Based On Gamma-glutamyl Transpeptidase To Platelet Ratio(GPR)predicts Prognostic Outcome After Radical Resection Of Solitary Hepatocellular Carcinoma

Background and objective: Gamma-glutamyl transpeptidase to platelet ratio(GPR)is used as prognostic indicators for many tumors,including hepatocellular carcinoma(HCC);However,in the studies of the correlation between GPR and HCC postoperative prediction,GPR’s cut-off value is not consistent,thus limits its wide application.This study intends to explore the potential clinical value of GPR and the multi-factor model including GPR for recurrence and prognosis prediction in solitary HCC patients received radical resection.Methods: This study retrospectively analysed 295 HCC patients after radical resection.According to the Receiver Operating Characteristic(ROC)curve,the best cut-off value of GPR for predicting prognosis of HCC after surgery was determined.The Kaplan Meier method,univariate analysis and multivariate Cox regression analysis were performed to assess the important potential factors in the prognosis of HCC and determine the independent risk factors.Assign a value to each independent risk factor and establish a new scoring model.Then,using GPR and the new scoring model to evaluate overall survival(OS)and postoperative recurrence rate.Results: The GPR cut-off value obtained from the data included in this study was 0.30,the area under ROC curve is 0.716(sensitivity: 73.9%,pecificity: 62.6%),and its predictive efficiency for postoperative prognosis was more favourable than those of other cut-off values(0.76,0.84 and 0.94).The results of stepwise multivariate Cox proportional hazards models revealed that tumor size > 5 cm(HR = 1.86,95% CI: 1.31-2.66,p = 0.001),combination of microvascular invasion(HR = 2.07,95% CI: 1.83-3.05,p < 0.001),NLR > 2.31(HR = 2.12,95% CI: 1.49-3.02,p < 0.001),GPR > 0.30(HR = 2.23,95% CI: 1.51-3.29,p < 0.001)were four independent predictors of poor postoperative OS.Using these four variables,a novel prognostic scoring model was established and devised to identify different levels of risk: high,intermediate and low risk groups.We found that patients of high GPR level and high risk group indicated poorer OS and high recurrence rate after resection.Conclusion: GPR may serve as a prediction marker for postoperative prognosis and recurrence probabilities of HCC,and the new prognostic scoring model may be available for postoperative management among HCC patients.