Research Papers:

Insulin-like growth factor 1/Child-Turcotte-Pugh composite score as a predictor of treatment outcomes in patients with advanced hepatocellular carcinoma treated with sorafenib

Yehia I. Mohamed, Sunyoung Lee, Lianchun Xiao, Manal M. Hassan, Aliya Qayyum, Rikita Hiatia, Roberto Carmagnani Pestana, Abedul Haque, Bhawana George, Asif Rashid, Dan G. Duda, Hesham Elghazaly, Robert A. Wolff, Jeffrey S. Morris, James Yao, Hesham M. Amin and Ahmed O. Kaseb _

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Oncotarget. 2021; 12:756-766. https://doi.org/10.18632/oncotarget.27924

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Yehia I. Mohamed1, Sunyoung Lee1, Lianchun Xiao2, Manal M. Hassan3, Aliya Qayyum4, Rikita Hiatia3, Roberto Carmagnani Pestana1, Abedul Haque5, Bhawana George5, Asif Rashid6, Dan G. Duda7, Hesham Elghazaly8, Robert A. Wolff1, Jeffrey S. Morris2, James Yao1, Hesham M. Amin5 and Ahmed O. Kaseb1

1 Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

2 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

3 Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

4 Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

5 Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

6 Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

7 Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

8 Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Correspondence to:

Ahmed O. Kaseb,email: [email protected]

Keywords: IGF-1; Child-Pugh; sorafenib; liver reserve; hepatocellular carcinoma

Received: November 09, 2020     Accepted: March 08, 2021     Published: April 13, 2021

Copyright: © 2021 Mohamed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: Sorafenib was the first systemic therapy approved for the treatment of Child-Turcotte-Pugh (CTP) class A patients with advanced hepatocellular carcinoma (HCC). However, there are no biomarkers to predict survival and treatment outcomes and guide HCC systemic therapy. Type 1 insulin-like growth factor (IGF-1)/CTP composite score has emerged as a potential hepatic reserve assessment tool. Our study investigated the association of the IGF/CTP score with overall survival (OS) and progression-free survival (PFS) of HCC patients treated with sorafenib.

Materials and Methods: In this prospective study, patients with HCC were treated with sorafenib and followed up until progression/death. We calculated the IGF/CTP score and used the Kaplan-Meier method and log-rank test to estimate and compare the time-to-event outcomes between patient subgroups.

Results: 171 patients were included, 116 of whom were CTP class A. Median PFS for IGF/CTP score AA and AB patients were 6.88 and 4.28 months, respectively (p = 0.1359). Median OS for IGF/CTP score AA and AB patients were 14.54 and 7.60 months, respectively (p = 0.1378). The PFS and OS was superior in AA patients, but the difference was not significant, likely due to the sample size. However, there was a significant difference in early OS and PFS curves between AA and AB (p = 0.0383 and p = 0.0099), respectively.

Conclusions: In CTP class A patients, IGF/CTP score B was associated with shorter PFS and OS, however, study was underpowered to reach statistical significance. If validated in larger cohorts, IGF/CTP score may serve as stratification tool in clinical trials, a hepatic reserve assessment tool for HCC outcomes prediction and to assist in therapy decisions.

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