The De Ritis (aspartate transaminase/alanine transaminase) ratio as a predictor of oncological outcomes in patients after surgery for upper urinary tract urothelial carcinoma
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Abstract
Purpose
Recently, several studies have shown that the De Ritis ratio (aspartate transaminase/alanine transaminase) can be a useful prognostic biomarker for certain types of malignant tumors. However, the prognostic value of the De Ritis ratio in patients with upper tract urothelial carcinoma remains largely unknown. The aim of the present study was to evaluate the prognostic significance of the De Ritis ratio in patients who had undergone radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma.
Methods
In total, 1049 patients who underwent RNU at eight institutions from 2004 to 2015 were reviewed retrospectively. The De Ritis ratio and conventional clinicopathological parameters were analyzed. Survival analysis was performed using the Kaplan–Meier method and log-rank test. Multivariate analysis was carried out using the Cox proportional hazards regression model. De Ritis ratio cutoff values were derived from receiver operating characteristic (ROC) curves.
Results
ROC analysis showed the cutoff De Ritis ratio for overall death to be 1.6 (p = 0.002). The cancer-specific survival (CSS) and overall survival (OS) were significantly shorter for patients with a high De Ritis ratio (>1.6). Multivariate analysis revealed an independent relationship between an increased De Ritis ratio (>1.6) and shorter CSS (hazard ratio, HR 2.49, 95% confidence interval, CI 1.70–3.64; p = 0.001) and OS (HR 1.84, 95% CI 1.34–2.52; p = 0.001).
Conclusion
The De Ritis ratio can be a significant predictor of oncological outcomes in patients with upper urinary tract urothelial carcinoma after surgery.
Keywords
Alanine transaminase Aspartate aminotransferase Prognosis Survival Transitional cell carcinomaAbbreviations
- ALT
Alanine transaminase
- AST
Aspartate aminotransferase
- UTUC
Upper urinary tract urothelial carcinoma
- RNU
Radical nephroureterectomy
- ECOG-PS
Eastern Cooperative Oncology Group performance status
- CSS
Cancer-specific survival
- RFS
Recurrence-free survival
- OS
Overall survival
- HR
Hazard ratio
- LVI
Lypmhovascular invasion
Notes
Authors’ contributions
ECH participated in the design of the study, performed the statistical analysis, and drafted the manuscript. JEH, SHC, SGK, HKH, and CWJ participated in the design of the study and performed the statistical analysis. YHC, HSC, MSK, SIJ, TWK, THK, HTK, JHN, MKK, CSK, SHK, JC, CHL, JYK, BST, JHK, and HHK collected the clinical data. JEH, DDK, TGK, and CK made critical revision of the manuscript for important intellectual content. YHC and ECH conceived of the study and approved the final draft of the manuscript. All authors read and approved the final draft of the manuscript.
Compliance with ethical standards
Conflict of interests
The authors declare that they have no conflict of interests.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee. The institutional ethics committee approved this study, and informed consent was waived by the board.
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