Article
The prognostic value of pre-cystectomy serum γ-glutamyltransferase levels in patients with invasive bladder cancer
Search Medline for
Authors
-
Tina Schubert
- Uniklinik Würzburg
-
Fahmy Hassan
- Uniklinik Würzburg
-
Manuel Alexander Schmid
- Uniklinik Würzburg
-
Markus Renninger
- Uniklinik Würzburg
-
Arnulf Stenzl
- Uniklinik Würzburg
-
Hubert Kübler
- Uniklinik Würzburg
-
Georgios Gakis
- Uniklinik Würzburg
| Published: | May 17, 2018 |
|---|
Outline
Text
Background: Prior experimental studies have shown that the enzyme γ-glutamyltransferase (γ-GT) is overexpressed during carcinogenetic transformation of urothelial cells. This analysis aimed to elucidate the prognostic value of serum γ-GT, glutamat-pyruvat-transaminase (GPT) and glutamat-oxalat-transaminase (GOT) levels in patients with invasive bladder cancer (BC).
Patients and methods: Preoperative serum γ-GT, GPT and GOT concentrations were assessed in 324 patients treated with RC for clinically non-metastatic BC between 2002 and 2013. Laboratory values were obtained 1-3 days prior to RC. Uni- and multivariable analyses were carried out to evaluate clinicopathologic features and survival after RC. The median follow-up was 36 months (IQR: 10-55).
Results: Elevated preoperative γ-GT, GPT and GOT levels were diagnosed in 77 (23.8%), 20 (6.2%) and 18 (5.5%) patients, respectively. Elevated γ-GT levels were significantly associated with advanced tumor stage (pT3a; p=0.001), lymph-node tumor involvement (p<0.001), positive surgical margins (p=0.018), lymphovascular invasion (p=0.024), muscle-invasive disease at primary diagnosis (p=0.033), increased tumor size (continuously coded; p=0.035), receipt of neoadjuvant chemotherapy (p=0.006), higher Eastern Cooperative Performance Status (p=0.001), hydronephrosis at RC (p=0.049), increased preoperative serum C-reactive protein levels (p<0.001) and elevated serum GPT and GOT levels (both p<0.001). Patients with elevated γ-GT concentration exhibited inferior 3-year disease-free (52.5% vs. 63.2%; p=0.19), cancer-specific (71.1% vs. 80.9%; p=0.042) and overall survival rates (49.2% vs. 69.6%; p=0.005) compared to patients with normal levels. On multivariable analysis, higher ECOG performance status, hydronephrosis at RC (both p=0.010), positive surgical margin status (p=0.014), lymph node positive disease (p=0.030), advanced tumor stage (p=0.032), and an elevated γ-GT concentration (p=0.043) were independent predictors of all-cause mortality.
Conclusions: Elevated preoperative γ-GT levels are associated with a significantly increased risk for locally advanced bladder cancer and mortality. These data suggest that γ-GT levels may be a useful prognostic marker for patients after RC for BC.
