Association between Plasma Vascular Endothelial Growth Factor Level and Response to Transarterial Chemoembolization in Patients with Intermediate Stage Hepatocellular Carcinoma

Abstract

Chemoembolization (TACE) is the most widely used primary treatment for unresectable HCC and the recommended first line-therapy for patients at intermediate stage of the disease. It is well-known that vascularization of HCC is mostly dependent on the hepatic artery. This characteristic of HCC provides a basic rationale for transarterial therapy as an effective treatment of HCC. Acute arterial obstruction induces ischemic tumor necrosis with a high rate of objective responses. Because HCC is a highly vascular tumor, screening patients for markers of increased angiogenesis, which may be detected even before HCC, is clinically significant. Vascular endothelial growth factor (VEGF) has successfully been correlated with stimulation of angiogenesis and therefore it could reflect functional tumor activity, which is otherwise often difficult to be assessed by conventional imaging modalities. Tumor expression of VEGF has been shown to be related to microscopic venous invasion, metastasis spread and poor prognosis of HCC. The current study was designed to assess the clinical usefulness of pre-treatment VEGF level as a predictor of outcome in patients undergoing TACE therapy for HCC. Another aim of the study is to assess the value of VEGF as an indicator of recurrence or residual of tumor after TACE. The current study was conducted on 50 patients, 25 HCC patients (group 1) and 25 patients with chronic liver disease due to hepatitis C virus (group 2) (as a control group). All patients were fulfilling the inclusion criteria of the study. All the patients were subjected to: 1. Complete history taking. 2. Thorough clinical examination 3. Laboratory investigations including: Complete blood picture, liver profile (s.albumin, total and direct bilirubin, prothrombin time and liver enzymes) kidney function tests (serum creatinine, blood urea nitrogen, sodium and potassium), viral markers (HCV, HBsAg, HBcAb) and AFP. 4. Serum VEGF level assay was done for of both groups by ELISA technique (first reading). 5. Ultrasound to detect the hepatic focal lesion. 6. Triphasic pelvi-abdominal CT to diagnose HCC Patients of group (1) underwent 25 sessions of TACE at the start of the study.