Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Department of Medical Statistics, The Catholic University of Korea College of Medicine, Seoul, Korea.
PLoS One. 2021 Feb 5;16(2):e0245052. doi: 10.1371/journal.pone.0245052. eCollection 2021.
Emerging evidence that an elevated serum gamma-glutamyltransferase (GGT) level is associated with an increased risk of gastrointestinal cancer, but still controversial. The aim of this study to assess the relationship between GGT level and risk of gastrointestinal cancer, and the contribution of the interaction of hyperglycemia with elevated GGT level to the incidence of gastrointestinal cancer by the stratified analysis. A total of 8,120,665 Koreans who received medical checkups in 2009 were included. Subjects were classified according to the quartile of GGT level for women and men. The incidence rates of gastrointestinal cancer for each group were analyzed using Cox proportional hazards models. During follow-up, 129,853 cases of gastrointestinal cancer newly occurred (esophagus, 3,792; stomach, 57,932; and colorectal, 68,789 cases). The highest GGT quartile group showed an increased risk of gastrointestinal cancer (esophagus, hazard ratio = 2.408 [95% confidence interval, 2.184-2.654]; stomach, 1.121 [1.093-1.149]; and colorectal, 1.185 [1.158-1.211]). The risk increased significantly with the rise in GGT quartile level, regardless of the site of cancer. The stratified analysis according to glycemic status showed that the effect of elevated GGT was predominant in the risk of esophageal cancer. The effect of elevated GGT further increased the risk of stomach and colorectal cancers in diabetic patients. An elevated level of GGT was associated with an increased risk of gastrointestinal cancer, regardless of the site of cancer. The effect of the increase in GGT level on the risk of gastrointestinal cancer depended on the type of cancer and glycemic status.
越来越多的证据表明，血清γ-谷氨酰转移酶（GGT）水平升高与胃肠道癌风险增加相关，但仍存在争议。本研究旨在评估 GGT 水平与胃肠道癌风险之间的关系，以及通过分层分析评估高血糖与 GGT 水平升高的相互作用对胃肠道癌发病率的贡献。共纳入 2009 年接受体检的 8120665 名韩国人。根据女性和男性 GGT 水平的四分位数将受试者进行分类。使用 Cox 比例风险模型分析每组胃肠道癌的发病率。在随访期间，新发生了 129853 例胃肠道癌（食管 3792 例，胃 57932 例，结直肠 68789 例）。最高 GGT 四分位组胃肠道癌风险增加（食管，危险比=2.408[95%置信区间，2.184-2.654]；胃，1.121[1.093-1.149]；结直肠，1.185[1.158-1.211]）。无论癌症部位如何，随着 GGT 四分位水平的升高，风险显著增加。根据血糖状况进行的分层分析表明，在食管癌风险中，升高的 GGT 作用更为明显。在糖尿病患者中，升高的 GGT 进一步增加了胃癌和结直肠癌的风险。GGT 水平升高与胃肠道癌风险增加相关，无论癌症部位如何。GGT 水平升高对胃肠道癌风险的影响取决于癌症类型和血糖状况。
