Abstract: Objective The aim of this study was to explore the value of magnetic resonance imaging (MRI) as well as serum alpha fetal protein heteromorphism 3 (AFP-L3) and vascular endothelial growth factor (VEGF) levels as predictors of tumor response in patients with primary liver cancer (PLC) undergoing transcatheter hepatic artery chemoembolization (TACE). Methods 64 patients with PLC were encountered in our hospital between January 2019 and June 2020, and all patients underwent TACE and followed-up for two years. The patients were checked-up by MRI regularly after TACE, and serum AFP-L3 and VEGF levels were detected by ELISA. The routine blood examination was carried out, and the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were collected.The unconditional multivariate Logistic stepwise regression analysis was adopted, and the predictive value of serum AFP-L3, VEGF, and NLR and PLR for prognosis of patients with PLC after TACE was analyzed by receiver operating characteristic curve (ROC). Results Three months after TACE, the MRI scan showed complete remission in 28 cases(43.8%), partial remission in 16 cases (25.0%), stable disease in 12 cases (18.8%) and progressive disease in 8 cases (12.5%), with the disease control rate (DCR) of 87.5% in our series; at the end of two year follow-upperiod, 30 patients (46.9%) died; the tumor diameters, cancerous tissue necrosis, and the DCR were significantly different between deads and survivals (P＜0.05); the multivariate Logistic regression analysis showed that the continuous multi-nodular tumormargin, incomplete tumor envelope, high serum AFP-L3 and VEGF levels, and the increasedNLR and the PLR were the independent risk factors for poor prognosis in patients with PLC after TACE(P＜0.05); the sensitivities and the specificities were 69.1% and 68.2%, 88.2% and 68.2%, 73.5% and 86.4%, and 83.8%and 77.3% when serum AFP-L3 level greater than 80.9μg/mL, serum VEGF level greater than 119.9μmol/L, the NLR greater than 2.3 or the PLR greater than 13.9 were set as the cut-off-value in predicting poor prognosis in patients with PLC after TACE. Conclusion The clinicians should take risk factors for poor prognosis into considerationin in patients with PLC after TACE, and make therapy strategy carefully and appropriately, which might improve the prognosis.

Key words: Hepatoma, Transcatheter hepatic artery chemoembolization, Magnetic resonance imaging, Fetal protein heteromorphism 3, Vascular endothelial growth factor, Prognosis