Abstract
Emerging evidence that an elevated serum gamma-glutamyltransferase (GGT) level is associated with an increased risk of gastrointestinal cancer, but still controversial. The aim of this study to assess the relationship between GGT level and risk of gastrointestinal cancer, and the contribution of the interaction of hyperglycemia with elevated GGT level to the incidence of gastrointestinal cancer by the stratified analysis. A total of 8,120,665 Koreans who received medical checkups in 2009 were included. Subjects were classified according to the quartile of GGT level for women and men. The incidence rates of gastrointestinal cancer for each group were analyzed using Cox proportional hazards models. During follow-up, 129,853 cases of gastrointestinal cancer newly occurred (esophagus, 3,792; stomach, 57,932; and colorectal, 68,789 cases). The highest GGT quartile group showed an increased risk of gastrointestinal cancer (esophagus, hazard ratio = 2.408 [95% confidence interval, 2.184-2.654]; stomach, 1.121 [1.093-1.149]; and colorectal, 1.185 [1.158-1.211]). The risk increased significantly with the rise in GGT quartile level, regardless of the site of cancer. The stratified analysis according to glycemic status showed that the effect of elevated GGT was predominant in the risk of esophageal cancer. The effect of elevated GGT further increased the risk of stomach and colorectal cancers in diabetic patients. An elevated level of GGT was associated with an increased risk of gastrointestinal cancer, regardless of the site of cancer. The effect of the increase in GGT level on the risk of gastrointestinal cancer depended on the type of cancer and glycemic status.
Highlights
Serum gamma-glutamyltransferase (GGT) is an indicator related to hepatic dysfunction and used as a surrogate marker that reflects excessive alcohol consumption [1, 2]
The hazard ratio (HR) in the Q4 group of impaired fasting glucose (IFG) was higher than that in the Q1–3 group of diabetes mellitus (DM), not significant (IFG/Q4, HR: 1.214 [95%CI: 1.180–1.248]; and DM/Q1-3, 1.193 [1.161–1.227]) (Fig 3C). In this nationwide population-based study, we demonstrated that an elevated serum GGT level was significantly associated with the risk of gastrointestinal cancer
In regard to site-specific cancer incidence, the risks of esophageal, stomach, and colorectal cancers all increased as the GGT level increased
Summary
Serum gamma-glutamyltransferase (GGT) is an indicator related to hepatic dysfunction and used as a surrogate marker that reflects excessive alcohol consumption [1, 2]. Several epidemiologic studies have reported that elevated GGT level is associated with the incidence of various. Association between elevated GGT level and risk of gastrointestinal cancer receiving authorization to access the data can be found here: https://nhiss.nhis.or.kr/bd/ab/ bdaba032eng.do. The authors of this study did not receive any special privileges in accessing the data
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