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Preoperative serum gamma-glutamyl transferase to alanine aminotransferase ratio is a convenient prognostic marker for Child-Pugh A hepatocellular carcinoma after operation

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

The ratio of serum gamma-glutamyl transferase (GGT) to alanine aminotransferase (ALT) is a parameter for assessing responses to antiviral therapies. The relationship between the prognosis of hepatitis B-associated hepatocellular carcinoma (HCC) and preoperative GGT/ALT is studied in hepatectomized Child-Pugh A patients.

Methods

Two hundred and nineteen patients with hepatitis B virus-related HCC were included. Serum ALT and GGT levels were examined preoperatively and the GGT/ALT ratios were calculated. Their prognostic capabilities were evaluated by Cox-regression model.

Results

As dichotomized variables, GGT and ALT were distributed unequally (P < 0.001). Most patients had high levels of GGT (n = 110) but low levels of ALT (n = 185). ALT displayed no relation to recurrence or survival, while GGT was independently associated with survival (P = 0.002). The GGT/ALT ratio could predict survival precisely either in a continuous or dichotomized fashion (P < 0.001 and 0.001, respectively), and also related to recurrence when dichotomized (P = 0.002). Additionally, high GGT/ALT ratio was associated with high early recurrence rates, more recurrence-related deaths and various aggressive tumor characteristics such as larger tumor size, vascular invasion, poor encapsulation and advanced BCLC stage. In further stratified analyses, this ratio could discriminate the outcomes of patients with high- or low-α-fetoprotein level.

Conclusions

The elevated GGT/ALT ratio was a promising predictor for poor prognosis of Child-Pugh A HCC patients after operation mainly through its tight relevance to the primary tumor burden.

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Abbreviations

HCC:

Hepatocellular carcinoma

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

ALT:

Alanine aminotransferase

GGT:

Gamma-glutamyl transferase

BCLC:

Barcelona clinic liver cancer

AFP:

α-fetoprotein

CT:

Computed tomography

MRI:

Magnetic resonance imaging

TTR:

Time to recurrence

OS:

Overall survival

ROC:

Receiver operating curve

AUC:

Area under curve

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Acknowledgments

This article was supported by grants from the National Natural Science Foundation of China (30700794), the Chinese Ministry of Education (107039), and the National Key Sci-Tech Special Project of China (2008ZX10002-019).

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Authors and Affiliations

  1. Liver Cancer Institute, Zhongshan Hospital and Shanghai Medical School of Fudan University, Key Laboratory for Carcinogenesis and Cancer Invasion, Chinese Ministry of Education, 136 Yi Xue Yuan Road, 200032, Shanghai, People’s Republic of China

    Min-Jie Ju, Shuang-Jian Qiu, Jia Fan, Jian Zhou, Qiang Gao, Ming-Yan Cai, Yi-Wei Li & Zhao-You Tang

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  1. Min-Jie Ju
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  2. Shuang-Jian Qiu
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Correspondence to Zhao-You Tang.

Additional information

M.-J. Ju and S.-J. Qiu have contributed equally to this work.

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Ju, MJ., Qiu, SJ., Fan, J. et al. Preoperative serum gamma-glutamyl transferase to alanine aminotransferase ratio is a convenient prognostic marker for Child-Pugh A hepatocellular carcinoma after operation. J Gastroenterol 44, 635–642 (2009). https://doi.org/10.1007/s00535-009-0050-x

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  • DOI: https://doi.org/10.1007/s00535-009-0050-x

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