The prognostic utility of IGF-1 in hepatocellular carcinoma treated with stereotactic body radiotherapy

Ahmed Allam Mohamed; Cennet Sahin; Marie-Luise Berres; Oliver Beetz; Martin von Websky; Thomas Vogel; Florian W R Vondran; Philipp Bruners; Matthias Imöhl; Katharina Frank; Edith Vogt; Binney Pal Singh; Michael J Eble

doi:10.1016/j.ctro.2024.100887

The prognostic utility of IGF-1 in hepatocellular carcinoma treated with stereotactic body radiotherapy

Clin Transl Radiat Oncol. 2024 Nov 12:50:100887. doi: 10.1016/j.ctro.2024.100887. eCollection 2025 Jan.

Authors

Ahmed Allam Mohamed^{1

2}, Cennet Sahin^{3

2}, Marie-Luise Berres^{3

2}, Oliver Beetz^{4

2}, Martin von Websky^{4

2}, Thomas Vogel^{4

2}, Florian W R Vondran^{4

2}, Philipp Bruners^{5

2}, Matthias Imöhl^{6

2}, Katharina Frank^{1

2}, Edith Vogt^{1

2}, Binney Pal Singh^{1

2}, Michael J Eble^{1

2}

Affiliations

¹ Radiation Oncology Department, University Hospital RWTH Aachen, Aachen, Germany.
² Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany.
³ Gastroenterology, Hepatology and Infectious Diseases Department, University Hospital RWTH Aachen, Aachen, Germany.
⁴ General, Visceral, Pediatric and Transplantation Surgery Department, University Hospital RWTH Aachen, Aachen, Germany.
⁵ Diagnostic and Interventional Radiology Department, University Hospital RWTH Aachen, Aachen, Germany.
⁶ Laboratory Diagnostic Center, University Hospital RWTH Aachen, Aachen, Germany.

Abstract

Background: Hepatocellular carcinoma (HCC) poses a significant challenge for patients ineligible for surgical resection or liver transplantation. Local therapies like Stereotactic Body Radiotherapy (SBRT) are crucial for those with liver-limited disease. Insulin-like growth factor-1 (IGF-1) is a potential biomarker for liver function. This study evaluates IGF-1's prognostic value in predicting survival outcomes in HCC patients undergoing SBRT.

Methods: We analyzed 42 HCC patients treated with SBRT between May 2021 and January 2024, with IGF-1 levels measured within four weeks before SBRT. Patient demographics, tumor metrics, and clinical outcomes were examined. The prognostic significance of IGF-1 was assessed using Cox proportional hazards and ROC curve analysis to determine optimal IGF-1 cutoffs for survival prediction. A nomogram predicting 1-year and 2-year survival was constructed using a multivariate Cox model.

Results: IGF-1 levels were significantly lower in patients with cirrhosis or sarcopenia. Median overall survival (OS) was 24 months, with a significant survival difference favoring patients with IGF-1 levels above 62.4 ng/ml (Hazard Ratio [HR]: 5.9, P = 0.0025). A multivariable Cox model including Child-Turcotte-Pugh (CTP) score, IGF-1, and tumor volume effectively predicted survival. IGF-1 and tumor volume significantly impacted OS (HR: 6.9 and 1.004, p = 0.014 and 0.0022, respectively). Integrating IGF-1 with CTP score improved predictive accuracy (c-index 0.66 to 0.75, p = 0.052).The nomogram, integrating IGF-1 with the CTP and tumour volume, exhibited robust predictive accuracy with an area under the curve (AUC) of 0.84 for 2-year survival.

Conclusion: IGF-1 is a reliable biomarker for liver function and survival prediction in HCC patients undergoing SBRT. Higher IGF-1 levels indicate better prognosis. The developed nomogram, incorporating IGF-1, enhances clinical decision-making for SBRT management. Further validation in larger cohorts is needed.

Keywords: Hepatocellular carcinoma; IGF-1; Liver cancer prognosis; Nomogram; SBRT; Survival analysis.