Mediating effect of VEGF-C in correlation of serum TNF-α with postoperative upper extremity lymphedema
Objective:To analyze the mediating effect of vascular endothelial growth factor-C(VEGF-C)in the correlation of serum tumor necrosis factor-α(TNF-α)with postoperative upper extremity lymphedema.Methods:90 patients admitted to a hospital from January 2018 to February 2022 were selected as a study group,who developed upper extremity lymphedema one year after the breast cancer surgery.Another 90 patients from the same hospital who did not develop upper extremity lymphedema one year after the operation of breast cancer were chosen as a control group.After one year's follow-up,the changes of the upper extremity lymphedema were ob-served.Expression of VEGF-C and serum level of TNF-α between the 2 groups and different edema grades 2 years after the operation were compared.Pearson Correlation Coefficient was used to analyze the correlation of VEGF-C expression with serum TNF-α and upper extremity lymphedema grade of the study group patients one or two years after the operation.AMOS 24.0 structural equation modeling was constructed and Bootstrap was used to assess the mediating effect of expression of VEGF-C in the correlation of serum TNF-α with postoperative upper extremity lymphedema one or two years after the operation.Results:The positive rate of VEGF-C expression in the study group was lower than that of the control group,while TNF-α level was higher than that of the control group.TNF-α levels among patients with different lymphedema grades in the study group demonstrated:mild group<moderate group<severe group,the differ-ences being significant(P<0.05).Two years after the operation,the positive rate of VEGF-C expression of the patients with edema was lower than those without edema in the study group,while TNF-α level was higher than that of the patients without edema.TNF-α levels among patients with different lymphedema grades in the study group demonstrated:mild group<moderate group<severe group,the differences being significant(P<0.05).Correlation analysis showed that one year after the operation,TNF-α level was positively correlated with upper extremity lymphedema grade(r=0.642,P<0.05);two years after the operation,VEGF-C expression of the cancer tissue was negatively correlated with serum TNF-α and upper extremity lymphedema grade(r=-0.685,-0.754,P<0.05)and serum TNF-α level was positively correlated with upper extremity lymphedema grade(r=0.669,P<0.05).Mediating effect analysis indicated that,one year after the operation,ser-um TNF-α level had direct predictive effect on the postoperative development of upper extremity lymphedema(P<0.05);two years after the operation,VEGF-C had mediating effect as serum TNF-α exerted influence on the postoperative development of upper extremity lymphedema.Conclusion:Serum TNF-α may indirectly lead to the postoperative complication of upper extremity lymphedema through VEGF-C in patients with breast cancer.Postoperative regular de-tection of serum TNF-α of the patients,especially two years after the breast cancer operation,is clinically recommended,which may prevent the development of upper extremity lymphedema.
Breast cancerVascular endothelial growth factor-CTumor necrosis factor-αUpper extremity lymphedemaMedia-ting effect
万方数据
维普
