Surgery, Gastroenterology and Oncology

Identification of biomarkers that correlate with prognosis is crucial in hepatocellular carcinoma (HCC) because of the high recurrence rates seen after surgical treatments. Serum levels of fetoprotein (AFP) are widely used clinically, but the prognostic value of AFP remains unclear.
AFP levels are influenced not only by the presence of HCC but also by the severity of the underlying liver disease. Furthermore, AFP could be normal in up to 30% of HCC patients. Thus, additional biomarkers are needed. Insulin-like growth factors 1 (IGF-1) is a growth factor with dose-dependent proliferation and anabolic effects, and its interaction with IGF-1 receptor (IGF-1R) may promote tumor progression.
On the other hand, hepatic synthesis of IGF-1 is significantly reduced due to underlying chronic liver disease in HCC patients, and previous studies demonstrated that circulating IGF-1 is a useful predictor of hepatic reserve in HCC patients. We evaluated circulating IGF-1 and AFP levels in a cohort of HCC patients undergoing liver resection or liver transplantation at a single institution (Fundeni Clinical Institute, Romania).
We found that plasma IGF-1 was decreased in HCC patients as compared with healthy individuals, and that plasma IGF-1 was associated with the presence of cirrhosis in HCC patients. In addition, we found that plasma IGF-1 levels were significantly associated with disease-free survival (DFS) and overall survival (OS).
This correlation was due to the significant association between higher IGF-1 and more favorable DFS and OS following liver transplantation. Independent validation of this biomarker is warranted in the setting of liver transplantation to confirm and further define the prognostic implications of plasma IGF-1 in HCC patients.

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