Increased serum VEGF in 13 children with Wilms' tumour falls after surgerybut rising levels predict poor prognosis

Vascular endothelial cell growth factor (VEGF, a potent endothelial cell mi togen in vitro) may be important in tumour development and its spread in vi vo. In this preliminary study, we tested the hypotheses that (i) raised ser um levels in Wilms' tumour fall after surgery, and (ii) rising levels predi ct adverse outcome. Serum VEGF was measured (ELISA) in 13 children about to undergo surgery, and serially on the following day, a week later, and fina lly 3-6 months after surgery. A simple followup at 6 months was also perfor med. The control group was 60 healthy adults. Before surgery, the median (i nter-quartile range) VEGF in the children was 20 ng/ml (10.4-70.5) and was 1 ng/ml (0.5-4.0) in the adults. This difference is statistically highly si gnificant (P = 0.0001). After surgery, levels in the children fell signific antly to 1.3 ng/ml (0.5-7.95) the following day and to 1.9 ng/ml (0.5-5.0) the following week (P < 0.001, ANOVA). Six months after surgery, three of t he children had died. A level of > 10 ng/ml measured 3 months after surgery correctly identified all three deaths: levels were 1.3 ng/ml (0.5-1.9) in the survivors and were 20.0 ng/ml (15-104) in those who died. These data in dicate a rapid reduction in raised VEGF following surgery for Wilms' tumour , but that rising levels predict poor prognosis. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.