Relevance of gamma-glutamyltransferase--a marker for apoptotic balance--in predicting tumor stage and prognosis in cervical cancer

Introduction

Recent large epidemiologic population-based studies identified gamma-glutamyltransferase (GGT) as a marker for increased cervical cancer incidence. Furthermore, high levels of GGT seem to increase the risk of progression of high-grade cervical dysplasia to invasive carcinoma. Therefore, we evaluated the association between pre-therapeutic serum GGT levels, tumor stage and prognosis in patients with cervical cancer.

Materials and methods

In this multi-center trial, pre-therapeutic GGT levels were examined in 692 patients with cervical cancer. GGT levels were correlated with clinico-pathological parameters. Patients were assigned to previously described GGT risk groups and uni- and multivariable survival analyses were performed.

Results

GGT serum levels were associated with FIGO stage (p < 0.0001) and age (r = 0.2, p < 0.0001) but not with lymph node involvement (p = 0.85), and histological type (p = 0.98). High-risk GGT group affiliation (p = 0.01 and p < 0.0001) was associated with poor disease-free and overall survival in a univariate analysis, but not in a multivariable Cox-regression model (p = 0.59 and p = 0.171). We further investigated the association between prognosis and GGT and observed a linear correlation between GGT and prognosis. Therefore we were not able to identify a clear prognostic cut-off value for GGT in patients with cervical cancer.

Conclusions

High GGT - a marker for apoptosis and cervical cancer risk - is associated with advanced tumor stage in patients with cervical cancer.