WASHINGTON – Poorer psychosocial functioning was associated with greater expression of vascular endothelial growth factor – and greater expression, in turn, was associated with shorter disease-free survival – in a small study of patients with newly diagnosed head and neck squamous cell carcinoma.
Vascular endothelial growth factor (VEGF) not only plays a pivotal role in angiogenesis, but it is also regulated by stress hormones and key cytokines, according to Carolyn Y. Fang, Ph.D., who presented the findings at the annual meeting of the Society of Behavioral Medicine.
She and her team administered a battery of psychosocial questionnaires to assess perceived stress, depressive symptoms, and social support in 37 patients who had been newly diagnosed with HNSCC and sought treatment at the Fox Chase Cancer Center in Philadelphia. Expression of VEGF in tumor tissue that had been obtained during surgery was then evaluated via immunohistochemistry, and was categorized as weak, moderate, or intense.
Higher levels of perceived stress and depressive symptoms were significantly associated with greater VEGF expression in an analysis that controlled for disease stage, Dr. Fang reported. Patients with "intense" VEGF expression, for instance, had a mean perceived stress score that was approximately 47% higher than that of patients with "weak" VEGF expression.
In addition, patients who reported lower levels of social support were more likely to have intense VEGF expression, but this did not reach statistical significance, said Dr. Fang, codirector of the cancer prevention and control program at Fox Chase.
The patients were predominantly male (70.3%) with a mean age of 57 years. Most were married or living with a partner (62%), and half had a high school education or less. Primary tumor sites were the oral cavity (66%), larynx (20%), and oropharynx (14%). More than 40% were classified as having early-stage disease.
A survival analysis looking at two categories of VEGF expression – high and low – and controlling for disease stage and other relevant variables showed that patients with high VEGF expression were more than 2.5 times more likely to die than were those with low expression. "This finding is not a novel finding, but we did confirm here that VEGF expression was associated with disease-free survival," Dr. Fang said in a later interview, noting that follow-up averaged about 5 years.
"At this point, the data on VEGF are preliminary and are just a snapshot in time," Dr. Fang said. "We need to follow this up with a larger longitudinal study in which we can capture the trajectory of psychosocial functioning over time and do multiple assessments of VEGF and other biomarkers [like EGFR] over time."
A combination of previous findings prompted the investigators to do the study. These included reported associations between psychosocial factors and expression of VEGF in patients with other types of cancer, and associations of VEGF with tumor aggressiveness and poor prognosis in HNSCC populations specifically.
Dr. Fang noted that when the patient population was divided into early-stage and late-stage HNSCC, associations among psychosocial functioning and VEGF remained strong for early-stage patients, but were less apparent among late-stage patients.
The psychosocial questionnaires administered in the study were the PSS (Perceived Stress Scale), the CES-D (Center for Epidemiologic Studies–Depression Scale), and the ISEL (Interpersonal Support Evaluation List).
Dr. Fang and her coinvestigators reported having no relevant financial disclosures.