Elevated serum gamma-glutamyltransferase is associated with an increased risk of oesophageal carcinoma in a cohort of 8,388,256 Korean subjects

Abstract

Gamma-glutamyltransferase (GGT) is a marker for hepatic injury and alcohol consumption. However, the association of GGT with the risk of oesophageal carcinoma (OC) has not been fully recognized to date. Therefore, this study aimed to determine the association between elevated GGT and OC, by also considering the body mass index (BMI) of the subjects. Clinical data from 8,388,256 Korean individuals, who were aged 40 years and over and who received healthcare check-ups arranged by the national insurance program in 2007 and 2008, were analysed. Newly diagnosed OC was identified using claims data during a median follow-up duration of 8.72 years. During the study period, 6,863 individuals (0.08%) developed OC. We found that there was an increased risk of OC in subjects with serum GGT values >18 IU/L. Furthermore, a BMI <18.5 kg/m2 (underweight) was associated with increased OC risk, while a BMI ≥23.0 kg/m2 was associated with a reduced OC risk. Individuals who were both underweight and in the highest GGT quartile (≥40 IU/L) had a far greater risk of OC compared to other individuals (hazard ratio: 3.65, 95% confidence interval: 3.10-4.30). In conclusion, increased serum GGT was associated with an increased risk of developing OC in the general Korean population, regardless of age, sex, smoker status, or alcohol consumption.

Fig 1. Flowchart showing the enrolment process for the study cohort.

NHIC, National Health Insurance Corporation.

Fig 2

Association between the Hazard Ratio for Oesophageal Cancer and the Serum Gamma-glutamyltransferase Level (A) and Body Mass Index (B) in the General Korean Population.

Fig 3. Kaplan-Meier survival curves showing freedom from oesophageal cancer in Korea.

Q1-4 denotes the quartile of the serum value of gamma-glutamyltransferase (GGT). The incidence is presented as the annual incidence rate per 10,000 person-years, adjusted for age, sex, body mass index (BMI), smoking, drinking, exercise, income, residence locale, diabetes, hypertension, and dyslipidaemia. Subjects with (A) the highest serum GGT quartile and (B) lowest BMI quartile (underweight) showed the highest incidences of oesophageal cancer.