Prognostic Significance of Serum Insulin-Like Growth Factor-1 in Hepatocellular Cancer Patients: A Validation Study

Sahin Lacin; Suayib Yalcin; Yusuf Karakas; Manal M Hassan; Hesham Amin; Yehia Ibrahim Mohamed; Asif Rashid; Jeffrey S Morris; Lianchun Xiao; Aliya Qayyum; Ahmed O Kaseb

doi:10.2147/JHC.S258930

Prognostic Significance of Serum Insulin-Like Growth Factor-1 in Hepatocellular Cancer Patients: A Validation Study

J Hepatocell Carcinoma. 2020 Sep 16:7:143-153. doi: 10.2147/JHC.S258930. eCollection 2020.

Authors

Affiliations

¹ Yeditepe University, Faculty of Medicine, Department of Medical Oncology, İstanbul, Turkey.
² Hacettepe University, Hacettepe Cancer Institute, Department of Medical Oncology, Ankara, Turkey.
³ University of Texas, MD Anderson Cancer Center, Department of Epidemiology, Division of Cancer Prevention and Population Sciences, Houston, Texas, USA.
⁴ University of Texas, MD Anderson Cancer Center, Department of Hematopathology, Division of Pathology and Laboratory Medicine, Houston, Texas, USA.
⁵ University of Texas, MD Anderson Cancer Center, Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, Houston, Texas, USA.
⁶ University of Texas, MD Anderson Cancer Center, Department of Pathology, Division of Pathology and Laboratory Medicine, Houston, Texas, USA.
⁷ Department of Biostatistics, Epidemiology and Informatics Center for Clinical Epidemiology and Biostatistics University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
⁸ University of Texas, MD Anderson Cancer Center, Department of Biostatistics, Division of Basic Sciences, Houston, Texas, USA.
⁹ University of Texas, MD Anderson Cancer Center, Department of Diagnostic Radiology, Division of Diagnostic Imaging, Houston, Texas, USA.

Abstract

Background: The Child-Turcotte-Pugh score (CTP) is the most commonly used tool to assess hepatic reserve and predict survival in hepatocellular cancer (HCC). The CTP stratification accuracy has been questioned and attempts have been made to improve the objectivity of the system. Serum insulin-like growth factor-1 (IGF-1)-CTP has been proposed to improve CTP prognostic accuracy. We aimed to validate the IGF-CTP score in our patient population.

Patients and methods: A total of 84 diagnosed HCC patients were enrolled prospectively. IGF-CTP scores in addition to CTP scores were calculated. C-index was used to compare the prognostic significance of the two scoring systems and overall survival (OS).

Results: Cirrhosis was present in 48 (57.1%) patients, 35 (41.7%) patients were non-cirrhotic, 36 (42.8%) patients were hepatitis B (HBV) positive, and 8 (9.5%) patients were hepatitis C (HCV) positive. Serum IGF-1 levels were significantly lower in cirrhotic compared with non-cirrhotic patients (p=0.04). There was a significant difference in OS rates of patients with serum IGF-1 level <50 ng/mL and patients with serum IGF-1 levels ≥50 ng/mL (p=0.02); the OS rates were 6.5 and 14.8 months, respectively (p=0.02). The median OS of all patients was 7.38 months (95% CI: 5.89-13.79). The estimated C-index for CTP and IGF-CTP scores was 0.605 (95% CI: 0.538, 0.672) and 0.599 (95% CI: 0.543, 0.655), respectively. The U statistics indicated that the C-indices between two scoring systems are not statistically different (P= 0.91).

Conclusion: This study evaluated IGF-1 levels and the IGF-CTP classification in a predominantly HBV (+) cohort of HCC patients with 41.7% non-cirrhotic. Although the prognostic value was similar, among patients with CTP-A, class those reclassified as IGF-CTP B had shorter OS than those with IGF-CTP score A. Thus, further validations of IGF-CTP score in similar populations may add additional value as a stratification tool to predict HCC outcome.

Keywords: Child–Turcotte–Pugh; cirrhosis; hepatocellular carcinoma; insulin-like growth factor-1.

Grants and funding

P30 CA016672/CA/NCI NIH HHS/United States