Associations Between Circulating Insulin-Like Growth Factor 1 and Mortality in Women With Invasive Breast Cancer

Serum C-peptide level and the risk of cardiovascular diseases mortality and all-cause mortality: a meta-analysis and systematic review

Aims and background

Recently, the serum of C-peptide has been the focus of researchers as a possible predictor of mortality. However, the possible association of serum C-peptide with cardiovascular diseases (CVDs) mortality and all-cause mortality has not been clearly identified. This meta-analysis aimed to assess the relationship between serum C-peptide and the risk of CVDs mortality and all-cause mortality.

Methods

A comprehensive and systematic search was performed in various important databases, including the PubMed, Web of Science, and Scopus to find relevant studies up to November 2022. The reported hazard ratio (HR) [95% confidence interval (CI)] for all studies was converted into log HR, and their SD was calculated. Then to compute the pooled HR, the random-effects model with inverse variance weighting method was performed.

Results

Twenty-three studies were included in the meta-analysis. Fourteen studies reported HR for all-cause mortality, and nine studies for CVDs-related mortality. The pooled results indicate a significant association between serum C-peptide and the risk of all-cause mortality (HR: 1.22; 95% CI: 1.12-1.32, I²= 76.8%; P-value < 0.001). Also, higher serum C-peptide was related to the increased risk of CVDs mortality (HR: 1.38; 95% CI: 1.08-1.77, I²= 81.8%; P-value = 0.012).

Conclusions

Our investigation suggested that an increased level of serum C-peptide is associated with a higher risk of both CVDs and all-cause mortality. Further, large-scale studies and sufficient samples are recommended to present a convincing link between C-peptide and the risk of CVDs and all-cause mortality.

Systematic Review Registration

identifier, CRD42022364842.

Preoperative Risk Stratification of Increased MIB-1 Labeling Index in Pituitary Adenoma: A Newly Proposed Prognostic Scoring System

The MIB-1 index is an important risk factor for progression-free survival (PFS) in pituitary adenoma (PA). Preoperatively, the MIB-1 index is not available in the decision-making process. A preoperative method regarding MIB-1 index estimation in PA has not been evaluated so far. Between 2011 and 2021, 109 patients with tumor morphology data, MIB-1 index data, and inflammatory and pituitary hormone laboratory values underwent surgery for PA. An MIB-1 index cutoff point (≥4/<4%) determines the probability of PFS in completely resected PA. An elevated MIB-1 index (≥4%) was present in 32 cases (29.4%) and was significantly associated with increased IGF-1, age ≤ 60, increased ACTH, and increased fibrinogen levels in the multivariable analysis. A scoring system (“FATE”) using preoperative IGF-1, age, ACTH, and plasma fibrinogen level enables the estimation of the MIB-1 index (sensitivity 72%, specificity 68%). The FATE score is also significantly associated with the time to PA progression after the complete resection of the PA. We propose the FATE score to preoperatively estimate the risk of an elevated MIB-1 index (≥4%), which might enable tailoring to medical decision-making, and follow-up interval scheduling, as well as inform future studies analyzing proliferative activities.

Prognostic significance of circulating insulin growth-like factor 1 and insulin growth-like factor binding protein 3 in renal cell carcinoma patients

