Validation of an IGF-CTP scoring system for assessing hepatic reserve in egyptian patients with hepatocellular carcinoma

// Reham Abdel-Wahab 1,6 , Samir Shehata 6 , Manal M. Hassan 1 , Lianchun Xiao 2 , Ju-Seog Lee 3 , Sheree Cheung 1 , Hoda H. Essa 6 , Hesham M. Hassabo 1 , Ahmed S. Shalaby 1 , Eman Mosad 7 , Kanwal Raghav 1 , Asif Rashid 4 , Robert A. Wolff 1 , Jeffrey S. Morris 2 , Hesham M. Amin 5,8 and Ahmed O. Kaseb 1 1 Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 2 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 3 Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 4 Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 5 Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 6 Department of Clinical Oncology, Assiut University, Egypt 7 Department of Pathology, Assiut University, Egypt 8 Graduate School of Biomedical Sciences, Houston, Texas, USA Correspondence to: Ahmed O. Kaseb, email: // Keywords : IGF-1, Child-Pugh, validation, liver reserve, hepatocellular carcinoma Received : March 26, 2015 Accepted : May 01, 2015 Published : May 19, 2015 Abstract Background The Child-Turcotte-Pugh score (CTP) is the standard tool for hepatic reserve assessment in hepatocellular carcinoma (HCC). Recently, we reported that integrating plasma insulin-like growth factor-1 (IGF-1) level into the CTP score was associated with better patient risk stratification in two U.S. independent cohorts. Our current study aimed to validate the IGF-CTP score in patients who have different demographics and risk factors. Patients and Methods We prospectively recruited 100 Egyptian patients and calculated their IGF-CTP score compared to CTP score. C-index was used to compare the prognostic significance of the two scoring systems. Finally, we compared our results with our U.S. cohorts published data. Results IGF-CTP score showed significant better patient stratification compared to CTP score in the international validation cohort. Among CTP class A patients, who usually considered for active treatment and clinical trial enrollment, 32.5% were reclassified as IGF-CTP class B with significantly shorter OS than patients reclassified as class A with hazard ratio [HR] = 6.15, 95% confidence interval [CI] = 2.18 -17.37. Conclusion IGF-CTP score showed significantly better patient stratification and survival prediction not only in the U.S. population but also in international validation population, who had different demographics and HCC risk factors.