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

Authors Li S, Xu W, Liao M, Zhou Y, Weng J, Ren L, Yu J, Liao W, Huang Z

Received 11 October 2020

Accepted for publication 17 December 2020

Published 9 February 2021 Volume 2021:8 Pages 23—33

DOI https://doi.org/10.2147/JHC.S286213

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Ahmed Kaseb


Siming Li,1,* Wentao Xu,1,* Minjun Liao,1,2,* Yuanping Zhou,2 Jun Weng,1 Liying Ren,1 Junxiong Yu,1,3 Weijia Liao,1 Zhaoquan Huang1,4

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

*These authors contributed equally to this work

Correspondence: Weijia Liao
Laboratory of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, People’s Republic of China
Email liaoweijia288@163.com
Zhaoquan Huang
Department of Pathology, Guilin Medical University, Guilin, 541001, Guangxi, People’s Republic of China
Email 191990449@qq.com

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: hepatocellular carcinoma, AFP-negative, GLR, prognosis, early-recurrence

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