IGF1 and neoplasm: High VEGF levels have been associated with tumor cell proliferation, poor encapsulation of the tumor nodules, venous invasion, higher grade, and a poor prognosis following resection.[36] mTOR activation through PI3K/Akt pathway is associated with increased expression of growth factors such as EGF, TGF-α, IGF, and hepatocyte growth factor (HGF) that promote HCC cell proliferation and survival.[37, 38]