Serum Insulin-Like Growth Factor-1 (IGF-1): a Novel Prognostic Factor for Early Recurrence of Hepatocellular Carcinoma (HCC).

BACKGROUND

Early recurrence within 1 year is the leading cause of early death in patients with hepatocellular carcinoma (HCC) after liver resection. Circulating levels of insulin-like growth factor-1 (IGF-1) reflect the liver function and prognosis of patients with HCC. In the present study, we aimed to evaluate whether baseline and dynamic changes in serum IGF-1 were associated with early recurrence in patients with HCC who underwent liver resection.

METHODS

A total of 144 HCC patients who underwent liver resection were included in this study. Circulating levels of IGF-1 and other tumor-related indexes were collected during the perioperative period. Univariate and multivariate analyses were used to examine potential risk factors for early recurrence. Receiver operating characteristic (ROC) was used to determine the cutoff value of preoperative IGF-1 and compare the predictive use of independent risk factors for early recurrence alone or in combination.

RESULTS

Early recurrence was observed in 50 (34.7%) patients in a median follow-up period of 17.9 months. Serum IGF-1 levels achieved complete recovery within 30 days after hepatectomy. Multivariate analysis indicated that microscopic vascular invasion (MVI) (HR = 2.479, p = 0.002), preoperative low circulating IGF-1 level (HR = 0.276, p < 0.001), and delayed recovery of IGF-1 level at 30 days after liver resection (ᇞIGF-1 < 0) (HR = 2.293, p = 0.005) were three independent risk factors for early recurrence in HCC patients. When three independent risk factors were combined, the area under the ROC curves (AUCs) was significantly increased to 0.803 and markedly larger than those for the individual risk factors (p < 0.001).

CONCLUSIONS

A low preoperative circulating IGF-1 level, negative ᇞIGF-1, and MVI were significantly associated with an increased risk of early recurrence in HCC patients, and applying the three independent risk factors together may improve the prognosis of early recurrence in patients with HCC after liver resection.