Perioperative GMCSF limits the proangiogenic plasma protein changes associated with colorectal cancer resection

Abstract Aims Colorectal resection (CR) increases plasma VEGF levels which may promote residual tumor growth. This study assessed the effect of perioperative GMCSF on plasma levels of sVEGFR1, Ang-1 and Ang-2 and also the impact of post-GMCSF plasma on in vitro endothelial cell (EC) growth and invasion. Ang-2 increases while sVEGFR1 and Ang-1 impede angiogenesis. Methods Fifty-nine CR cancer patients were randomized to 7 perioperative doses of GMCSF or saline for 3 days prior and 4 days after CR. Blood samples were taken pre-drug (PreRx) and on several postoperative days (POD). Protein levels were assessed and PreRx and POD 5 plasma added to EC cultures after which branch point formation (ECBPF) and invasion (ECI) were measured. Results sVEGFR1 levels were significantly higher on POD 1 and POD 5 in both groups but the GMCSF POD 5 level was twice the control value ( p  = 0.002). Ang-2 levels were higher on PODs 1 and 5 in both groups ( p p  = 0.03). Ang-1 decreases were noted in all ( p  = not significant, ns). The control group POD 5 ECBPF was 35.8% greater than Pre Rx ( p  = 0.001) while the GMCSF result was 18.0% lower ( p  = ns); the control POD 5 median percent change from baseline was greater than the GMCSF result( p  = 0.008). The POD 5 ECI was +12.2% for the control group vs. baseline ( p  = ns) and −17.2% for the GMCSF group ( p  = ns): the control median percent change was greater than in the GMCSF group( p  = 0.045). Conclusion CR-related plasma changes are proangiogenic (>Ang-2) and anti-angiogenic (>sVEGFR1); the net effect is promotion of in vitro ECBPF. GMCSF limits the proangiogenic changes (higher POD 5 sVEGFR1 levels and lower Ang-2 elevations, lower POD 5 ECBPF and ECI). The clinical import of these effects is unclear; perioperative GMCSF has anti-angiogenic plasma effects that may limit tumor growth. Further investigation is warranted.