Assessing blood vascular endothelial growth factor level in patients with vulvovaginal atrophy

Introduction. Angiogenesis is essential for growth and development of blood vessels in normal tissues, during wound healing, and a crucial factor in tumor progression. One of the main stimulators of angiogenesis is vascular endothelial growth factor (VEGF) that promotes active endothelial cell proliferation and migration. In malignant tumors, VEGF supports the development of tumor vessels, which may correlate with cancer prognosis and diagnosis.

Aim: to assess blood VEGF level in patients with vulvovaginal atrophy (VVA) and hormone-dependent malignant tumors of the female reproductive system (breast, cervical, ovarian, and endometrial cancers), in women with VVA and hormone-dependent benign tumors of the female reproductive system and healthy women.

Materials and Methods. A cross-sectional study assessed 68 diagnosed cases of VVA and cancer of the female reproductive organs (group 1) – with breast cancer (BC), cervical cancer (CC), endometrial cancer (EC), ovarian cancer (OC); 53 women with VVA and benign diseases of the female genital organs (group 2) and 80 healthy perimenopausal women without gynecological pathology (control group). Adenocarcinoma, stage 1A was verified as a histopathological type of malignant neoplasms. Plasma VEGF concentrations were quantitated using an enzyme-linked immunosorbent assay (ELISA). Blood samples were obtained by puncturing a peripheral vein before surgery. Statistical data processing was performed using the StatTech v. 4.8.5 program (StatTech LLC, Russia).

Results. The median plasma VEGF level in 80 healthy women (control group) comprised 190 (range 40.00–661.50) pg/ml, in group 1 – 452.0 (range 69.98–2808.44) pg/ml and in group 2 – 323.0 (range 95.7–1100.0) pg/ml. The median VEGF level and interquartile range in 30 patients with BBA and ВС, 10 patients with BBA and CC, 10 patients with BBA and EС, and 9 patients with BBA and ОС was 632.0 [360.0–1110.5] pg/ml, 228.0 [209.5–238.5] pg/ml, 448.0 [422.0–499.5] pg/ml and 503.0 [211.0–1337.0] pg/ml, respectively. VEGF concentrations in patients with VVA and BC, OC and EC were significantly higher than in healthy women (Mann-Whitney U-test, p = 0.001, p = 0.021 and p < 0.0001, respectively). However, in patients with BBA and CC, VEGF levels did not significantly differ from those in healthy women. The median plasma VEGF level in patients with BBA and benign diseases of the female genital organs vs. control group was significantly elevated reaching 323.0 (range 95.7–1100.0) pg/ml, which demonstrates statistically significant differences compared with the control group (p = 0.007).

Conclusion. Significant differences were found between VEGF level in women with BBA and malignant neoplasms of the reproductive system and in women with BBA and benign neoplasms of the female genital organs compared with control group (healthy women). The obtained results indicate a crucial role for VEGF in angiogenesis processes associated with malignant diseases. Increased VEGF expression in women with VVA compared to healthy women may be related to impaired vascularization and tissue regeneration in the vagina and vulva further exacerbated by malignant processes.

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