Insulin growth-like factor-1 (IGF-1) and its main binding protein insulin growth-like factor binding protein 3 (IGFBP-3) play important roles in cancer development and progression. We hypothesize that circulating IGF-1 and IGFBP-3 may have significant prognostic values in renal cell carcinoma (RCC) patients. We used 1,010 histologically confirmed RCC patients in this case series study to test this hypothesis. We constructed a weighted genetic risk score (GRS) using a large panel of genome-wide association study (GWAS)-identified single nucleotide polymorphisms (SNPs) to predict circulating IGF-1 and IGFBP-3 level, respectively. We analyzed the associations of the GRS with the prognosis of RCC patients using multivariate Cox proportional hazards model. We found significant associations between genetically predicted circulating IGF-1 level, but not IGFBP-3, and RCC prognosis. RCC patients with better prognosis had significantly higher baseline circulating IGF-1 level than those with worse prognosis. Dichotomized at the median value of GRS, patients with high IGF-1 exhibited significantly lower risks of recurrence (HR=0.81, 95% CI, 0.65-0.99, P=0.045) and death (HR=0.74, 95% CI, 0.60-0.91, P=0.004). If patients were dichotomized at the 75% value of GRS, those with the highest quarter of GRS had 27% lower risk of recurrence (OR=0.73, 95% CI, 0.55-0.96, P=0.025) and 34% lower risk of death (OR=0.66, 95% CI, 0.50-0.87, P=0.003) than the other three quarters of patients. High IGF-1/IGFBP-3 ratio was also associated with reduced risks of recurrence and survival. In conclusion, high circulating IGF-1 level and IGF-1/IGFBP-3 ratio at diagnosis is associated with better prognosis in RCC patients.

Identification of differentially expressed genes-related prognostic risk model for survival prediction in breast carcinoma patients

Since the imbalance of gene expression has been demonstrated to tightly related to breast cancer (BRCA) genesis and growth, common genes expressed of BRCA were screened to explore the essence in-between. In current work, most common differentially expressed genes (DEGs) in various subtypes of BRCA were identified. Functional enrichment analysis illustrated the driving factor of deactivation of the cell cycle and the oocyte meiosis, which critically triggers the development of BRCA. Herein, we constructed a 12-gene prognostic risk model relative to differential gene expression. Subsequently, the K-M curves, analysis on time-ROC curve and Cox regression were performed to assess this risk model by determining the respective prognostic value, and the prediction performance were ascertained for both training and validation cohorts. In addition, multivariate Cox regression was analysed to reveal the independence between risk score and prognostic stage, and the accuracy and sensitivity of prognosis are particularly improved after clinical indicators are included into the analysis. In summary, this study offers novel insights into the imbalance of gene expression within BRCA, and highlights 12 selected genes associated with patient prognosis. The risk model can help individualize treatment for patients at different risks, and propose precise strategies and treatments for BRCA therapy.

Role of the IGF-1 Axis in Overcoming Resistance in Breast Cancer

Over the last two decades, many studies have demonstrated that the insulin-like growth factor-1 (IGF-1) is involved in a number of patho-physiological processes, as well as in the development of different types of solid tumors, including breast cancer (BC). Preclinical and clinical data showed that IGF-1 receptor (R) is overexpressed and hyper-phosphorylated in several subtypes of BCs. The central implications of this pathway in tumor cell proliferation and metastasis make it an important therapeutic target. Moreover, the IGF-1 axis has shown strong interconnection with estrogen regulation and endocrine therapy, suggesting a possible solution to anti-estrogen resistance. IGF-1R might also interfere with other pivotal therapeutic strategies, such as anti HER2 treatments and mTOR inhibitors; several clinical trials are ongoing evaluating the role of IGF-1R inhibition in modulating resistance mechanisms to target therapies. Our aim is to offer an overview of the most recent and significant field of application of IGF-1 inhibitors and relevant therapeutic strategies, weighing their possible future impact on clinical practice.

Pre- and Postoperative Circulating IGF-I, IGFBP-3, and IGFBP-7 Levels in Relation to Endocrine Treatment and Breast Cancer Recurrence: A Nested Case-Control Study

