Evaluating the role of preoperative plasma insulin-like growth factor 1 (IGF-1) as a predictor of survival and recurrence in patients with resectable hepatocellular carcinoma.

e16318 Background: Low serum Insulin-like Growth Factor 1 (IGF-1) levels are associated with multinodularity, and shorter overall survival (OS) in patients with advanced unresectable HCC. In this study, we sought to evaluate whether preoperative IGF-1 levels may also be associated with OS and recurrence-free survival (RFS) in patients who underwent hepatic resection for HCC. Methods: Patients undergoing hepatectomy for HCC from September 2001 to May 2023 were identified from a prospectively maintained database at a tertiary cancer referral center. Patients without levels of IGF-1 within 2 months of hepatectomy were excluded. The median level of IGF-1 was 87 and was used as a cutoff to categorize high vs low IGF-1 levels. This cutoff was used instead of the more established 50 as patients in surgical cohorts naturally have healthier livers, and thus higher levels of IGF-1 than advanced unresectable HCC on which this cutoff was established. The primary endpoint was OS and the secondary endpoint was RFS. The Kaplan-Meier method was used to compute the median OS and RFS, while multivariable Cox regression model was applied to study the association of serum IGF-1 levels with OS and RFS. Results: Fifty-one patients were included in this study. Median age was 66 years, with 33 males and 18 females. The median (IQR) IGF-1 value was 87 (57-124) ng/mL. Patients with low IGF-1 were more likely to be elderly (≥65), with a history of diabetes, hypertension, and tobacco use (p < 0.05 for all). They were also more likely to have multinodular tumors (31% vs 4%, p = 0.012), higher AFP levels (median 71 vs 3 ng/mL, p = 0.019), and BCLC stage B (31% vs 8%, p = 0.041). The median follow-up was 61 months. RFS was not significantly different between the high and low IGF-1 groups (1-year RFS 59% vs 64%, p = 0.545). OS was significantly longer in patients with high IGF-1 compared to patients with low IGF-1 (5-year OS 80% vs 40%, p = 0.027). On multivariable analysis, high IGF-1 was significantly associated with better OS (HR 0.33, 95% CI 0.12-0.93; p = 0.035). Conclusions: Low preoperative levels of IGF-1 was not associated with recurrence but it was a predictor of poor survival after liver resection for HCC. Since low plasma IGF-1 levels is associated with low hepatic reserve and increasing severity of chronic liver disease, our results may be explained by a decreased overall life expectancy and a decreased ability to intervene and provide alternative treatment options at time of recurrence in patients with low IGF (≤87 ng/mL).