Pre-operative serum vascular endothelial growth factor can select patientsfor adjuvant treatment after curative resection in colorectal cancer

We aim to determine the clinical usefulness of pre-operative serum vascular endothelial growth factor (VEGF) as a predictor of outcome in patients und ergoing curative resection for colorectal cancer. Serum VEGF was assayed by quantitative ELISA in 81 patients prior to curative resection for node-neg ative (n = 53) and node-positive (n = 28) disease. Median follow-up for pat ients without cancer death was 27 months (range 21-37). Pre-operative serum VEGF was significantly higher in patients who went on to develop metastase s than those who did not (median, 713 pg ml-1 vs. 314 pg ml-1, P < 0.0001). Using multivariate Cox regression analysis, pre-operative serum VEGF was t he most important prognostic factor independent of nodal status and adjuvan t chemotherapy, and was superior to nodal status in predicting outcome (P < 0.00001). At 575 pg ml-1, pre-operative serum VEGF was 64% sensitive and 8 9% specific in predicting the development of metastases in curative resecti ons, with a positive predictive value of 73% and a negative predictive valu e of 85%. Pre-operative serum VEGF is a powerful predictor of outcome follo wing curative surgery for colorectal cancer. These data support the measure ment of pre-operative serum VEGF as a method for selecting patients who req uire adjuvant therapy. (C) 2000 Cancer Research Campaign http://www.bjcance r.com.