Is the expression of γ-glutamyl transpeptidase messenger RNA an indicator of biological behavior in recurrent hepatocellular carcinoma?

Aim: To investigate the correlation between gamma-glutamyl transpeptidase (γ-GTP) expression in the primary HCC and post-resection recurrence and its biological behaviors. Methods: Forty consecutive patients having curative resection for HCC were included in this study. The primers for reverse-transcription polymerase chain reaction (RT-PCR) were corresponding to the 5′-noncoding human γ-GTP mRNA of fetal liver (type A), HepG2 cells (type B), and placenta (type C). Both thetancef and non-cancerous tissues of the resected liver were analyzed. The correlations between the expression of γ-GTP and the clinicopathological variables and outcomes (recurrence and survival) were studied. Results: Those with type B γ-GTP mRNA in cancer had significant higher recurrence rate than those without it (63.6 % vs 14.3 %). Both those with type B in cancer and in non-cancer died significantly more than those without it (45.5 % vs 0 % and 53.6 % vs 0 %, respectively). By multivariate analysis, the significant predictors of recurrence included high serum AFP (P=0.0108), vascular permeation (P=0.0084), and type B γ-GTP mRNA in non-cancerous liver (P=0.0107). The significant predictors of post-recurrence death included high serum AFP (P=0.0141), vascular permeation (P=0.0130), and daughter nodules (P=0.0053). As to the manifestations (recurrent number ≧2, recurrent extent ≧2 segments, extra-hepatic metastasis, and death) in recurrent patient, there were no statistical significant differences between those with type B in the primary tumor and those without it. The difference between those with type B in non-cancerous liver and those without it also was not significant. Conclusion: Patients of HCC with type B γ-GTP mRNA both in cancer and in non-cancerous tissue had a worse outcome, earlier recurrence, and more post-recurrence death.