title: Association between insulin-like growth factor-2 and metastases after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: a prospective study.
abstract: BACKGROUND
  Hypoxia up-regulates insulin-like growth factor-2 (IGF-2) and thus stimulates the growth of hepatocellular carcinoma (HCC) cells. In the current study, the authors prospectively evaluated changes in plasma IGF-2 levels in HCC patients after transcatheter arterial chemoembolization (TACE), which usually results in hypoxic insult to liver tissue. The authors also examined the association between changes in plasma IGF-2 levels after TACE and HCC progression, especially in relation to metastasis.
  
  
  METHODS
  Plasma IGF-2 levels were measured before and 4 weeks after TACE in 46 patients with HCC. Three months after TACE, the patients were evaluated for the occurrence of metastatic HCC.
  
  
  RESULTS
  In 13 of the 46 patients, post-TACE plasma IGF-2 levels decreased by > 20% (Group 1) compared with their basal levels; in 18 patients, the IGF-2 levels changed within 20% (Group 2) and in 15 patients the IGF-2 levels increased by > 20% (Group 3). Plasma IGF-2 levels had a tendency to increase in patients with large-sized tumors, high serum alpha-fetoprotein (AFP) levels, and the heterogeneous uptake of iodized oil. Metastatic foci were found in 9 patients in Group 3 (60%), in contrast to only 3 patients in Group 2 (17%) and in none of the patients in Group 1 (P = 0.001). On multivariate analysis, higher Child-Pugh scores and increased plasma IGF-2 levels (Group 3) were found to be independent risk factors for metastasis.
  
  
  CONCLUSIONS
  Increased plasma IGF-2 levels after TACE, which are common in patients with large-sized tumors and high serum AFP levels, appear to be associated with the occurrence of metastatic HCC after TACE.
authors: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea.
authors: B C
authors: BC
authors: Song
authors: Y H
authors: YH
authors: Chung
authors: J A
authors: JA
authors: Kim
authors: H C
authors: HC
authors: Lee
authors: H K
authors: HK
authors: Yoon
authors: K B
authors: KB
authors: Sung
authors: S H
authors: SH
authors: Yang
authors: K
authors: K
authors: Yoo
authors: Y S
authors: YS
authors: Lee
authors: D J
authors: DJ
authors: Suh
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007335:Insulin-Like Growth Factor II / Q000032:analysis*; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011446:Prospective Studies; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins; D007335:Insulin-Like Growth Factor II