# Prognostic Analysis of VEGF, CRP and Contrast-Enhanced Ultrasound Combined with Interventional Embolization for Primary Liver Cancer

## TL;DR

This study explores how combining VEGF, CRP, and contrast-enhanced ultrasound can help predict outcomes for liver cancer patients undergoing chemoembolization.

## Contribution

The study introduces a combined approach using VEGF, CRP, and CEUS to improve prognosis prediction for TACE in liver cancer.

## Key findings

- VEGF and CRP levels showed statistically significant differences between progressive and non-progressive groups.
- Contrast-enhanced ultrasound parameters like IMAX and TTP were associated with tumor progression.
- The combination of these biomarkers and imaging techniques has potential prognostic value for TACE outcomes.

## Abstract

To examine the predictive significance of C-reactive protein (CRP), contrast-enhanced ultrasonography (CEUS), and vascular endothelial growth factor (VEGF) in interventional chemoembolization of primary liver cancer.

A total of 277 patients with primary liver cancer, 162 males and 115 females, aged 41-73 years, were selected from January 2020 to January 2023 in our hospital. These patients received hepatic arterial chemoembolization (TACE). Correlations of VEGF, CRP and contrast-enhanced ultrasound with the progression of TACE within two years were observed. Interventional embolization, comparable preoperative serum VEGF and CRP tests and contrast-enhanced ultrasound (CEUS) quantitative data were used, with the BCLC criteria being stage B, Child‒Pugh grades A‒B, and Eastern Cooperative Oncology Group (ECOG) scores of 0‒1. VEGF was assessed via enzyme-linked immunosorbent assay (ELISA), and CRP was assessed via immunoturbidimetry. Blood was collected at a proximal time point before embolization. CEUS was used to intravenously inject the contrast agent under low mechanical index conditions to obtain dynamic curves of the artery, portal vein and delay period. The ROIs of the lesion and control areas were selected. Two trained radiologists independently measured peak intensity, time to peak, lavage rate and area under the curve in a blinded manner, and the average value was taken for analysis. The primary outcomes were overall survival and progression-free survival, and the secondary outcomes were the objective response rate and disease control rate at 4–8 weeks after surgery. Candidate variable screening was performed via LASSO, a multivariate Cox model was constructed to evaluate prognosis, the proportional hazards hypothesis was tested and processed, and landmark and time-dependent covariate analyses were used for early postoperative indicators.

Contrast-enhanced ultrasound revealed that the maximum tumor tissue strength (IMAX) was 158.74 ± 43.67% and 185.72 ± 51.47% in the progressive and non-progressive groups, respectively. The maximum strength difference between the tumor and parenchyma (IMAX T-P) was 52.18 ± 9.17% (84.52 ± 10.82%), and the tumor tissue ascent times were 8.32 ± 2.85 s and 15.03 ± 6.85 s. The clearance times (WTs) were 12.23 ± 5.14 and 23.05 ± 11.47 s, and the TTP times of the maximum tumor strength were 10.32 ± 3.48 s and 17.05 ± 6.05 s. RT 1, RT t-p, TTP 1, and TTP t-p were not significantly correlated with tumor progression (P>0.05). Two groups of patients had conventional VEGF levels [(342.3+/- 72.9, 183.6+/- 62.5 pg /mL] and CRP levels [(19.7+/- 6.8, 11.4+/- 7.3 mg/L], and the difference between before and after comparison [(+/- 33.4, 43.7 to 65.8+/- 71.5) pg /mL, (5.1+/- 4. 2, -3.8 ± 4.0 mg/L], and the difference was statistically significant (P<0.05).

The combination of VEGF, CRP and contrast-enhanced ultrasound for the prediction of TACE has potential prognostic application value.