Insulin-Like Growth Factor-1 Score Improves Assessment of Prognosis in Hepatocellular Carcinoma


Key Points

  • Stratification was significantly stronger for IGF-CTP vs CTP score in both training and validation cohorts.
  • Patients reclassified by IGF-CTP were more accurately stratified; for example, patients reclassified as IGF-CTP-B from CTP-A had significantly worse overall survival vs those remaining in IGF-CTP-A in both cohorts.

In a study reported in the Journal of the National Cancer Institute, Kaseb et al developed a plasma insulin-like growth factor 1 (IGF-1)–based score for hepatic reserve in hepatocellular carcinoma and compared its predictive ability with that of the Child-Turcotte-Pugh (CTP) score in two cohorts of patients. They found that the IGF-1–based scoring system provided better risk stratification than CTP score.

Study Details

In the study, plasma IGF-1 levels were retrospectively assessed in a training set of 310 hepatocellular carcinoma patients from The University of Texas MD Anderson Cancer Center; optimal ranges correlating with overall survival were identified as > 50 ng/mL (= 1 point; 43%), 26 to 50 ng/mL (= 2 points; 35%), and < 26 ng/mL (= 3 points; 22%). CTP score was modified by replacing ascites and encephalopathy grading with plasma IGF-1 value (IGF-CTP scoring) and the prognostic performance of the IGF-CTP and CTP scores were compared in the training cohort and a prospective validation cohort of 155 patients.

Prognostic Performance

Both the IGF-CTP and CTP scores stratified patients into low- (A = 4–5 points on IGF-CTP, 5–6 points on CTP), intermediate- (B = 6–7 points on IGF-CTP, 7–9 points on CTP), and high-risk (C = > 7 points on IGF-CTP, > 10 points on CTP) groups that differed in overall survival in both cohorts (P < .001 in both). For example, for low-, intermediate-, and high-risk groups, median overall survival was 25.9, 9.5, and 5.1 months on IGF-CTP and 16.9, 8.8, and 2.1 months on CTP in the validation cohort. C-index analysis showed that prognostic stratification with IGF-CTP was significantly better than CTP in both the training (0.608 vs 0.573, P = .003) and validation (0.672 vs 0.579, P = .005) cohorts.  


Patients reclassified by IGF-CTP scoring were more accurately stratified in their new risk group. For example, in the training cohort, 72.1% of CTP-A patients were classified as IGF-CTP-A and had median overall survival of 19.3 months, whereas 26.5% were reclassified as IGF-CTP-B and had shorter median overall survival of 13.6 months (HR = 1.45,  P = .03). Of patients classified as CTP-B, 38.4% were also classified as IGF-CTP-B and had median overall survival of 6.5 months, whereas 38.4% were reclassified as lower risk (IGF-CTP-A) and had longer median overall survival of 23.5 months (HR = 0.48,  P = .02) and 23.2% were reclassified as higher risk (IGF-CTP-C) and had shorter median overall survival of 3.7 months (HR = 3.23, P < .001).

In the validation cohort, 53.2% of CTP-A patients were classified as IGF-CTP-A and had median overall survival of 25.9 months, whereas 46.0% were reclassified as intermediate risk (IGF-CTP-B) and had lower median overall survival of 11.0 months (HR = 2.83, P < .001); median overall survival in this subgroup group was similar to the median overall survival of 8.8 months in the IGF-CTP-B patients who were also CTP-B.

The investigators concluded, “The IGF-CTP score is simple, blood-based, and cost-effective, stratified [hepatocellular carcinoma] better than CTP score, and validated well on two independent cohorts. International validation studies are warranted.”

Ahmed O. Kaseb, MD, of The University of Texas MD Anderson Cancer Center, is the corresponding author for the Journal of the National Cancer Institute article.

The study was supported by grants from the National Institutes of Health. The study authors reported no potential conflicts of interest.

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