Prognostic significance of the pretreatment serum gamma-glutamyltransferase levels in Chinese patients with non-metastatic cervical cancer

Abstract

This study was performed to evaluate the prognostic significance of the pretreatment serum gamma-glutamyltransferase (GGT) levels in a Chinese cohort of patients with early-stage or locally advanced cervical cancer. The pretreatment serum GGT levels were examined in 290 cervical cancer patients with stage I-III disease and 230 healthy controls selected from a cancer-free population in the same region. Patients were assigned to normal or high-risk GGT groups, as previously described, and the GGT levels were correlated to clinicopathologic parameters and survival data. The GGT levels in cervical cancer patients were significantly higher than those in healthy controls (35.6 ± 29.1 vs. 24.1 ± 14.7 U/L, P < 0.001). In addition, the pretreatment serum GGT levels were associated with the histology type (P = 0.023), lymph node involvement (P = 0.040), stage (P = 0.029), recurrence (P = 0.015) and death (P = 0.005), but not with age (P = 0.432), tumor size (P = 0.067) or degree of differentiation (P = 0.901). Moreover, univariate survival analysis revealed that patients with high GGT levels tended to have poorer disease-free survival (DFS) [hazard ratio (HR), 1.721; 95% confidence interval (CI), 1.189–2.491; P = 0.004] and overall survival (OS) (HR, 1.929; 95% CI, 1.294–2.876; P = 0.001) compared to those with normal GGT levels. However, a multivariate Cox-regression model did not support these data (HR, 1.373; 95% CI, 0.925–2.039; P = 0.116 for DFS and HR, 1.357; 95% CI, 0.887–2.078; P = 0.160 for OS, respectively) after adjusting for other confounding variables. High pretreatment serum GGT was associated with more advanced tumor behavior, but could not serve as an independent prognostic indicator in patients with early-stage or locally advanced cervical cancer.

A Systematic Review of Serum γ-Glutamyltransferase as a Prognostic Biomarker in Patients with Genitourinary Cancer

“…Recently, two meta-analyses demonstrated that patients with a high serum GGT level not only had a poor prognosis (in terms of overall survival, recurrence-free survival, and disease-free survival) but also had several unfavorable clinicopathological features, including vascular invasion and the tumor burden [ 5 , 6 ]. Similar findings were also reported in other organs, including the uterus [ 81 , 82 , 83 , 84 , 85 ], colorectum [ 86 ], ovaries [ 23 ], esophagus [ 87 , 88 ], breasts [ 89 , 90 ], gallbladder [ 91 ], nasopharynx [ 92 , 93 ], stomach [ 74 , 94 ], lungs [ 95 ], and pancreas [ 96 ]. In urogenital organs, too, recent studies have demonstrated that serum GGT can predict survival in patients with advanced GU cancer, including RCC [ 11 , 12 ], PC [ 13 ], and UC [ 14 ].…”

The Predictive Value of Pre-therapeutic Serum Gamma-glutamyl transferase in Efficacy and Adverse Reactions to Neoadjuvant Chemotherapy among Breast Cancer Patients

“…Until now, there has been no consensus on the optimal cutoff value for serum GGT levels. In the current study, we selected the final quintile (29 U/L) of all patients' pre-therapeutic serum GGT levels for stratification, which is also a median value between the average (24 U/L) and the cutoff value of previous GGT cancer risk groups (36 U/L) [ 8 12 13 16 17 ]. The final quintile is often used as the stratified value of a risk model in other clinical studies [ 18 19 ]; hence, we considered it reasonable to use it in this study.…”

“…A number of studies have also indicated that GGT is a prognostic biomarker for several cancers in the adjuvant or rescue settings, such as in cervical cancer [ 13 ], endometrial cancer [ 12 ], renal cell carcinoma [ 14 ], and primary metastatic breast cancer [ 8 ]; nevertheless, data for patients receiving NAC are limited. Previous reports have focused on the relationship between serum GGT levels and survival and have not assessed treatment responses.…”

“…As Staudigl et al [ 8 ] stated, high pre-therapeutic serum GGT levels (≥ 23.1 U/L) were significantly associated with decreased 5-year overall survival (OS) in patients with primary metastatic breast cancer. Zhu et al [ 13 ] also found that serum GGT level was significantly higher in cervical cancer patients than in healthy people, demonstrating a potential association between GGT and poor disease-free survival (DFS) and OS. Furthermore, Luo et al [ 14 ] indicated that preoperative GGT was an independent prognostic factor of cancer-specific survival and relapse-free survival (RFS) in renal cell carcinoma with venous tumor thrombus and that high GGT (≥ 37.5 U/L) could lead to poor survival.…”

Expression Status and Prognostic Significance of Gamma-Glutamyl Transpeptidase Family Genes in Hepatocellular Carcinoma

“…Moreover, serum GGT combined with other serum biomarkers were effective diagnostic markers of AFP-negative HCC, especially in individuals with early stage, small size or good liver function (42). More researchers continue to assess the prognostic role of serum GGT in cervical cancer (43), esophageal squamous cell carcinoma (44), ovarian cancer (45), renal cell carcinoma (25), and HCC (46). By carrying out a clinical analysis, Zhang et al (15) found that a high concentration of serum GGT was positively associated with advanced TNM stage and large tumor size and was an independent element for predicting the OS rate of patients with primary HCC.…”