Serum insulin‐like growth factor I evaluation as a useful tool for predicting the risk of developing hepatocellular carcinoma in patients with hepatitis C virus‐related cirrhosis

Abstract

BACKGROUNDAlthough experimental studies have demonstrated an important role of insulin‐like growth factor I (IGF‐I) in hepatocarcinogenesis, the clinical data about IGF‐I in patients with hepatocellular carcinoma (HCC) are scarce and controversial. To the authors' knowledge, this is the first prospective study investigating the longitudinal correlation between modifications in serum IGF‐I levels and the development of HCC in a cohort of patients with hepatitis C virus (HCV)‐related cirrhosis.METHODSOne hundred fourteen consecutive patients with HCV‐related Child Grade A cirrhosis were followed prospectively at the Second University of Naples for 56.4 ± 12.0 months with ultrasound examinations of the liver and serum α‐fetoprotein determination every 6 months. At each clinical evaluation, the severity of disease was graded according to the established Child–Pugh scoring system. Serum IGF‐I levels were measured prospectively at the study entry and at least every 12 months throughout follow‐up.RESULTSTwenty patients (19.2%) developed HCC during follow‐up. Eleven of these patients had persistent Child Grade A cirrhosis for the whole study, whereas the other 9 patients developed HCC after their cirrhosis progressed from Child Grade A to Grade B. In patients who remained free of HCC for the whole study, serum IGF‐I concentrations did not modify significantly during follow‐up. Conversely, in patients who developed HCC, IGF‐I levels decreased significantly during follow‐up (from 72.6 ± 29.9 μg/L to 33.8 ± 14.5 μg/L; P = 0.001). In these patients, the significant decrease occurred both in patients with persistent Child Grade A cirrhosis and in patients with cirrhosis that progressed from Child Grade A to Grade B. The reduction in IGF‐I level preceded the diagnosis of HCC by 9.3 ± 3.1 months.CONCLUSIONSThis prospective study demonstrates that, in patients with HCV‐related cirrhosis, 1) the development of HCC is accompanied by a significant reduction of serum IGF‐I levels independent of the grade of impairment of liver function; and 2) modification of the IGF‐I level precedes the morphologic appearance of HCC, permitting a precocious diagnosis of the tumor. Cancer 2002;95:2539–45. © 2002 American Cancer Society.DOI 10.1002/cncr.11002

Clinical benefits of biochemical markers of bone turnover in Egyptian children with chronic liver diseases

“…Also, our results are in agreement with the findings of Orsini et al [25] who found similar results in hepatosplenic schistosomiasis patients and the results of Mazziotti et al [26] in patients with hepatocellular carcinoma (HCC) and hepatitis C vir us-related cirrhosis. The reduction in IGF-1 level also can precede the diagnosis of HCC [26] .…”

“…Also, our results are in agreement with the findings of Orsini et al [25] who found similar results in hepatosplenic schistosomiasis patients and the results of Mazziotti et al [26] in patients with hepatocellular carcinoma (HCC) and hepatitis C vir us-related cirrhosis. The reduction in IGF-1 level also can precede the diagnosis of HCC [26] . Similarly, decreased serum IGF-1 level has been recorded both in patients with viral cirrhosis [9,27] and in patients with hepatitis B infection without cirrhosis [28] .…”

Role of biomarkers in the prediction and diagnosis of hepatocellular carcinoma

“…The serum levels of IGFⅠ are significantly lower in patients with HCC compared with patients without HCC [49] . At a threshold of 4.1 mg/g IGFⅠ has a 63% sensitivity and a 90% specificity for diagnosings of HCC.…”

Evaluation of Taline-1, MCP-1 and IGF-1 in Prediction the Risk of Developing Hepatocellular Carcinoma in Patients With Liver Cirrhosis

“…However, the relevance of IGF-I to hepatocellular carcinoma is somewhat different from other malignancies because the majority of circulating IGF-I is produced by the liver (25) .…”