Insulin-like growth factor-I (IGF-I) and its binding proteins (BPs) have been associated with breast cancer risk, especially high IGF-I concentrations and the biologically active fraction estimated as the IGF-I/IGFBP-3 molar ratio. The relation of circulating IGF-I and IGFBP-3 concentrations with risk of breast cancer recurrence has been less documented. In addition a new member to a sub-group of the IGFBP-superfamily was recently identified, the low affinity IGFBP-7. To date, the role of systemic IGFBP-7 in breast cancer progression has not been investigated. Our purpose was to establish whether circulating IGF-I, IGFBP-3, and IGFBP-7 levels are related to recurrence-risk in breast cancer. A case-control study was nested within the population-based BCBlood cohort of 853 breast cancer patients diagnosed 2002-2010 in Sweden and followed through 2012. In total, 95 patients with recurrence and 170 controls were matched on age and tumor characteristics. Plasma IGF analytes and tumor membrane IGF-I receptor (IGF-IR^m) positivity were analyzed and recurrence-risk was evaluated with conditional logistic regression. Preoperative tertiles of IGF-I and IGFBP-3 were both positively associated with recurrence-risk, but not IGFBP-7. The trend was of borderline significance for IGF-I, T1:REF, T2 OR:1.6, T3 OR: 2.2 adjusted P _trend=0.057 and significant for IGFBP-3 T1:REF, T2 OR:1.2, T3 OR: 2.1 adjusted P _trend=0.042. The models were adjusted for age, anthropometric factors, smoking, and treatments. There was a significant interaction between IGFBP-7 and IGF-IR^m positivity on recurrence, where the highest IGFBP-7 highest IGFBP-7 tertile conferred increased recurrence-risk in patients with IGF-IR^m positive tumors but not in those with IGF-IR^m negative tumors (P _interaction=0.024). By the 1-year visit, age-adjusted IGF-I levels were reduced by 17% while IGFBP-3 and IGFBP-7 were stable. IGF-I levels were significantly reduced by radiotherapy in all patients and by tamoxifen in patients with ER⁺ tumors. Postoperative changes >10% (n=208) in IGF-I, IGFBP-3, IGFBP-7, or the IGF-I/IGFBP-3 ratio did not predict recurrence after adjustment for preoperative levels, age, anthropometric factors, smoking, and treatments. In conclusion, this study suggests that preoperative IGF-I and IGFBP-3 levels, but not postoperative changes, might provide independent prognostic information and influence breast cancer recurrence. The role of IGFBP-7 in breast cancer merits further study.

21-Gene Recurrence Assay Associated With Favorable Metabolic Profiles in HR-Positive, HER2-Negative Early-Stage Breast Cancer Patients

BACKGROUND

Comprehensive investigations of the associations between 21-gene recurrence assay and metabolic profiles in Chinese breast cancer patients are limited.

METHODS

We evaluated the relations of the 21-gene recurrence risk score (RS) and the expression of cancer-related genes with metabolic factors and biomarkers of insulin and the insulin-like growth factor (IGF) axis, and examined the interactions between the 21-gene RS and these metabolic profiles on breast cancer recurrence in Chinese women with HR-positive, HER2-negative early-stage breast cancer.

RESULTS

The 21-gene RS was inversely associated with body mass index ([BMI]β: -0.178 kg/m²; P=0.040), the homeostasis model assessment of insulin resistance index ([HOMA-IR] β: -0.031; P=0.042), insulin (β: -0.036 uIU/ml; P=0.009), and C-peptide (β: -0.021 ug/L; P=0.014) and was positively associated with high-density lipoprotein cholesterol (β: 0.025 mmol/L; P=0.004), which were driven by the relation patterns between specific cancer-related genes and these metabolic profiles. Each 10-unit increase in the 21-gene RS was associated with 28% (95% CI: 5-47%) higher risk of breast cancer recurrence; this association was also observed in patients with favorable metabolic profiles in relevant to an absence of obesity, insulin resistance, hyperglycemia, hypertension, or dyslipidemia (28-44% higher risk) and among women with a low level of insulin, C-peptide, or the IGF1/IGFBP3 ratio (41-155% higher risk).

CONCLUSIONS

The 21-gene RS was related to favorable metabolic profiles including lower BMI, HOMA-IR, insulin, and C-peptide, and higher HDL in Chinese breast cancer patients, and its prognostic impact on breast cancer recurrence was more likely to present among patients with relatively favorable metabolic profiles.