). Multivariate analyses showed that, in addition to smoking status, VEGF level in the top quintile was an independent prognostic factor for OS (HR=2.7, 95%CI: 1.1-6.5), CS (HR=3.3, 1.1-9.4) and BCS (HR=8.9, 1.3-61). Fenretinide did not affect the long-term outcome of patients with NMIBC. High serum VEGF level was a significant predictor of overall and cancer death and may help to identify high-risk subjects who may benefit from a preventive therapy.
Cancer Prevention Research , résumé, 2016