Gamma-glutamyl transferase-to-lymphocyte ratio as a prognostic marker in patients with hepatocellular carcinoma undergoing hepatectomy

doi:10.4240/wjgs.v17.i2.98578

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World Journal of Gastrointestinal Surgery

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Surg. Feb 27, 2025; 17(2): 98578
Published online Feb 27, 2025. doi: 10.4240/wjgs.v17.i2.98578

Gamma-glutamyl transferase-to-lymphocyte ratio as a prognostic marker in patients with hepatocellular carcinoma undergoing hepatectomy

Peng-Cheng Zhou, Rui Huang, Hai-Tao Wang, Jun Yang, Jian-Dong Peng, Zi-Xuan Fu, Wen-Jun Liao, Hai-Qiang Ma, Lin-Quan Wu, En-Liang Li

Peng-Cheng Zhou, Jun Yang, Jian-Dong Peng, Zi-Xuan Fu, Wen-Jun Liao, Lin-Quan Wu, En-Liang Li, Department of General Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330008, Jiangxi Province, China

Rui Huang, Hai-Qiang Ma, School of Statistics and Data Science, Jiangxi University of Finance and Economics, Nanchang 330013, Jiangxi Province, China

Hai-Tao Wang, Department of General Surgery and Thoracic Surgery, Jishui County People's Hospital, Ji’an 331600, Jiangxi Province, China

Co-first authors: Peng-Cheng Zhou and Rui Huang.

Co-corresponding authors: Lin-Quan Wu and En-Liang Li.

Author contributions: Zhou PC, Yang J, and Li EL designed this work; Peng JD, Wang HT, and Fu ZX collected the clinical data; Zhou PC and Huang R performed the statistical analyses; Zhou PC and Huang R wrote this article; Liao WJ, Ma HQ, and Wu LQ revised and reviewed the manuscript; All authors reviewed the manuscript. Zhou PC was responsible for patient screening, enrollment, and collection of clinical data, and wrote the first draft of the manuscript. Huang R completed the data analysis and revised the initial draft. Both authors made critical and indispensable contributions to the completion of the project and thus qualify as co-first authors of the paper. Li EL and Wu LQ played important and indispensable roles in experimental design, data interpretation, and manuscript preparation, serving as co-corresponding authors. Li EL applied for and obtained funding for this research project, and conceptualized, designed, and supervised the entire project process as well as revised the early version of the manuscript. Wu LQ was instrumental in the re-analysis and interpretation of data, figure plotting, comprehensive literature review, and preparation and submission of the current version of the manuscript. The collaboration between Li EL and Wu LQ was crucial for the publication of this manuscript and other manuscripts still in preparation.

Supported by the National Natural Science Foundation of China, No. 82060447 and No. 82260553; the Key Project of Jiangxi Provincial Natural Science Foundation, No. 20224ACB206035; the General Project of Jiangxi Provincial Natural Science Foundation, No. 20232BAB206109; Jiangxi Provincial Natural Science Foundation, No. 20242BAB26002, and the Youth Project of Jiangxi Provincial Natural Science Foundation, No. 20224BAB216057.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Second Affiliated Hospital of Nanchang University.

Informed consent statement: This study was a retrospective study analyzing electronic medical records and is subject to exemption from consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The raw data supporting the conclusions of this article will be made available by the author En-liang Li (lienliangyx@163.com) upon reasonable request.

Corresponding author: En-Liang Li, DPhil, Doctor, Department of General Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 1 Minde Road, Donghu District, Nanchang 330008, Jiangxi Province, China. lienliangyx@163.com

Received: June 29, 2024
Revised: October 19, 2024
Accepted: December 10, 2024
Published online: February 27, 2025
Processing time: 206 Days and 15.1 Hours

Abstract

BACKGROUND

We investigated the utility of gamma-glutamyl transferase-to-lymphocyte ratio (GLR) as a predictive indicator for postoperative survival in patients with hepatocellular carcinoma (HCC) across different time periods and developed a predictive model based on this.

AIM

To evaluate the prognostic accuracy of GLR for overall survival (OS) in patients with HCC and its impact over time.

METHODS

This study enrolled 301 patients with HCC treated with curative hepatectomy. Exclusion criteria included non-HCC hepatic malignancies, inadequate records, and prior cancer treatments. Baseline demographics, clinical features, and hematological parameters were recorded. Time-dependent receiver operating characteristic curve analysis was used to determine the optimal GLR threshold for survival prediction at 13 months. Statistical analyses included the Kaplan-Meier method, multivariate Cox regression, and the creation of a prognostic nomogram.

RESULTS

Out of 301 patients, 293 were eligible for analysis, with a male predominance (84.6%). High preoperative GLR correlated with several adverse clinical features. Optimal cutoff values for GLR were significantly associated with stratification of 13-month OS. Multivariate analysis identified age, liver enzymes, postoperative transarterial chemoembolization, Child-Pugh grade, and inflammatory markers as independent predictors of OS. Notably, GLR had a significant impact on long-term postoperative OS, with its influence becoming more pronounced over time.

CONCLUSION

GLR can serve as a potent prognostic tool for postoperative HCC management, particularly in predicting long-term outcomes.

Keywords: Hepatocellular carcinoma; Biomarker; Survival; Time-dependent; Nomogram

Core Tip: This study investigated gamma-glutamyl transferase-to-lymphocyte ratio (GLR) as a prognostic biomarker for hepatocellular carcinoma after curative liver resection. GLR was shown to predict both short-term and long-term survival, with its prognostic value increasing over time. A time-dependent Cox regression model and a prognostic nomogram were developed to enhance clinical decision-making. The findings suggested that GLR can provide valuable insights into patient risk stratification and guide postoperative management in patients with hepatocellular carcinoma.