<p>Prognostic Significance of Preoperative Gamma-Glutamyltransferase to Alkaline Phosphatase Ratio in Hepatocellular Carcinoma Patients with Curative Liver Resection: A Retrospective Cohort Study</p>

Abstract

Purpose: Gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) were involved in the development and progression of cancers. This study aimed to evaluate the prognostic value of a preoperative GGT:ALP ratio (GAR) in hepatocellular carcinoma (HCC) patients with curative liver resection. Patients and Methods: A total of 380 HCC patients underwent curative liver resection before December 2017 and from January to December 2018 were included and stratified into training set and validation set, respectively. Prediction accuracy was evaluated by the area under the receiver operating characteristic curve (AUC). Factors determined to be significant for overall survival (OS) and tumor-free survival (TFS) by using Cox regression analysis. The Kaplan-Meier method and Log rank test were utilized for survival analysis. Results: The AUC of GAR was 0.70 (P < 0.001). An optimal cutoff value of 0.91 yielded a sensitivity of 78.1% and a specificity of 60.4% for GAR (P < 0.001), which stratified the HCC patients into high-risk (>0.91) and low-risk (≤ 0.91) groups. Time-dependent ROC revealed that the AUCs for 1-, 3-, and 5-year OS predictions for GAR were 0.60, 0.69 and 0.62, respectively. In addition, GAR was identified as an independent risk factor for OS and TFS both in training and validation cohort by univariate and multivariate Cox regression analysis, as well as a good prognostic indicator for patients with Barcelona Clinic Liver Cancer stage C or without vascular invasion. Notably, the AUC of the GAR for survival was better than several potential prognostic indices (P < 0.05). Conclusion: We identified the GAR as a prognostic indicator in two independent cohorts of HCC patients with curative liver resection. The patients with decreased GAR score were significantly associated with better OS and TFS.

Diagnostic value of gamma‐glutamyl transpeptidase to alkaline phosphatase ratio combined with gamma‐glutamyl transpeptidase to aspartate aminotransferase ratio and alanine aminotransferase to aspartate aminotransferase ratio in alpha‐fetoprotein‐negative hepatocellular carcinoma

“… 22 , 23 Study has also demonstrated that the GAPR was significant associated with BCLC stage, vascular invasion, and tumor size of HCC. 12 GAR was a superior prognostic factor for survival outcome than several potential prognostic indices. 34 Because these indicators are related to the occurrence and development of HCC, we select them as diagnostic indicators for APF‐NHCC.…”

“…The ratio of GGT to ALP can be regarded as a new prognostic factor in the clinical treatment of HCC. 12 Therefore, the ratio of GGT and ALP may serve as a useful tool for predicting the occurrence of HCC. When AAR, GAR, and GAPR were individually used for the differentiation of AFP-NHCC patients from controls, the diagnostic value of GAPR was significantly higher than that of AAR and GAR, especially in terms of sensitivity.…”

“…The ratio of GGT to ALP can be regarded as a new prognostic factor in the clinical treatment of HCC. 12 Therefore, the ratio of GGT and ALP may serve as a useful tool for predicting the occurrence of HCC.…”

“…11 Moreover, The ratio of GGT to ALP (GAPR) has a good prognostic effect on patients with large tumor size in HCC. 12 The role of AAR and GAPR in HCC prognosis has been described in many studies. But now, there have been few reports on the diagnostic value of AAR and GAPR in AFP-NHCC patients.…”

“… 11 Moreover, The ratio of GGT to ALP (GAPR) has a good prognostic effect on patients with large tumor size in HCC. 12 …”