| Hepatocellular Carcinoma (HCC) is one of the most common malignancies in our country. Now transcatheter hepatic arterial chemoembolization(TACE) is generally accepted as one of modus operandi(effective treatments) to middle and advanced stage, but its recurrence and metastasis rate are high. It is an important factor that neovascularization and collateral circulation establishment in the perimeter of tumor to cause recurrence post-embolism.Vascular endothelial growth factor (VEGF) is now knowed as a strongest angiogenesis inducing factor to neovascularization .It is not only relevant with neovascularization proliferation but also directly participates in infiltration and metastasis.Thalidomide has the effect of anti-angiogenesis and immunoregulation ,which was observed in many studies in HCC.In the study, the enzyme linked immunosorbent assay was adopted to detect the serum VEGF levels before and a month after TACE in patients with HCC, which was accepted thalidomide combination with TACE treatment, then observed the changes and compared with the patients accepted with TACE treatment alone, meanwhile, compared alpha fetoprotein(AFP) positive patients with negative patients. The influence of thalidomide on serum VEGF levels before and after TACE in patients with HCC and the effect of combination treatment were evaluated.Methods:1. Sixty patients were to be selected by standard, AFP positive and negative patients were each 30 examples. Single blind method was applied to randomly extract each 15 cases from AFP positive and negative patients into AFP positive therapeutic alliance group (below abbreviated positive combination group),AFP negative therapeutic alliance group(below abbreviated negative combination group, positive combination group plus negative combination group was combination groups) and AFP positive simple intervention group(below abbreviated positive simple group),AFP negative simple intervention group(below abbreviated negative simple group, positive simple group plus negative simple group was simple groups) respectively . I.E. there are each 15 AFP positive and negative patients in simple and combination groups.2. Simple group was adopted TACE treatment alone. Combination group was adopted thalidomide combination with TACE treatment. TACE: All patients were accepted TACE by the way of Seldinger. Per cutem arteria femoralis punctura, puts the pipage in the feeding artery through arteria hepatica propria ultraselection, MMC10mg,5-FU1.0g may be perfused and emulsifying agent from which ADM30- 50mg and 40% inlet lipiodol were completely emulsified may be injected after tumor visualized.The dosage of lipiodol depends on the size of focus of infection and tolerance of patients. Take orally thalidomide: take medicine before TACE.50mg every time, three times a day, last 14 days.3. Collect samples: All subjects were collected 4ml blood through ulnar vein in the morning,on empty stomach state, separated in 2 hours and imbibed serum subpackage sealed up. Putted in the -30℃deep freeze refrigerator examine together. 4. All cases were collected venous blood before and a month after TACE respectively to examine the levels of VEGF and AFP.Results:1. The VEGF levels of combination and simple group before treatment were (238.01±92.09) and (225.42±73.88) pg/ml respectively, there was no significant difference between them, P>0.05; The VEGF levels of simple group after treatment was higher, then combination group was lower, there were significant differences between them by statistical analysis P<0.05. There was significant difference between two groups before and a month after treatment in difference values, P<0.01.2. The comparisons of VEGF levels between AFP positive and negative patients : Before treatment , the VEGF levels of AFP positive combination and simple groups were(252.86±94.45) and (228.73±69.94) pg/ml respectively ; AFP negative combination and simple groups were (223.15±90.40) and (222.12±80.04) pg/ml respectively. I.e. whether or not AFP positive, there were no significant differences between combination and simple groups before treatment (P>0.05). After treatment,①The levels of AFP positive combination group was obviously decreased compared with pretherapy: (169.23±65.95) pg/ml VS (252.86±94.45) pg/ml; and AFP negative combination group was also obviously decreased compared with pretherapy: (142.72±65.62) pg/ml VS (222.12±80.04) pg/ml. I.e. whether or not AFP positive, the levels of combination group after treatment was obviously lower compared with pretherapy, there were significant differences (P<0.01).②AFP positive and negative simple groups post-treatment were all higher compared with pretherapy: (310.48±118.38) pg/ml VS (228.73±69.94) pg/ml and (312.89±98.34) pg/ml VS (222.12±80.04) pg/ml respectively. I.e. whether or not AFP positive, the levels of simple group after treatment were obviously higher compared with pretherapy, By statistical analysis,there were no significant differences (P>0.05).3. The comparison of AFP levels of AFP positive patients:the levels before treatment between combination and simple groups were (604±181) ng/ml and (612±174) ng/ml respectively,(P>0.05), after treatment were (284±49) ng/ml and (355±83) ng/ml respectively, and the difference value was significant between them (P<0.05).Conclusions:1. TACE treatment may induce the liver cancer to increase VEGF expression.2. Thalidomide may control VEGF production and be used in the liver cancer comprehensive therapy .there is no apparent relevance with AFP;Meanwhile hints that thalidomide combination with TACE treatment is possible to make AFP positive and negative patients with HCC benefits.3. Thalidomide combination with TACE treatment may make serum AFP levels significantly decrease of AFP positive patients ,enhance the therapeutic effect of TACE.
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