The Significance of Gamma-Glutamyl Transpeptidase to Lymphocyte Count Ratio in the Early Postoperative Recurrence Monitoring and Prognosis Prediction of AFP-Negative Hepatocellular Carcinoma

Siming Li; Wentao Xu; Minjun Liao; Yuanping Zhou; Jun Weng; Liying Ren; Junxiong Yu; Weijia Liao; Zhaoquan Huang

doi:10.2147/JHC.S286213

The Significance of Gamma-Glutamyl Transpeptidase to Lymphocyte Count Ratio in the Early Postoperative Recurrence Monitoring and Prognosis Prediction of AFP-Negative Hepatocellular Carcinoma

J Hepatocell Carcinoma. 2021 Feb 9:8:23-33. doi: 10.2147/JHC.S286213. eCollection 2021.

Authors

Siming Li^#¹, Wentao Xu^#¹, Minjun Liao^#^{1

2}, Yuanping Zhou², Jun Weng¹, Liying Ren¹, Junxiong Yu^{1

3}, Weijia Liao¹, Zhaoquan Huang^{1

4}

Affiliations

¹ Laboratory of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, People's Republic of China.
² Department of Infectious Diseases, Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China.
³ Department of Anesthesiology, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, People's Republic of China.
⁴ Department of Pathology, Guilin Medical University, Guilin, 541001, Guangxi, People's Republic of China.

^# Contributed equally.

Abstract

Background: Currently, there is still a lack of effective biomarkers for the recurrence monitoring and survival prognosis assessment of hepatocellular carcinoma (HCC) patients with alpha-fetoprotein (AFP)-negative (≤20 ng/mL) after radical resection.

Methods: The clinicopathological data of 606 patients (303 in the AFP-negative group and 303 in the AFP-positive group) who underwent radical resection of HCC were analyzed retrospectively.

Results: The gamma-glutamyl transpeptidase to lymphocyte count ratio (GLR) of patients in the AFP-negative group was lower than that in the AFP-positive group (p <0.001). The GLR level of the early-recurrence group was higher than that of the non-early-recurrence group (p =0.003). GLR had fair accuracy in predicting the early-recurrence of HCC patients [c-index=0.654 (95% CI=0.606-0.702); AUC=0.681 (95% CI=0.625-0.733)]. Univariate analysis showed that patients with tumor size <5 cm, no microvascular invasion, single tumor, no metastasis, BCLC stage 0-A, no recurrence, and GLR ≤45.0 had longer disease-free survival (DFS) and overall survival (OS) among AFP-negative HCC patients. In addition, multivariate Cox proportional hazards regression analysis showed that tumor size <5 cm (p =0.003), no recurrence (p <0.001), and GLR <45.0 (p <0.001) were independent predictors of longer OS.

Conclusion: GLR may be a potential indicator for early recurrence monitoring and prognosis evaluation in HCC patients with AFP-negative after radical resection.

Keywords: AFP-negative; GLR; early-recurrence; hepatocellular carcinoma; prognosis.

Grants and funding

This work was supported in part by the National Key Sci-Tech Special Project of China (No. 2018ZX10302207), the National Natural Science Foundation of China (No. 81772923) and the Science and Technology Planning Project of Guilin (No. 20190218-1).