Abstract: Objective To investigate the evaluation value of hypoxia-inducible factor-1 (HIF-1), alpha-fetoprotein Lens culinaris agglutinin 3 (AFP-L3) and soluble programmed death ligand 1 (sPD-L1) in the treatment of transcatheter arterial chemoembolization (TACE) combined with sorafenib in patients with primary liver cancer (PLC). Methods A total of 112 PLC patients who received TACE combined with sorafenib were included in the observation group. According to the presence or absence of portal vein tumor thrombus (PVTT) before treatment, they were divided into the PVTT combined group (n=84 cases) and the PVTT free group (n=28 cases). And according to the results of the efficacy evaluation after 2 courses, they were divided into the stable group (n=79 cases) and the progressive group (n=33 cases). The control group was selected from 40 healthy subjects who came to our hospital during the same period. The serum levels of HIF-1, AFP-L3 and sPD-L1 were compared between the observation group and the healthy group, the stable group and the progressive group before and after treatment. Pearson analysis was applied to examine the correlation among the Child-pugh grade, proportion of iodol deposition after surgery, and median time to tumor progression (MTTP). The ROC curve was used to evaluate the efficacy of single and combined detection of HIF-1, AFP-L3, and sPD-L1 in assessing disease severity and treatment effect. Results The levels of HIF-1, AFP-L3 and sPD-L1 in the PVTT subgroup were (112.59±8.36) pg/mL, (19.53±3.46) % and (11.37±2.49) ng/mL. which were higher than (82.45±6.37) pg/mL, (14.67±2.29) %, (6.09±1.73) ng/mL in the PVTT subgroup and (17.36±3.51) pg/mL, (2.18±0.54) %, (1.62±0.41) ng/mL in the healthy group. The difference was statistically significant (t=24.725, 27.647, 41.529, all P<0.05). The levels of HIF-1, AFP-L3 and sPD-L1 in the stable group before treatment were (76.42±5.83) pg/mL, (15.38±2.94) % and (6.23±1.79) ng/mL. It was lower than (120.65±8.74) pg/mL, (21.36±3.82) % and (9.86±2.31) ng/mL in the progressive group, and the difference was statistically significant (t=9.367, 8.463, 8.458, all P<0.05). HIF-1, AFP-L3 and sPD-L1 in the stable group after treatment were (37.59±4.68) pg/mL, (10.16±2.56) % and (4.37±0.86) μg/mL. It was lower than (132.61±9.75) pg/mL, (23.29±4.31) % and (12.69±2.04) μg/mL in the progressive group, and the difference was statistically significant (t=14.725, 12.165, 13.027, all P<0.05). Pearson analysis showed that HIF-1, AFP-L3 and sPD-L1 levels in the observation group were positively correlated with preoperative Child-pugh grade, and negatively correlated with postoperative iodol deposition and MTTP (P<0.05). ROC curve showed that the AUC of HIF-1, AFP-L3 and sPD-L1 single and combined tests to evaluate the disease severity and efficacy of PLC were 0.782, 0.829, 0.736 and 0.931, respectively, and the sensitivity and specificity of the combination were higher than that of any single test (all P<0.05). Conclusion The combined detection of HIF-1, AFP-L3 and sPD-L1 has a high clinical value in the evaluation of PLC preoperative disease degree and the effect of TACE combined with sorafenib.

Key words: Primary liver cancer, Hepatic arterial chemoembolization, Sorafenib, Serological index