TY - JOUR
T1 - Development and validation of insulin-like growth factor-1 score to assess hepatic reserve in hepatocellular carcinoma
AU - Kaseb, Ahmed O.
AU - Xiao, Lianchun
AU - Hassan, Manal M.
AU - Chae, Young Kwang
AU - Lee, Ju Seog
AU - Vauthey, Jean Nicolas
AU - Krishnan, Sunil
AU - Cheung, Sheree
AU - Hassabo, Hesham M.
AU - Aloia, Thomas
AU - Conrad, Claudius
AU - Curley, Steven A.
AU - Vierling, John M.
AU - Jalal, Prasun
AU - Raghav, Kanwal
AU - Wallace, Michael
AU - Rashid, Asif
AU - Abbruzzese, James L.
AU - Wolff, Robert A.
AU - Morris, Jeffrey S.
PY - 2014/5/14
Y1 - 2014/5/14
N2 - Background Child-Turcotte-Pugh (CTP) score is the standard tool to assess hepatic reserve in hepatocellular carcinoma (HCC), and CTP-A is the classic group for active therapy. However, CTP stratification accuracy has been questioned. We hypothesized that plasma insulin-like growth factor 1 (IGF-1) is a valid surrogate for hepatic reserve to replace the subjective parameters in CTP score to improve its prognostic accuracy. Methods We retrospectively tested plasma IGF-1 levels in the training set (n = 310) from MD Anderson Cancer Center. Recursive partitioning identified three optimal IGF-1 ranges that correlated with overall survival (OS): greater than 50ng/mL = 1 point; 26 to 50ng/mL = 2 points; and less than 26ng/mL = 3 points. We modified the CTP score by replacing ascites and encephalopathy grading with plasma IGF-1 value (IGF-CTP) and subjected both scores to log-rank analysis. Harrell's C-index and U-statistics were used to compare the prognostic performance of both scores in both the training and validation cohorts (n = 155). All statistical tests were two-sided. Results Patients' stratification was statistically significantly stronger for IGF-CTP than CTP score for the training (P =. 003) and the validation cohort (P =. 005). Patients reclassified by IGF-CTP relative to their original CTP score were better stratified by their new risk groups. Most important, patients classified as A by CTP but B by IGF-CTP had statistically significantly worse OS than those who remained under class A by IGF-CTP in both cohorts (P =. 03 and P <. 001, respectively, from Cox regression models). AB patients had a worse OS than AA patients in both the training and validation set (hazard ratio [HR] = 1.45, 95% confidence interval [CI] = 1.03 to 2.04, P =. 03; HR = 2.83, 95% CI = 1.65 to 4.85, P <. 001, respectively). Conclusions The IGF-CTP score is simple, blood-based, and cost-effective, stratified HCC better than CTP score, and validated well on two independent cohorts. International validation studies are warranted.
AB - Background Child-Turcotte-Pugh (CTP) score is the standard tool to assess hepatic reserve in hepatocellular carcinoma (HCC), and CTP-A is the classic group for active therapy. However, CTP stratification accuracy has been questioned. We hypothesized that plasma insulin-like growth factor 1 (IGF-1) is a valid surrogate for hepatic reserve to replace the subjective parameters in CTP score to improve its prognostic accuracy. Methods We retrospectively tested plasma IGF-1 levels in the training set (n = 310) from MD Anderson Cancer Center. Recursive partitioning identified three optimal IGF-1 ranges that correlated with overall survival (OS): greater than 50ng/mL = 1 point; 26 to 50ng/mL = 2 points; and less than 26ng/mL = 3 points. We modified the CTP score by replacing ascites and encephalopathy grading with plasma IGF-1 value (IGF-CTP) and subjected both scores to log-rank analysis. Harrell's C-index and U-statistics were used to compare the prognostic performance of both scores in both the training and validation cohorts (n = 155). All statistical tests were two-sided. Results Patients' stratification was statistically significantly stronger for IGF-CTP than CTP score for the training (P =. 003) and the validation cohort (P =. 005). Patients reclassified by IGF-CTP relative to their original CTP score were better stratified by their new risk groups. Most important, patients classified as A by CTP but B by IGF-CTP had statistically significantly worse OS than those who remained under class A by IGF-CTP in both cohorts (P =. 03 and P <. 001, respectively, from Cox regression models). AB patients had a worse OS than AA patients in both the training and validation set (hazard ratio [HR] = 1.45, 95% confidence interval [CI] = 1.03 to 2.04, P =. 03; HR = 2.83, 95% CI = 1.65 to 4.85, P <. 001, respectively). Conclusions The IGF-CTP score is simple, blood-based, and cost-effective, stratified HCC better than CTP score, and validated well on two independent cohorts. International validation studies are warranted.
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U2 - 10.1093/jnci/dju088
DO - 10.1093/jnci/dju088
M3 - Article
C2 - 24815863
AN - SCOPUS:84905161621
SN - 0027-8874
VL - 106
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 5
M1 - dju088
ER -
