Abstract
The detection of γ-glutamyl transferase (GGT) has previously been reported to be useful in the diagnosis in hepatocellular carcinoma (HCC). The aim of the present study was to investigate the baseline serum GGT levels in patients with intermediate HCC (Barcelona Clinic Liver Cancer stage B) following treatment with transcatheter arterial chemoembolization (TACE) combined with three-dimensional conformal radiotherapy (3DCRT). A total of 154 intermediate HCC patients with Child-Pugh grade A were retrospectively investigated. Receiver operating characteristic (ROC) analysis was used to determine the optimal threshold for the GGT serum levels, and univariate and multivariate analyses were used to establish the prognostic factors. The median overall survival (OS) time was 24.3 months. The optimal threshold for GGT was 85 U/L (sensitivity, 75.13%; specificity, 69.81%; and area under the ROC curve, 0.763). The one-, three- and five-year OS rates were 79.9, 49.7 and 17.2%, respectively, for patients with low GGT levels (≤85 U/l) and 52.3, 22.1 and 8.5%, respectively, for patients with high GGT levels (>85 U/l) (P=0.007). The results indicated that the serum GGT level was an independent prognostic factor (hazard ratio=2.32; P=0.007) for OS. Furthermore, in subgroups stratified according to serum α-fetoprotein, gross tumor volume and radiation dose, serum GGT was also found to correlate with OS (P<0.05). Therefore, the baseline GGT level may be a significant prognostic factor for intermediate HCC patients with Child-Pugh grade A following TACE combined with 3DCRT.
Highlights
Worldwide, hepatocellular carcinoma (HCC) is the fifth most prevalent type of cancer and, after lung and stomach cancer, is the third most common cause of cancer‐related mortalities [1]
The criteria for entry into this study were as follows: i) HCC confirmed by liver biopsy or with the clinical features defined by the American Association for the Study of Liver Diseases [persistently elevated α‐fetoprotein (AFP) levels (>400 ng/ml) in conjunction with characteristic abdominal computed tomography (CT) or magnetic resonance imaging (MRI) with arterial phase enhancement and venous phase washout] [12]; ii) all patients of intermediate stage (BCLC stage B) with Child‐Pugh grade A according to the Barcelona Clinic Liver Cancer (BCLC) staging system [11]; iii) Eastern Cooperative Oncology Group performance status of 0‐1 [13]; and iv) available follow‐up data
The results indicated that GGT levels (P=0.003), alanine transferase (ALT) levels (P=0.012), ALB levels (P=0.038), gross tumor volume (GTV) (P=0.002), AFP levels (P=0.01), total number of transcatheter arterial chemoembolization (TACE) procedures (P=0.039) and radiation dose (P=0.044) were all associated with overall survival (OS)
Summary
Hepatocellular carcinoma (HCC) is the fifth most prevalent type of cancer and, after lung and stomach cancer, is the third most common cause of cancer‐related mortalities [1]. Γ‐glutamyl transferase (GGT) is a cell surface heterodimeric glycoprotein, which is routinely tested for in clinical examinations. It is a simple biological marker which can be obtained from the patient at a low cost. Studies have demonstrated that serum GGT can predict tumor response and survival after TACE and surgery [9,10]; little is known regarding the prognostic role of GGT in treatment with combined TACE and 3DCRT. 154 intermediate [Barcelona Clinic Liver Cancer (BCLC) stage B] [11] HCC patients were retrospectively investigated and the predictive value of the baseline serum GGT level with regard to overall survival (OS) was analyzed following the combined treatment
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