Erythrocyte Sedimentation Rate and Gamma-glutamyl Transpeptidase Combined are Potent Predictors of Survival and Tumor Characteristics inHepatocellular Carcinoma Patients

Introduction: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are acute phase reactants and gamma-glutamyl transpeptidase (GGT) is a liver enzyme that is associated with prognosis in patients with hepatocellular carcinoma (HCC). Objective: To evaluate the value of ESR and GGT singly and together in HCC prognosis and as predictors of tumor aggressiveness parameters. Methods: The database from a large cohort of Turkish HCC patients was examined retrospectively for the prognostic usefulness of blood ESR and GGT levels and the associated patient subgroup characteristics. Results: Patients with low vs. high blood ESR or GGT values had greater than double survival, with hazard ratios (HR) by Cox regression of 1.543 and 1.833 respectively. The combination of ESR plus GGT was associated with a 3- fold survival difference and an HR of 2.410. Patients with high vs. low ESR plus GGT levels had significantly greater maximum tumor diameters, alpha-fetoprotein levels, multifocality and percent of patients with portal vein thrombosis. Significant survival differences were also found for patients with low serum alpha-fetoprotein levels. Addition of CRP levels to the ESR plus GGT combination added further discriminant survival information, but for greater computational complexity. Conclusions: ESR plus GGT is a useful and powerful prognosticator in HCC patients, including those with low alpha-fetoprotein levels and significantly associates with all the tumor parameters of HCC patients.