Preoperative serum gamma-glutamyl transferase to alanine aminotransferase ratio is a convenient prognostic marker for Child-Pugh A hepatocellular carcinoma after operation

J Gastroenterol. 2009;44(6):635-42. doi: 10.1007/s00535-009-0050-x. Epub 2009 Apr 22.


Background: The ratio of serum gamma-glutamyl transferase (GGT) to alanine aminotransferase (ALT) is a parameter for assessing responses to antiviral therapies. The relationship between the prognosis of hepatitis B-associated hepatocellular carcinoma (HCC) and preoperative GGT/ALT is studied in hepatectomized Child-Pugh A patients.

Methods: Two hundred and nineteen patients with hepatitis B virus-related HCC were included. Serum ALT and GGT levels were examined preoperatively and the GGT/ALT ratios were calculated. Their prognostic capabilities were evaluated by Cox-regression model.

Results: As dichotomized variables, GGT and ALT were distributed unequally (P < 0.001). Most patients had high levels of GGT (n = 110) but low levels of ALT (n = 185). ALT displayed no relation to recurrence or survival, while GGT was independently associated with survival (P = 0.002). The GGT/ALT ratio could predict survival precisely either in a continuous or dichotomized fashion (P < 0.001 and 0.001, respectively), and also related to recurrence when dichotomized (P = 0.002). Additionally, high GGT/ALT ratio was associated with high early recurrence rates, more recurrence-related deaths and various aggressive tumor characteristics such as larger tumor size, vascular invasion, poor encapsulation and advanced BCLC stage. In further stratified analyses, this ratio could discriminate the outcomes of patients with high- or low-alpha-fetoprotein level.

Conclusions: The elevated GGT/ALT ratio was a promising predictor for poor prognosis of Child-Pugh A HCC patients after operation mainly through its tight relevance to the primary tumor burden.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alanine Transaminase / blood*
  • Carcinoma, Hepatocellular / blood*
  • Carcinoma, Hepatocellular / surgery*
  • Carcinoma, Hepatocellular / virology
  • Female
  • Hepatectomy
  • Humans
  • Liver Neoplasms / blood*
  • Liver Neoplasms / surgery*
  • Liver Neoplasms / virology
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Prognosis
  • ROC Curve
  • Survival Analysis
  • gamma-Glutamyltransferase / blood*


  • gamma-Glutamyltransferase
  • Alanine Transaminase