Qiu MQ, Chen MM, Yang WJ, Qiu WS. Gamma-glutamyl transferase as a redox-gatekeeper biomarker for pancreatic cystic neoplasms: A concise roadmap from epidemiology to bedside. World J Gastroenterol 2026; 32(3): 114948 [DOI: 10.3748/wjg.v32.i3.114948]
Corresponding Author of This Article
Wu-Si Qiu, MD, PhD, Associate Chief Physician, Associate Professor, Department of Surgical Education and Research, Department of Neurosurgery, Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Gongshu District, Hangzhou 310015, Zhejiang Province, China. shihai954@163.com
Research Domain of This Article
Medicine, General & Internal
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Letter to the Editor
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 21, 2026 (publication date) through Jan 18, 2026
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Publication Name
World Journal of Gastroenterology
ISSN
1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Qiu MQ, Chen MM, Yang WJ, Qiu WS. Gamma-glutamyl transferase as a redox-gatekeeper biomarker for pancreatic cystic neoplasms: A concise roadmap from epidemiology to bedside. World J Gastroenterol 2026; 32(3): 114948 [DOI: 10.3748/wjg.v32.i3.114948]
Ming-Qi Qiu, School of Pharmacy, Inner Mongolia Medical University (Jinshan Campus), Hohhot 010110, Inner Mongolia Autonomous Region, China
Ming-Min Chen, Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Wen-Jie Yang, Department of Neurosurgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
Wu-Si Qiu, Department of Surgical Education and Research, Department of Neurosurgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
Co-corresponding authors: Ming-Min Chen and Wu-Si Qiu.
Author contributions: Qiu MQ and Qiu WS participated in the formation of the idea; Qiu MQ, Chen MM and Yang WJ performed references acquisition and interpretation; all authors wrote the initial manuscript, and have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wu-Si Qiu, MD, PhD, Associate Chief Physician, Associate Professor, Department of Surgical Education and Research, Department of Neurosurgery, Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Gongshu District, Hangzhou 310015, Zhejiang Province, China. shihai954@163.com
Received: October 9, 2025 Revised: November 13, 2025 Accepted: December 10, 2025 Published online: January 21, 2026 Processing time: 106 Days and 12.4 Hours
Abstract
Serum gamma-glutamyl transferase (GGT), a marker of hepatobiliary and oxidative stress, emerged as a predictor of incident pancreatic cystic neoplasms (PCNs) in a 2.65-million nationwide cohort followed for > 10 years. The highest GGT quartile conferred 11% excess PCN risk, with hazard ratios rising across quartiles and persisting after 3- and 5-year lag exclusions. In redox-oncology, pancreatic GGT1 isoform upregulated by oncogenic KRAS cleaves extracellular glutathione, promoting reactive oxygen species-mediated DNA damage, Wnt/β-catenin, and interleukin-6/signal transducer and activator of transcription 3 inflammatory circuits cooperating with GNAS mutations to initiate intraductal papillary mucinous neoplasm. We propose: (1) Refining age-specific GGT thresholds via repeated measurements and restricted cubic splines; (2) Integrating GGT with carbohydrate antigen 19-9, carcinoembryonic antigen, and KRAS/GNAS circulating tumor DNA in machine-learning radiomic models for personalized 5-year malignancy risks per Fukuoka guidelines; and (3) Validating cost-effectiveness in multi-ethnic populations before screening. This repositions GGT as a globally available redox biosignature for PCN early detection, potentially reducing pancreatic cancer burden.
Core Tip: This letter embeds the newly discovered gamma-glutamyl transferase-pancreatic cystic neoplasm association within a redox-oncology framework, supplies fresh single-cell evidence for pancreatic GGT1 induction by KRAS, and sketches a pragmatic three-tier roadmap (threshold refinement-multi-omic integration-cost-effectiveness validation) to expedite clinical translation.
