The Study Of Relationship Between VEGF Expression And Low Molecular Weight Heparin With GP Regimen The Efficacy Of Chemotherapy In NSCLC Patients

ObjectiveTo investigate the relationship between vascular endothelial growth factor(vascular endothelial growth factor,VEGF)expression status and the efficacy of receiving low molecular weight heparin(low molecular weight heparin,LMWH)combined with GP regimen chemotherapy in patients with non-small cell lung cancer.Method(1)The 180 non-small cell lung cancer patients were diagnosed by histopathologyfrom January 1,2018 to December 31,2019 in our hospital.The patients were consecutive selected..The paraffin samples from these patients were collected.The expression of VEGF protein in NSCLC tissues were detected by immunohistochemistry method.According to the expression of VEGF in these selected patients,they were divided into VEGF low expression group and VEGF high expression group.(2)Low expression group and high expression group were treated with GP chemotherapy and GP combined with LMWH.Chemotherapy regimen in GP group: cisplatin(75 mg/m2,d1)/gitabine(l.0-1.25g/m2,d1,d8)(1 cycle per 21 days);GP combined with LMWH group: increased LMWH on the basis of treatment in GP group,1 day before the start of each chemotherapy cycle,5000 IU of low molecular weight heparin calcium injection was subcutaneously injected once daily for 1consecutive week;(3)All patients were evaluated after two cycles of chemotherapy.The relationship between VEGF expression status and the relationship between LMWH and VEGF expression state were analyzed.Uses the Cox multivariate analysis the influence factors of PFS of these patients with NSCLC.(4)Serum levels of VEGF were measured by enzyme linked immunosorbent assay,the indicators of coagulationfunction prothrombin time(PT),fibrinogen(FIB),D-dimer(D-D)were measured by biochemical methods,adverse reactions during treatment and and compared between the groups.Results:(1)The average age of 180 patients was 59.45±1.65(age range 18-75 years,median age 59 years).Among them,118(65.56%)were male,62(34.44%)were female,111(61.76%)were smokers,69(38.33%)were non-smokers,66(36.67%)were low VEGF expression,114(63.33%)were high VEGF expression.Among them,105(58.33%)were lymph node metastasis positive,75(41.67%)were lymph node metastasis negative.The high expression of VEGF was higher than that in distant metastasis group and lymph node metastasis group,and the difference was statistically significant.(2)Comparison of patient PFS in each group :173 patients could be evaluated PFS,of which,the median PFS between GP group and the combined chemotherapy group were(5.53 months vs 3.30 months),and the difference was statistically significant(P<0.05).PFS univariate analysis showed that the with negative lymph node metastasis PFS longer than those with positive lymph node metastasis(5.99 months vs4.13 months,P<0.001),but the effects of sex,age and smoking on PFS were not statistically significant;(3)Evaluation of efficacy:180patients received chemotherapy treatment,chemotherapy at the end of 2 cycles to receive evaluation of the efficacy.The objective remission rate(objective response rate,ORR)was 20.56% and the disease control rate(disease control rate,DCR)was50.56% in 180 patients.VEGF patients with high expression in GP group and LMWH GP combined chemotherapy group ORR(9.23% vs 23.01%),DCR(33.85% vs53.20%)the difference was statistically significant(P<0.05).In GP programme,Patients with low VEGF expression and patients with high VEGF expression compared with the ORR(36.49% vs 9.23%)and DCR(79.82% vs33.85%),the difference was statistically significant(P<0.05).(4)Comparison of serum VEGF levels after GP chemotherapy and GP combined with LMWH:the VEGF high expression patients with LMWH combined with GP chemotherapy,the average serum VEGF level before the 3rd chemotherapy was significantly lower than that before the1 st chemotherapy in VEGF group,the difference was statistically significant(P<0.05).(5)There was no significant difference the PT、FIB、D-D level of the four groups before treatment(P>0.05).After treatment,the PT、FIB、D-D level of the patients in the LMWH group was lower than that of the group before treatment(P<0.05).(6)Complications: All the patients in each group had mild adverse reactions during the treatment period and returned to normal after symptomatic treatment,Comparison of adverse reactions GP chemotherapy and GP combined with LMWH,there was no significant difference(P>0.05).Conclusion:1.VEGF expression status is closely related to distant metastasis and lymph node metastasis in patients with non-small cell lung cancer.2.Low molecular weight heparin combined with chemotherapy can inhibit VEGF expression,inhibit tumor progression and improve patients quality of life.3.The state of VEGF expression was negatively correlated with the effect of chemotherapy,the higher the VEGF expression,the worse the effect of chemotherapy.4.Low molecular weight heparin is a drug with low bleeding risk,low effect on coagulation function and high safety.