Effects of various interventions on the occurrence of macrovascular invasion of hepatocellular carcinoma after the baseline serum γ-glutamyltransferase stratification.

Background: Elevated serum gamma-glutamyltransferase (gamma-GT) levels are related to an increased cancer risk and worse prognosis in many cancers. We evaluated the effects gamma-GT stratification on the occurrence of macrovascular invasion (MVI) in patients with hepatocellular carcinoma (HCC) who underwent hepatic resection (HR), transcatheter arterial chemoembolization (TACE), or TACE combined with radiofrequency ablation (TACE-RFA). Patients and methods: A total of 903 patients with HCC in Barcelona Clinic Liver Cancer Stage A or B were included. Of these patients, 118 underwent HR, 445 underwent TACE-RFA, 256 underwent TACE, and 84 patients received conservative treatment only (control group). gamma-GT, albumin, alpha-fetoprotein, and intervention were selected as significant predictive factors for MVI in 1 year by forward selection. The optimal cutoff value of gamma-GT was 39 IU/L according to receiver operating characteristic analysis, with a sensitivity and specificity of 87.0% and 45.6%, respectively. Results: The 1-year MVI incidence of patients with HCC in the group with gamma-GT IU/L was higher than that of the group with gamma-GT >= 39 IU/L treated with HR, TACE-RFA, or TACE (P=0.0166, P=0.0041, and P<0.001, respectively). The MVI rates at 1 year were similar in the group with gamma-GT IU/L that underwent HR, TACE-RFA, or TACE and the control group (P=0.4402, P=0.2214, and P=0.4159, respectively). Different effects of various treatments with gamma-GT >= 39 IU/L group on the occurrence of MVI are not significant (P=0.5167). However, the incidence of MVI after TACE was significantly higher than that after HR or TACE-RFA in gamma-GT >= 39 IU/L group (P=0.0253). Conclusion: Baseline serum gamma-GT stratification may help select the appropriate treatment to reduce the MVI incidence.