Abstract: Objective To explore the predictive value of albumin-bilirubin (ALBI), cysteine aspartic acid protease-4 (Caspase-4), and apparent diffusion coefficient value (ADC) for the recurrence of primary liver cancer (PLC) in patients after transarterial chemoembolization (TACE) therapy. Methods A total of 90 PLC patients who underwent TACE therapy and were admitted to the Department of Hepatobiliary Surgery of the Affiliated Hospital of Inner Mongolia Medical University from January 2022 to December 2024 were selected as the observation group. According to whether recurrence occurred within 6 months after TACE, they were divided into a recurrence group (n=31 cases) and a non-recurrence group (n=59 cases). Ninety healthy individuals who underwent physical examinations in our hospital during the same period of time were selected and included in the control group. The ALBI score, Caspase-4 level and ADC value were detected and compared between the observation group and the control group, and between the recurrence group and the non-recurrence group in the observation group. Pearson analysis was used to analyze the correlations between ALBI, Caspase-4 and ADC in the observation group and the levels of alpha-fetoprotein heterogeneity 3 (AFP-L3), Child-Pugh classification and Model for advanced liver Cancer (MELD) score. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive efficacy of the combined detection of ALBI, Caspase-4 and ADC for the recurrence of PLC in patients after TACE treatment. Results The ALBI of the observation group was (2.34±0.47) points, which was higher than that of the control group (1.05±0.26 points). The Caspase-4 and ADC were (34.59±4.62) ng/mL and (1.93±0.45) mm²/s, respectively, which were lower than those of (57.86±6.37) ng/mL and (3.08±0.67) mm²/s in the control group, and the differences were statistically significant (t=10.265, 12.364, 8.792) All P<0.05. The ALBI of the recurrence subgroup in the observation group was (2.87±0.56) points, which was higher than that of the control group (1.93±0.32 points). The Caspase-4 and ADC were (23.65±3.09) ng/mL and (1.61±0.38) mm²/s, respectively, which were lower than those of the control group [(40.27±5.16) ng/mL and (2.36±0.59) mm²/s], and the differences were statistically significant (t=9.014, 11.276, 8.317) All P<0.05. Pearson analysis showed that in the observation group, ALBI was positively correlated with AFP-L3, Child-Pugh classification and MELD score, while Caspase-4 and ADC were negatively correlated with AFP-L3, Child-Pugh and MELD score (P<0.05). The ROC curve showed that the AUCs of single and combined detection of ALBI, Caspase-4 and ADC levels for evaluating the recurrence of PLC patients after TACE were 0.752, 0.783, 0.826 and 0.915, respectively. The sensitivity and specificity of the combined detection were both higher than those of any single detection (all P<0.05). Conclusion The combined detection of ALBI, Caspase-4 and ADC has a relatively higher predictive value for the recurrence of PLC patients after TACE therapy.

Key words: Primary liver cancer, Transarterial chemoembolization, Recurrence, Serological indicators, Predictive value