Prognostic impact of the pretreatment aspartate transaminase/alanine transaminase ratio in patients treated with first‐line systemic tyrosine kinase inhibitor therapy for metastatic renal cell carcinoma

• Published in: International journal of urology Vol. 25; no. 6; pp. 596 - 603
• Main Authors: Kang, Minyong, Yu, Jiwoong, Sung, Hyun Hwan, Jeon, Hwang Gyun, Jeong, Byong Chang, Park, Se Hoon, Jeon, Seong Soo, Lee, Hyun Moo, Choi, Han Yong, Seo, Seong Il
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.06.2018
• Subjects: Alanine; Alanine transaminase; Aspartate transaminase; aspartate transaminase/alanine transaminase (De Ritis) ratio; Cancer; Confidence intervals; Enzyme inhibitors; Health risk assessment; Medical records; Metastases; Metastasis; metastatic renal cell carcinoma; prognosis; Renal cell carcinoma; survival outcomes; Transaminase; tyrosine kinase inhibitor; Tyrosine kinase inhibitors; metastatic renal cell carcinoma; tyrosine kinase inhibitor; aspartate transaminase/alanine transaminase (De Ritis) ratio; survival outcomes; prognosis
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.13574

Objectives To examine the prognostic role of the pretreatment aspartate transaminase/alanine transaminase or De Ritis ratio in patients with metastatic renal cell carcinoma receiving first‐line systemic tyrosine kinase inhibitor therapy. Methods We retrospectively searched the medical records of 579 patients with metastatic renal cell carcinoma who visited Samsung Medical Center, Seoul, Korea, from January 2001 through August 2016. After excluding 210 patients, we analyzed 360 patients who received first‐line tyrosine kinase inhibitor therapy. Cancer‐specific survival and overall survival were defined as the primary and secondary end‐points, respectively. A multivariate Cox proportional hazards regression model was used to identify independent prognosticators of survival outcomes. Results The overall population was divided into two groups according to the pretreatment De Ritis ratio as an optimal cut‐off value of 1.2, which was determined by a time‐dependent receiver operating characteristic curve analysis. Patients with a higher pretreatment De Ritis ratio (≥1.2) had worse cancer‐specific survival and overall survival outcomes, compared with those with a lower De Ritis ratio (<1.2). Notably, a higher De Ritis ratio (≥1.2) was found to be an independent predictor of both cancer‐specific survival (hazard ratio 1.61, 95% confidence interval 1.13–2.30) and overall survival outcomes (hazard ratio 1.69, 95% confidence interval 1.19–2.39), along with male sex, multiple metastasis (≥2), non‐clear cell histology, advanced pT stage (≥3), previous metastasectomy and the Memorial Sloan Kettering Cancer Center risk classification. Conclusion Our findings show that the pretreatment De Ritis ratio can provide valuable information about the survival outcomes of metastatic renal cell carcinoma patients receiving first‐line tyrosine kinase inhibitor therapy.