Purpose The Child-Pugh (CP) system is the major tool for assessing the underlying liver condition and guiding therapy decisions in hepatocellular carcinoma (HCC) patients. It is itself relatively quantitative and uses five empirically selected variables, including hepatic encephalopathy and ascites, which are clinically difficult to grade and may vary in severity according to medical management of patients. Insulin-like growth factor-1 (IGF-1) is produced predominantly in the liver, and hence reflects its synthetic function. Our study objective was to build a new CP score by integrating plasma IGF-1 level into the CP parameters to refine its prognostic stratification ability. Patients and Methods We prospectively collected plasma samples and clinical data from 310 individuals with HCC. IGF-1 levels were measured by ELISA and recursive partitioning was used to identify optimal cut points and IGF-1 ranges, using training and validation sets, and established the cut-off values of IGF-1 arranged so as to define the three distinct groups of IGF-1 with increasing liver function severity; A=1, B=2, and C=3. We then constructed the new score by replacing points from ascites and encephalopathy with plasma IGF-1 points; the new score points = 4-11. Finally, we performed log rank test for both systems, and also compared their prognostic abilities using concordance index (c-index). Results Compared with CP system, the new system (c -index = 0.608) improves the capacity in predicting OS and refined the stratification of all classes of the original CP (c-index = 0.573), (p value = 0.0029). Conclusion Replacing ascites and encephalopathy by plasma IGF-1 significantly improved prediction of OS and prognostic stratification of the conventional CP system. After external validation, the new scoring system may become the standard of care in guiding therapy decisions and stratifying HCC patients in clinical trials.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4560. doi:1538-7445.AM2012-4560