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:From January 2013 to July 2013,a total of 144 HCC patients admitted to our hospital were enrolled.IGF-1 and other tumor-related indexes were collected.Univariate and multivariate analyses were used to examine potential risk factors for early recurrence.Receiver operating characteristic(ROC)was used to determine the cut-off value of preoperative IGF-1 and compare the predictive use of independent risk factors for early recurrence alone or in combination.Kaplan-Meier analysis(log-rank test)was performed to compare the cumulative incidence of ER between subgroups.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 a mean 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(?IGF-1<0)(HR = 2.293,P = 0.005)were three independent risk factors for early recurrence in HCC patients.The AUCs for preoperative IGF-1,IGF-1 and MVI were 0.690(95%CI=0.608-0.765,P<0.001),0.667(95%CI = 0.584-0.743,P<0.001)and 0.625(95%CI = 0.541-0.704,P =0.004),respectively.Furthermore,when preoperative IGF-1,AIGF-1 and MVI were combined,the AUC was significantly increased to 0.803(95%CI = 0.728-0.864,P<0.001)and markedly larger than those for preoperative IGF-1(Z=2.629,P = 0.009),?IGF-1(Z = 3.575,P<0.001)or MVI(Z = 3.813,P<0.001)alone.Here,sensitivity and specificity for predicting early recurrence were 88.0%and 67.0%,respectively.The presence of MVI(48.4%vs.24.4%,P = 0.002),low preoperative IGF-1(54.8%vs.19.5%P<0.001),and negative IGF-1(53.6%vs.22.7%P<0.001)were significantly correlated with early cancer recurrence.Conclusion:A low preoperative circulating IGF-1 level,negative ?IGF-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.