Impact of Integrating Insulin-Like Growth Factor 1 Levels into Model for End-Stage Liver Disease Score for Survival Prediction in Hepatocellular Carcinoma Patients

Reham Abdel-Wahab, Manal M. Hassan, Bhawana George, Roberto Carmagnani Pestana, Lianchun Xiao, Sahin Lacin, Suayib Yalcin, Ahmed S. Shalaby, Humaid O. Al-Shamsi, Kanwal Raghav, Robert A. Wolff, James C. Yao, Lauren Girard, Abedul Haque, Dan G. Duda, Simona Dima, Irinel Popescu, Hesham A. Elghazaly, Jean Nicolas Vauthey, Thomas A. AloiaChing Wei Tzeng, Yun Shin Chun, Asif Rashid, Jeffrey S. Morris, Hesham M. Amin, Ahmed O. Kaseb

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: Liver reserve affects survival in hepatocellular carcinoma (HCC). Model for End-Stage Liver Disease (MELD) score is used to predict overall survival (OS) and to prioritize HCC patients on the transplantation waiting list, but more accurate models are needed. We hypothesized that integrating insulin-like growth factor 1 (IGF-1) levels into MELD score (MELD-IGF-1) improves OS prediction as compared to MELD. Methods: We measured plasma IGF-1 levels in training (n = 310) and validation (n = 155) HCC cohorts and created MELD-IGF-1 score. Cox models were used to determine the association of MELD and MELD-IGF-1 with OS. Harrell's c-index was used to compare the predictive capacity. Results: IGF-1 was significantly associated with OS in both cohorts. Patients with an IGF-1 level of ≤26 ng/mL in the training cohort and in the validation cohorts had significantly higher hazard ratios than patients with the same MELD but IGF-1 >26 ng/mL. In both cohorts, MELD-IGF-1 scores had higher c-indices (0.60 and 0.66) than MELD scores (0.58 and 0.60) (p < 0.001 in both cohorts). Overall, 26% of training and 52.9% of validation cohort patients were reclassified into different risk groups by MELD-IGF-1 (p < 0.001). Conclusions: After independent validation, the MELD-IGF-1 could be used to risk-stratify patients in clinical trials and for priority assignment for patients on liver transplantation waiting list.

Original languageEnglish (US)
Pages (from-to)836-846
Number of pages11
JournalOncology (Switzerland)
Volume98
Issue number12
DOIs
StatePublished - Nov 2020

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

MD Anderson CCSG core facilities

  • Biostatistics Resource Group

Fingerprint

Dive into the research topics of 'Impact of Integrating Insulin-Like Growth Factor 1 Levels into Model for End-Stage Liver Disease Score for Survival Prediction in Hepatocellular Carcinoma Patients'. Together they form a unique fingerprint.

Cite this