Novel Value of Preoperative Gamma-Glutamyltransferase Levels in the Prognosis of AFP-Negative Hepatocellular Carcinoma

Abstract EN

Background.

Gamma-glutamyltransferase (GGT) is involved in tumor development and progression, but its prognostic value in α-fetoprotein- (AFP-) negative (AFP<25 ng/mL) hepatocellular carcinoma (HCC) patients remains unknown.

Methods.

A large cohort of 678 patients with AFP-negative HCC following curative resection who had complete data were enrolled in this study.

The optimal cutoff value for the preoperative level of GGT was determined by the X-tile program.

Independent prognostic factors for overall survival (OS) and disease-free survival (DFS) were also identified.

Results.

The optimal cutoff values for the preoperative levels of GGT were 37.2 U/L and 102.8 U/L, which were used to divide all patients into three subgroups (group 1, GGT<37.2 U/L (n=211, 31.1%); group 2, GGT≥37.2 and <102.8 U/L (n=320, 47.2%); group 3, GGT≥102.8 U/L (n=147, 21.7%)), with distinct OS times (58.5 vs.

53.5 vs.

44.4 months, P<0.001) and DFS times (47.9 vs.

40.3 vs.

30.1 months, P<0.001).

Elevated preoperative GGT levels were associated with an unfavorable tumor burden (larger tumor size, multiple tumors, and microvascular invasion) and were selected as independent predictors of a worse OS (group 2 vs.

group 1, HR: 1.73 (1.13-2.65), P=0.011; group 3 vs.

group 1, HR: 3.28 (2.10-5.13), P<0.001) and DFS (group 2 vs.

group 1, HR: 1.52 (1.13-2.05), P=0.006; group 3 vs.

group 1, HR: 2.11 (1.49-2.98), P<0.001) in multivariable analysis.

Conclusions.

Elevated preoperative GGT levels are associated with an unfavorable tumor burden and serve as an independent prognostic marker for worse outcomes in AFP-negative HCC patients following resection.