The Predictive and Prognostic Value of Precystectomy Serum Gamma-Glutamyltransferase Levels in Patients With Invasive Bladder Cancer.

Abstract

The aim of the study was to elucidate the predictive and prognostic value of serum gamma-glutamyltransferase (GGT) in patients with invasive bladder cancer (BC). Preoperative serum GGT concentrations were assessed in 324 patients treated with RC for cM0 BC between 2002 and 2013. Laboratory values were obtained 1 to 3 days prior to RC. Uni- and multivariable analyses were carried out to evaluate clinicopathologic risk factors for survival. The median follow-up was 36 months (IQR: 10-55). Elevated preoperative GGT levels were diagnosed in 77 patients (23.8%). Elevated GGT was significantly associated with higher ECOG PS and tumor stage (both P= .001), lymph-node tumor involvement (P < .001), positive surgical margins (P= .018), lymphovascular invasion (P= .024), muscle-invasive disease at primary diagnosis (P= .033), increased tumor size (P= .035), hydronephrosis at RC (P= .049) and increased preoperative CRP, GPT and GOT levels (both P < .001). Patients with elevated GGT had decreased 3-year overall (49.2% vs. 69.6%; P= .005) and cancer-specific survival (71.1% vs. 80.9%; P= .042) compared with patients with normal levels. On multivariable analysis, advanced tumor stage (P= .032), lymph node positive disease (P= .030), positive soft tissue surgical margins (P= .014), hydronephrosis at RC (both P= .010), higher ECOG performance status and elevated GGT (P= .043) levels were independent predictors of all-cause mortality. Elevated preoperative serum GGT levels are associated with increased risk of locally advanced BC and mortality after RC. These data suggest that GGT levels may be useful for improved prognostication in invasive BC.