Plasma Biomarkers in Liver Cancer Refine Stratification of Patient Risk

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According to an Internal Medicine News report, data presented at the 2011 Gastrointestinal Cancers Symposium at the American Society of Clinical Oncology meeting on gastrointestinal cancers in January sponsored by the American Society of Clinical Oncology suggests that a simple blood test may improve on systems conventionally used to estimate prognosis in patients with hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is a vascular tumor derived mainly by vascular endothelial growth factor (VEGF)-mediated angiogenesis. It is always associated with chronic liver disease (CLD) and cirrhosis, which directly affect survival of HCC patients. In a study of 288 patients with HCC, baseline plasma levels of insulin-like growth factor 1 (IGF1) and vascular endothelial growth factor (VEGF) significantly refined the risk stratification seen with the Barcelona Clinic Liver Cancer (BCLC) system and the Cancer of the Liver Italian Program (CLIP) system, the two HCC risk stratification systems most commonly used in Western countries.

Lower plasma IGF1 and higher plasma VEGF levels significantly correlated with advanced clinicopathologic parameters and poor overall survival. According to the report:

As a whole, patients with stage C disease had a median overall survival of 11 months. But when levels of both growth factors were also considered, the population split into four groups having widely differing overall survival, ranging from 3 to 14 months.

Median overall survival was 14 months for patients with high levels of both growth factors, 12 months for patients with high IGF-1 and low VEGF levels, 6 months for patients with low levels of both growth factors, and 3 months for patients with low IGF-1 and high VEGF levels (P less than .0006).

The researchers focused on IGF1 because it is produced predominantly in the liver and circulating levels are lower in chronic liver disease, and VEGF because it is a principle mediator of angiogenesis. The low levels of IGF1 may be associated with more severe cirrhosis, while higher levels of VEGF observed may be associated with a more advanced tumor state.

According to lead investigator Dr. Ahmed O. Kaseb:

Baseline assessment of both markers – IGF-1 and VEGF – significantly improved the prediction of survival and prognostic stratification of HCC patients. If the results of forthcoming, large collaborative studies confirm our results, this approach will really be beneficial in stratification of patients in clinical trials, … guiding therapy decisions, and ultimately improving HCC outcome.

Abstract: IV-HCC: Clinical and prognostic implications of plasma IGF-1 and VEGF in patients with hepatocellular carcinoma

Source: Internal Medicine News