Evaluating the role of preoperative serum insulin-like growth factor 1 as a predictor of survival and recurrence for patients with resectable hepatocellular carcinoma.

[BACKGROUND] Low serum insulin-like growth factor 1 (IGF-1) level is associated with shorter overall survival (OS) in patients with advanced unresectable hepatocellular carcinoma (HCC). This study aimed to evaluate whether preoperative IGF-1 levels are associated with OS and recurrence-free survival (RFS) in patients with HCC who underwent hepatectomy.

[METHODS] Patients who underwent hepatectomy for HCC between 2001 and 2023 were identified from a prospectively maintained database at the MD Anderson Cancer Center. Patients with IGF-1 measured within 8 weeks after hepatectomy were included. The median IGF-1 level was used as a cutoff value to categorize high and low IGF-1 levels. The primary endpoint was OS, and the secondary endpoint was RFS.

[RESULTS] A total of 51 patients were included in this study. The median age was 66 years, and 65% of patients were males. The median IGF-1 level was 87 ng/mL. Patients with low IGF-1 levels were more likely to be ≥65 years old, with history of diabetes mellitus, hypertension, and tobacco use, and to have multinodular tumors and higher alpha-fetoprotein levels. After a median follow-up of 61 months, no difference in RFS between the high and low IGF-1 groups was found. OS was significantly longer in patients with high IGF-1 levels than in those with low IGF-1 levels (5-year OS: 80% vs 45%, respectively; P =.027). On multivariate analysis, a high IGF-1 level was significantly associated with better OS (hazard ratio, 0.33 [95% CI, 0.12-0.93]).

[CONCLUSION] Low preoperative IGF-1 levels were a predictor of poor survival after liver resection for HCC but did not correlate with recurrence rates. This may be related to poor hepatic reserve in patients with low IGF-1 levels.