Prognostic and clinicopathological significance of Gamma-Glutamyltransferase in patients with hepatocellular carcinoma A PRISMA-compliant meta-analysis

Background: Many studies explored the prognostic and clinicopathological significance of pretreatment serum GammaGlutamyltransferase (GGT) level in hepatocellular carcinoma (HCC). However, there are inconsistent results in the prognostic and clinicopathological significance of pretreatment serum GGT level in HCC. Thus, we conducted this meta-analysis to comprehensively assess the prognostic and clinicopathological significance of pretreatment serum GGT level in HCC patients. Methods: We systematically searched PubMed, EMBASE and Web of Science for relevant studies (up to June 14, 2018). The estimated hazard ratios (HRs) were used to assess the association between pretreatment serum GGT level and survival in HCC patients. The estimated odds ratios (ORs) were applied to evaluate the correlation between pretreatment serum GGT and clinicopathological features in HCC. Results: Our results showed that high pretreatment serum GGT level was significantly correlated with poor overall survival (OS) (HR=1.70, 95% CI: 1.54-1.87; P<. 01) and disease-free survival/relapse-free survival (DFS/RFS) (HR=1.56, 95% CI: 1.42-1.71; P<.01). Additionally, our results also revealed that there was a close correlation between GGT level and several clinicopathological features in HCC patients, including vascular invasion, tumor size, tumor number and Alpha-fetoprotein (AFP) level. Conclusions: This meta-analysis shows that high pretreatment serum GGT level is significantly correlated with poor survival and unfavorable clinicopathological features in HCC patients, suggesting that pretreatment serum GGT may be an economical and effective prognostic biomarker for HCC patients. However, more high-quality studies are still warranted to further validate our findings, considering there are several limitations in this meta-analysis.