The De Ritis (aspartate transaminase/alanine transaminase) ratio as a predictor of oncological outcomes in patients after surgery for upper urinary tract urothelial carcinoma

• Published in: International urology and nephrology Vol. 49; no. 8; pp. 1383 - 1390
• Main Authors: Cho, Yang Hyun, Hwang, Jun Eul, Chung, Ho Seok, Kim, Myung Soo, Hwang, Eu Chang, Jung, Seung Il, Kang, Taek Won, Kwon, Dong Deuk, Choi, Seock Hwan, Kim, Hyun Tae, Kim, Tae-Hwan, Kwon, Tae Gyun, Noh, Joon Hwa, Kim, Myung Ki, Kim, Chul-Sung, Kang, Sung Gu, Kang, Seok Ho, Cheon, Jun, Lee, Chan Ho, Ku, Ja Yoon, Ha, Hong Koo, Tae, Bum Sik, Jeong, Chang Wook, Ku, Ja Hyeon, Kwak, Cheol, Kim, Hyeon Hoe
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.08.2017; Springer Nature B.V
• Subjects: Aged; Alanine; Alanine transaminase; Alanine Transaminase - blood; Aspartate Aminotransferases - blood; Aspartate transaminase; Biomarkers - blood; Biomarkers, Tumor - blood; Bladder cancer; Carcinoma, Transitional Cell - blood; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Kidney Neoplasms - blood; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidney Pelvis; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Neoplasm Invasiveness; Neoplasm Staging; Nephrectomy; Nephrology; Proportional Hazards Models; Retrospective Studies; ROC Curve; Surgery; Survival; Survival analysis; Survival Rate; Transaminase; Tumor Burden; Tumors; Ureter - surgery; Ureteral Neoplasms - blood; Ureteral Neoplasms - pathology; Ureteral Neoplasms - surgery; Urinary tract; Urogenital system; Urology; Urology - Original Paper; Urothelial carcinoma; Alanine transaminase; Aspartate aminotransferase; Prognosis; Transitional cell carcinoma; Survival
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-017-1613-z

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.