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KMID : 1001020220200010034
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Journal of Urologic Oncology
2022 Volume.20 No. 1 p.34 ~ p.42
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De Ritis Ratio (Aspartate Transaminase/Alanine Transaminase) as a Significant Prognostic Factor With Upper Urinary Tract Carcinoma Who Underwent Radical Nephroureterectomy and Adjuvant Chemotherapy
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Yoon Jee-Hwan
Jeong Chang-Wook
Kwak Cheol
Kim Hyeon-Hoe
Ku Ja-Hyeon
Yu Ji-Hyeong
Yuk Hyeong-Dong
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Abstract
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Purpose: To investigate the correlation between preoperative De Ritis ratio (aspartate transaminase [AST]/alanine transaminase [ALT]) and postoperative clinical outcome in patients with upper urinary tract carcinoma (UTUC) who underwent radical nephroureterectomy (RNU) and adjuvant chemotherapy (ACH).
Materials and Methods: We respectively analyzed the clinical and pathological data of 102 patients who underwent RNU and ACH for UTUC. Patients were divided into 2 groups, according to the optimal value of AST/ALT ratio. The effect of the AST/ALT ratio was analyzed by the Kaplan-Meier method and Cox regression hazard models for patients' cancer-specific survival (CSS) and overall survival (OS).
Results: Mean survival time was 50.5±41.2 months. Mean age was 61.4±9.7years. Forty-one of the patients (46.5%) were in the high AST/ALT group. According to receiver operating characteristic analysis, the optimal AST/ALT ratio was 1.2. In Kaplan-Meier analyses, the high AST/ALT group showed worse outcomes in OS (p=0.007) and CSS (p=0.011). Using Cox regression models of clinical and pathological parameters to predict OS, high AST/ALT ratio (hazard ratio [HR], 5.428; 95% confidence interval [CI]; 1.803?16.334; p=0.002), pathological T3 (pT3) or higher (HR, 1.464; 95% CI; 1.156-1.857; p=0.002), and to predict CSS, high AST/ALT ratio (HR, 4.417; 95% CI; 1.545?12.632; p=0.005), and pT3 or higher (HR, 1.475; 95% CI; 1.172?1.904; p=0.002) were determined as independent prognostic factors.
Conclusions: Pretreatment AST/ALT ratio is a significant independent predictor of CSS and OS in advanced UTUC patients receiving systemic ACH after RNU.
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KEYWORD
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Alanine transaminase, Aspartate transaminase, Chemotherapy, Upper urinary tract carcinoma, Urothelial cell carcinoma
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