CA19-9 Level to Serum γ-Glutamyltransferase as a Potential Prognostic Biomarker in Patients with Pancreatic Head Carcinoma

Figures & data

Figure 1 Screening flowchart.

Figure 2 Time-dependent receiver operating characteristics curve. (The AUC of the CA19-9 to γ-glutamyltransferase ratio to predict the 1-year OS is 0.567.).

Figure 3 Long-term prognosis of patients with PHC. (A) Overall disease-free survival curve of patients; (B) overall survival curve of patients..

Table 1 Demographic and Pathologic Findings in the Two Groups of Patients with PHC

Variables	Group 1 (n=179)	Group 2 (n=160)	P
Gender (M/F)	86/93	86/74	0.294
Age (years), mean ± SD	63.5±9.9	62.5±10.3	0.372
Diabetes (N/A)	54/125	63/97	0.075
PBD (N/A)	35/144	21/139	0.112
TB (μmol/L)	80.4 (17.6,175.0)	12.3 (9.3,40.5)	0.000
CA19-9 (U/mL)	59.8 (22.4,182.7)	693.1 (233.6,2005.2)	0.000
GGT (U/L)	513 (115,960)	28 (18,153)	0.000
Intraoperative blood loss (mL)	500 (400,800)	500 (400,800)	0.455
Blood transfusion (N/A)	60/119	60/100	0.444
Operative time (h), mean ± SEM	9.7±2.6	10.1±3.2	0.254
Tumor size (cm), mean ± SD	3.7±1.7	4.0±1.8	0.116
Degree of differentiation (poor/moderate–high)	48/131	39/121	0.608
Portal system invasion (N/A)	58/121	64/96	0.146
Neoadjuvant chemotherapy (N/A	8/171	12/148	0.237
LN metastasis (±)	99/80	123/37	0.000
Resection margin (R0/R1)	166/13	148/12	0.933
Postoperative chemotherapy (N/A)	97/82	94/66	0.398
Chemotherapy period	2 (0,5)	2 (0,4)	0.635

Abbreviations: PBD, preoperative biliary drainage; TB, total bilirubin; CA19-9, carbohydrate antigen 19-9; GGT, γ-glutamyltransferase; LN, lymph node; R, resection margin.

Table 2 Morbidity and Mortality in the Two Groups

Variables	Group 1 (n=179)	Group 2 (n=160)	P
Postoperative hospital stay (days)	17 (14–24)	17 (13–22)	0.298
Perioperative mortality	2	1	0.922
Perioperative complications	51	44	0.839
Biochemical fistula	15	14	0.903
Pancreatic fistula
Level B	5	3	0.843
Level C	2	3	0.899
DGE	11	6	0.313
Abdominal infection	11	9	0.839
Abdominal hemorrhage	6	4	0.888

Abbreviation: DGE, delayed gastric emptying.

Figure 4 Overall long-term prognosis between the two groups in patients with PHC. (A) Overall disease-free survival curve of the two groups of patients; (B) overall survival curve of the two groups of patients.

Table 3 Univariate Analysis of Risk Factors for PHC Recurrence

Variables	N	1-year OS (%)	3-year OS (%)	χ^2	P
Gender				1.421	0.233
Male	172	53.3	21.9
Female	167	58.9	24.8
Age (years)				2.282	0.131
≤60	133	60.0	25.0
>60	206	53.3	22.0
Diabetes				3.122	0.077
Yes	117	50.3	17.6
No	222	59.1	26.5
PBD				1.848	0.174
Yes	56	56.2	32.8
No	283	56.0	21.6
Neoadjuvant chemotherapy				2.208	0.137
Yes	20	35.0	20.0
No	319	57.4	23.3
TB (μmol/L)				1.300	0.254
≤21	160	52.3	20.7
>21	179	59.2	25.5
GGT (U/L)				0.097	0.756
≤45	139	54.1	26.9
>45	200	57.3	21.4
CA19-9 (U/mL)				4.997	0.025
≤37	70	61.1	34.7
>37	269	54.6	20.4
CA19-9/GGT				16.071	0.000
≤2.07	179	68.2	28.2
>2.07	160	42.2	18.3
Operative time (h)				7.751	0.005
≤8	111	73.0	30.7
>8	228	47.4	19.3
Intraoperative blood loss (mL)				9.418	0.002
≤800	274	60.1	26.2
>800	65	39.1	10.3
Blood transfusion				16.757	0.000
Yes	120	37.0	15.8
No	219	66.4	27.3
Degree of differentiation				6.407	0.011
Poor	87	40.8	18.3
Moderate–high	252	61.3	24.8
Tumor size (cm)				6.646	0.010
≤4	242	61.0	25.6
>4	97	43.7	18.4
LN metastasis				42.160	0.000
Yes	222	45.9	13.2
No	117	75.5	42.1
Portal system invasion				16.234	0.000
Yes	122	38.4	17.7
No	217	65.6	26.4
Resection margin				3.612	0.057
R0	314	58.0	24.1
R1	25	32.0	16.0
Postoperative complications				0.593	0.441
Yes	95	59.7	23.6
No	244	54.6	22.6
Postoperative chemotherapy				0.018	0.893
Yes	191	57.2	21.2
No	148	54.6	25.2
Chemotheraputic cycles				0.082	0.775
≤2	211	55.5	22.6
>2	128	56.9	23.9

Abbreviations: OS, overall survival; PBD, preoperative biliary drainage; TB, total bilirubin; GGT, γ-glutamyltransferase; CA19-9, carbohydrate antigen 19-9; LN, lymph node; R, resection margin.

