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Figure 2 IGF-1, SIRT1, and FOXO1 in Osteosarcoma In osteosarcoma, increased levels of IGF-1 and IGF-1R have been found that seem to lead to tumor progression through transformation, proliferation, decreased susceptibility to apoptosis, and a phenotype prone to metastasis, including increase cell motility, invasion, and angiogenesis (109111)