Effects of Parenteral Nutrition Without and With Growth Hormone on Growth Hormone/Insulin-Like Growth Factor-1 Axis After Hepatectomy in Hepatocellular Carcinoma With Liver Cirrhosis

Abstract

Background: Complex alterations in the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis are thought to play an important role in the protein catabolism that complicates major surgical procedures. The aim of this study was to evaluate the potential roles of recombinant human growth hormone (rhGH) therapy after hepatectomy in hepatocellular carcinoma (HCC) with liver cirrhosis, and to investigate whether postoperative administration of rhGH increases the risk of tumor recurrences. Methods: Twenty-four patients with HCC in the setting of cirrhosis who underwent hepatectomy were randomly divided into 2 groups: parenteral nutrition (PN) group (n = 12) and rhGH + parenteral nutrition group (n = 12). Liver function, serum GH, IGF-1, and IGF binding protein-3 (IGFBP-3) were measured before operation, at postoperative days (POD) 1 and 6. IGF-1 and IGFBP-3 mRNA in liver tissue was measured by reverse transcriptase polymerase chain reaction. Liver Ki67 immunohistochemistry staining was studied. At the same time, 12 patients with cholelithiasis or liver hemangioma who underwent operation were segregated as a normal control. Results: On POD 6, compared with the PN group, serum prealbumin, GH, IGF-1, IGFBP-3, hepatic IGF-1 mRNA, IGFBP-3 mRNA, and liver Ki67 LI were higher in rhGH + PN group. The 6- and 12-month tumor-free survival rates, a median tumor-free survival time, were not different between the PN and rhGH + PN group. Conclusions: rhGH + PN can ameliorate changes in the GH/IGF-1 axis after hepatectomy for HCC in the setting of cirrhosis.

Postoperative hepatic insulin-like growth factor-1 (IGF-1) production may be severely disturbed in patients with liver cirrhosis, and the impaired IGF-1 production contributes to the suppressed postoperative protein metabolism in liver cirrhosis. Recombinant human growth hormone (rhGH) + parenteral nutrition can ameliorate changes in the growth hormone/IGF-1 axis after hepatectomy for hepatocellular carcinoma (HCC) in the setting of liver cirrhosis. Short-term use of rhGH in HCC patients with cirrhosis after operation may be safe.

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