Preoperative Serum Insulin-Like Growth Factor 1 Level as a Prognostic Factor in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma

Abstract

In this study, preoperative serum levels of insulin-like growth factor 1 (IGF-1) were determined in 216 hepatocellular carcinoma (HCC) patients who underwent hepatic resection to investigate a possible contribution of IGF-1 to the increased risk for HCC recurrence and mortality. During January 2010 and December 2013, 216 HCC patients receiving hepatectomy were recruited. The primary endpoint was the HCC recurrences within the 3-year follow-up. The secondary endpoint was all-cause mortality. The multivariate analyses with Cox regression model were applied to explore the clinical significance of IGF-1 serum levels and associated parameters on death and recurrence of HCC patients. The IGF-1 levels of included patients were determined, with a median value of 75.5 ng/mL (IQR, 40.3–93.0 ng/mL). The preoperative serum level of IGF-1 was negatively correlated with tumor size, Child–Pugh class, or tumor stage (P < 0.001 for all). In multivariate models comparing the first, second, and third quartiles with the fourth quartile of IGF-1, the levels of IGF-1 in Q1 and Q2 were associated with HCC recurrence, with an increased risk of 216% [hazard ratios (HR) = 3.16 (95% CI: 1.79–4.28)] and 106% [3.02 (1.36–3.11)]. Similarly, concentrations of IGF-1 in Q1 and Q2 were also related to all-cause mortality, with an increased recurrence risk of 238% [HR = 3.38 (95% CI: 1.85–4.36)] and 117% [3.02 (1.40–3.21)], respectively. Poor prognosis in HCC patients receiving hepatectomy could be indicated by low preoperative serum levels of IGF-1, which would be applied as a predictor.