Serum gamma-glutamyl transpeptidase-to-platelet ratio (GPR) can predict the prognosis of hepatocellular carcinoma: a meta-analysis and systematic review

BACKGROUND: The relationship between serum gamma-glutamyl transpeptidase-to-platelet ratio (GPR) before treatment and the prognosis of patients with hepatocellular carcinoma (HCC) is unclear. Here, we review and summarize existing data and try to determine the predictive value of GPR in the treatment of HCC. METHODS: We searched Web of Science, PubMed, Embase and China national knowledge infrastructure (CNKI) for clinical trials investigating GPR and HCC in participants with and without HCC. We developed the inclusion criteria based on the principle of population-intervention-result-control-study design. Studies that do not meet the standards were excluded. Studies were subjected to quality assessments using the Cochrane Risk of Bias Tool for cluster-randomized control trials. Sensitivity, statistical, heterogeneity, and publication bias analyses on STATA version 16.1 (STATA 2020). RESULTS: The pooled data from 7 studies of 1,952 patients showed that the specificity of GPR for predicting the prognosis of HCC was 0.67 (95% CI: 0.61–0.73), and the sensitivity was 0.62 (95% CI: 0.57–0.67). The Fagan chart prediction shows that the patient’s GPR indicates the prognostic effect of HCC. The positive predictive value is 32%, which is significantly higher than before. The ROC curve is used to analyze the effectiveness of GPR in predicting the prognosis of HCC, and the area under the curve (AUC) is 0.69 (0.65–0.73). There is no publication bias in this study (The Deek funnel chart, P=0.48). DISCUSSION: Our results are similar to those of most previous studies, and meta-analysis showed that GPR has well sensitivity, accuracy, and prognostic value in HCC.