Table 4 Multivariate Analysis of Independent Risk Factors for PHC Recurrence

Variables	RR	95% CI	P
CA19-9	0.728	0.639–1.367	0.728
CA19-9/GGT	1.397	1.054–1.852	0.020
Operative time	1.197	0.873–1.641	0.264
Intraoperative blood loss	1.028	0.670–1.578	0.899
Blood transfusion	0.791	0.551–1.135	0.203
Degree of differentiation	1.312	0.986–1.746	0.062
Tumor size	1.281	0.964–1.702	0.088
LN metastasis	2.325	1.711–3.160	0.000
Portal system invasion	1.561	1.167–2.086	0.003

Abbreviations: CA19-9, carbohydrate antigen 19-9; GGT, γ-glutamyltransferase; LN, lymph node.

Table 5 Univariate Analysis of Long-Term Survival in Patients with PHC

Variables	N	1-year OS (%)	3-year OS (%)	χ^2	P
Gender				2.024	0.155
Male	172	68.8	22.7
Female	167	68.4	24.1
Age (years)				1.600	0.206
≤60	133	71.0	24.9
>60	206	67.0	21.7
Diabetes				3.053	0.081
Yes	117	61.4	19.9
No	222	72.4	25.0
PBD				1.012	0.314
Yes	56	68.8	30.8
No	283	68.5	22.1
Neoadjuvant chemotherapy				1.983	0.159
Yes	20	45.0	20.0
No	319	70.1	23.5
TB (μmol/L)				1.762	0.184
≤21	160	67.6	20.2
>21	179	69.5	26.2
GGT (U/L)				0.074	0.786
≤45	139	70.1	26.7
>45	200	67.7	21.6
CA19-9 (U/mL)				5.048	0.025
≤37	70	79.6	33.5
>37	269	65.8	20.8
CA19-9/GGT				20.612	0.000
≤2.07	179	79.1	29.1
>2.07	160	56.7	17.2
Operative time (h)				8.114	0.004
≤8	111	82.9	31.2
>8	228	61.4	19.4
Intraoperative blood loss (mL)				10.330	0.001
≤800	274	73.6	26.4
>800	65	47.7	9.7
Blood transfusion				17.971	0.000
Yes	120	50.9	15.4
No	219	78.2	27.8
Degree of differentiation				6.332	0.012
Poor	87	52.4	17.3
Moderate–high	252	74.2	25.4
Tumor size (cm)				6.717	0.010
≤4	242	73.1	26.1
>4	97	57.7	16.5
LN metastasis				43.748	0.000
Yes	222	61.5	13.1
No	117	81.9	42.8
Portal system invasion				19.010	0.000
Yes	122	49.8	16.7
No	217	78.7	27.0
Resection margin				4.128	0.042
R0	314	69.0	24.4
R1	25	64.0	16.0
Postoperative complication				0.003	0.954
Yes	95	72.5	22.9
No	244	67.0	23.3
Postoperative chemotherapy				0.343	0.558
Yes	191	68.6	21.5
No	148	68.5	24.6
Chemotheraputic cycles				0.069	0.793
≤2	211	68.6	23.6
>2	128	68.6	25.2

Abbreviations: OS, overall survival; PBD, preoperative biliary drainage; TB, total bilirubin; GGT, γ-glutamyltransferase; CA19-9, carbohydrate antigen 19-9; LN, lymph node; R, resection margin.

Table 6 Multivariate Analysis of Long-Term Survival in Patients with PHC

Variables	RR	95% CI	P
CA19-9	0.887	0.599–1.314	0.550
CA19-9/GGT	1.526	1.143–2.038	0.004
Operative time	1.207	0.878–1.659	0.248
Intraoperative blood loss	1.070	0.698–1.641	0.756
Blood transfusion	0.792	0.549–1.140	0.209
Degree of differentiation	1.250	0.938–1.667	0.128
Tumor size	1.273	0.953–1.701	0.102
LN metastasis	2.389	1.753–3.256	0.000
Portal system invasion	1.621	1.214–2.166	0.001
Resection margin	1.053	0.649–1.709	0.834

Abbreviations: CA19-9, carbohydrate antigen 19-9; GGT, γ-glutamyltransferase; LN, lymph node.