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 : A prospective study
✍ Scribed by Gherardo Mazziotti; Francesca Sorvillo; Filomena Morisco; Antonella Carbone; Mario Rotondi; Gianfranca Stornaiuolo; Davide F. Precone; Michele Cioffi; Giovanni B. Gaeta; Nicola Caporaso; Carlo Carella
- Publisher
- John Wiley and Sons
- Year
- 2002
- Tongue
- English
- Weight
- 108 KB
- Volume
- 95
- Category
- Article
- ISSN
- 0008-543X
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✦ Synopsis
Background:
Although 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.
Methods:
One 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 alpha-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.
Results:
Twenty 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 microg/l to 33.8 +/- 14.5 microg/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.
Conclusions:
This 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.