Predictive value of gamma-glutamyl transpeptidase to lymphocyte count ratio in hepatocellular carcinoma patients with microvascular invasion

Abstract

Background: Microvascular invasion (MVI) is an independent risk factor for poor prognosis in hepatocellular carcinoma (HCC). However, there is still a lack of preoperative markers to predict MVI in HCC. This study intends to explore the potential application value of the gamma-glutamyl transpeptidase (GGT) to lymphocyte count ratio (GLR) in predicting MVI in HCC and provide guidance for clinical diagnosis and treatment. Methods: From March 2010 to December 2015, 230 HCC patients who underwent surgical treatment in the Affiliated Hospital of Guilin Medical University were selected. Clinicopathological parameters between the MVI group (n = 115) and the non-MVI group (n = 115) were comparatively analyzed. The GLR was used as the potential risk factor for HCC with MVI, and its optimal cut-off value was estimated by using the receiver operating characteristic (ROC) curve. The Kaplan-Meier method was used to analyze the survival of HCC patients, and univariate and multivariate Cox regression analyses were used to establish independent predictors affecting postoperative HCC patients. Results:The GLR levels in the MVI group and non-MVI group were 84.83 ± 61.84 and 38.42 ± 33.52 (p < 0.001), respectively. According to ROC curve analysis, the optimal cut-off value of GLR was 56.0, and the area under the ROC curve (AUC) was 0.781 (95% CI, 0.719-0.833) for the risk prediction of MVI in HCC patients. Multivariate analysis showed that tumor size > 5 cm, HCC combined with MVI and GLR > 56.0 were independent risk factors for poor prognosis in HCC patients. In addition, compared with the non-MVI group, patients in the MVI group had shorter progression-free survival (PFS) and overall survival (OS).Conclusion: GLR could be a predictive biomarker of HCC after operation and a potential predictor of HCC combined with MVI.

Gamma-glutamyl transpeptidase to platelet and gamma-glutamyl transpeptidase to lymphocyte ratio in a sample of Chinese Han population

“…High GPR (> 0.23) was an independent risk factor for hepatocellular carcinoma development in chronic hepatitis patients [ 17 ]. High GLR was also an independent prognostic factor of hepatocellular carcinoma and intrahepatic cholangiocarcinoma [ 8 , 9 ].…”

“…GPR and GLR were calculated as GGT/ULN of GGT/platelet count (10 9 /L)×100 [ 2 ] and as the ratio of GGT to lymphocyte cell count [ 8 ], respectively. The samples were excluded with White blood cell (WBC) less than 3.5 × 10 9 /L or more than 9.5 × 10 9 /L, lymphocyte less than 1.1 × 10 9 /L or more than 3.2 × 10 9 /L and platelet less than 125 × 10 9 /L or more than 350 × 10 9 /L and hepatic insufficiency with GGT more than 100 U/L.…”

“…Recently Lemoine M et al reported that the gamma-glutamyl transpeptidase (GGT) to platelet ratio (GPR) can predict significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa [ 2 ], which can be used in other populations and hepatitis B virus-related liver cancer [ 3 – 7 ]. More recently, gamma-glutamyl transpeptidase to lymphocyte ratio (GLR) were reported to be predictors of microvascular invasion in hepatocellular carcinoma [ 8 ] and intrahepatic cholangiocarcinoma patients following hepatectomy [ 9 ]. These tests supplied simple, cheap and convenient methods to assess the hepatic fibrosis level of patients with chronic hepatitis B and prognosis of patients with hepatocellular carcinoma.…”

Novel Nomogram Based on Inflammatory Markers for the Preoperative Prediction of Microvascular Invasion in Solitary Primary Hepatocellular Carcinoma

“… 7 In recent years, several studies have used a combination of different routine laboratory inflammatory markers to predict MVI before surgery. Previous studies have demonstrated that some preoperative inflammatory markers can be used to predict MVI in patients with HCC, such as the neutrophil-to-lymphocyte ratio (NLR), 8 platelet-to-lymphocyte ratio (PLR), 9 alkaline phosphatase (ALT)-to-lymphocyte ratio (ALR), 10 gamma-glutamyl transpeptidase (GGT)-to-lymphocyte ratio (GLR), 11 and lymphocyte-to-monocyte ratio (LMR). 12 Recently, some studies have reported that the GGT-to-platelet ratio (GPR), 13 aspartate aminotransferase (AST)-to-platelet ratio (APR), 14 and GGT-to-albumin ratio (GAR) 15 are independent risk factors that influence the prognosis of patients with HCC after surgery.…”

Construction and validation of a predictive model for hepatocellular carcinoma based on serum markers

“…Recently, it has been reported that AFP-L3 and protein induced by Vitamin K absence or Antagonist-II (PIVKA-II) have high specificity in the diagnosis of HCC (92.9% and 89%, respectively), but the sensitivity of these individual serum markers for early HCC diagnosis is suboptimal [ 11 , 12 ]. Furthermore, combined indicators such as neutrophil–lymphocyte ratio (NLR) [ 13 ], gamma-glutamyl transpeptidase to platelet ratio (GPR) [ 14 ], and gamma-glutamyl transpeptidase to lymphocyte ratio (GLR) [ 15 ] can be used to predict the prognosis and onset of HCC. Some studies have developed score models based on different variables such as gender, age, AFP levels, and pathological data, which have improved the accuracy of early HCC diagnosis.…”