Novel Nomograms Based on Gamma-Glutamyl Transpeptidase-to-Lymphocyte Ratio Predict Prognosis of Hepatocellular Carcinoma Patients After Hepatectomy

Abstract

Background The prediction of prognosis of hepatocellular carcinoma (HCC) is of great significance in improving disease outcome and optimizing clinical management, while reliable prognostic indicators are lacking. This study was conducted to develop readily-to-use nomograms for prognosis prediction of HCC after hepatectomy. Materials and Methods Data of eligible patients were collected and analyzed retrospectively. Independent prognostic factors were identified by Cox regression, and nomograms for the prediction of disease-free survival (DFS) and overall survival (OS) were developed. The performance of the nomograms was evaluated by receiver operating characteristics (ROC) curves, C-indexes and calibration curves and was verified by the validation cohort. The predictive value of the nomograms was also compared with the 8th edition of American Joint Committee on Cancer (AJCC) Tumor-Node-Metastasis (TNM) and the Barcelona Clinic Liver Cancer (BCLC) staging systems. Results In total, 599 patients were enrolled in the analysis: 420 in the training cohort and 179 in the validation cohort. The optimal cut-off value of Gamma-Glutamyl Transpeptidase-to-Lymphocyte Ratio (GLR) was 19.5. GLR contributed significantly to the nomograms with good predictive power. In ROC analyses, the areas under curve (AUCs) of the nomograms for 1-, 3- and 5-year DFS and OS prediction were 0.758, 0.756, 0.734 and 0.810, 0.799, 0.758, respectively. The C-indexes of the DFS nomogram were 0.697 (95% CI 0.665–0.729) in the training cohort and 0.710 (95% CI 0.664–0.756) in the validation cohort. For OS prediction, the C-indexes were 0.741 (95% CI 0.704–0.778) and 0.758 (95% CI 0.705–0.811) in the training and validation cohorts, respectively. The calibration curves demonstrated satisfactory agreement between nomogram predictions and actual observations. The nomograms demonstrated superior predictive performance to the TNM and the BCLC staging systems. Conclusion Our novel nomograms showed adequate performance in the prediction of HCC prognosis after hepatectomy, which may facilitate the risk stratification and individualized management of HCC patients.

Predictive nomograms based on gamma-glutamyl transpeptidase to prealbumin ratio for prognosis of hepatocellular carcinoma patients without microvascular invasion

“…This association can be attributed to the fact that abnormal liver function and cholestasis often lead to elevated levels of GGT, a component of the GPR. Elevated GGT levels have been implicated in tumor formation and progression through various mechanisms [ 15 ]. Consequently, previous studies have recommended utilizing the GGT to platelet ratio as a prognostic marker for HCC patients [ 16 , 17 ].…”

The Augural Interplay of Myosteatosis and Gamma-Glutamyltransferase in Patients Undergoing Comprehensive Surgical Intervention for Cholangiocarcinoma

“…The current corpus of scienti c literature posits that GGT plays a cardinal role in contributing to unfavorable outcomes in oncology patients by stimulating the generation of reactive oxygen species (ROS) within the neoplastic microcosm, thereby spurring the proliferation, expansion, and in ltration of the malignant growth [31]. A surge in GGT concentrations may be discerned in a diversity of hepatobiliary maladies, cementing its reputation as a sensitive and invaluable clinical barometer for these disorders [32][33][34]. Upon the event of biliary obstruction, GGT measurements may skyrocket, reaching between 5 to 30 times the standard parameters.…”

A novel liver-function-indicators-based prognosis signature for patients with hepatocellular carcinoma treated with anti-programmed cell death-1 therapy

“…Numerous studies have shown that these indicators can effectively evaluate the prognosis of HCC patients undergoing surgical resection [ 16 – 21 ]. Other blood biomarkers combined inflammation and liver function, including neo‐Glasgow prognostic score (neo-GPS) [ 22 ], aspartate aminotransferase-to-lymphocyte ratio index (ALRI) [ 23 ], gamma-glutamyl transpeptidase-to-lymphocyte ratio (GLR) [ 24 ], CRP-to-albumin ratio (CAR) [ 19 ]have also been reported as independent prognostic predictors for HCC. So far, there are limited studies on the prognostic values of these indicators for unresectable HCC patients receiving anti-PD-1 antibody treatments.…”