title: The Preoperative AST/ALT (De Ritis) Ratio Represents a Poor Prognostic Factor in a Cohort of Patients with Nonmetastatic Renal Cell Carcinoma.
abstract: OBJECTIVE
  Aminotransaminases, which are strongly involved in cellular metabolism and cancer cell turnover, represent easily measureable, potential blood based biomarkers. We evaluated the prognostic value of the preoperatively assessed AST/ALT (De Ritis) ratio on clinically meaningful end points in a large European cohort of patients with nonmetastatic renal cell carcinoma.
  
  
  METHODS
  We retrospectively evaluated clinicopathological data on 698 patients with nonmetastatic renal cell carcinoma operated on between 2005 and 2013 at a single tertiary academic center. The potential prognostic value of the AST/ALT ratio was analyzed using the Kaplan-Meier method, and univariate and multivariate Cox proportional regression models. The impact of the ratio on the predictive accuracy of the Leibovich prognosis score was determined by the Harrell c-index.
  
  
  RESULTS
  An increased (1.26 or greater) preoperative AST/ALT ratio was statistically significantly associated with several well established prognostic factors, including pathological T stage, as well as with histological tumor necrosis (p <0.05). On multivariate analysis an increased preoperative AST/ALT ratio was an independent prognostic factor for metastasis-free survival (HR 1.61, 95% CI 1.25-2.07, p <0.001) and overall survival (HR 1.76, 95% CI 1.34-2.32, p <0.001). The Harrell c-index was 0.77 using the Leibovich prognosis score and 0.81 when AST/ALT was added.
  
  
  CONCLUSIONS
  In our study cohort with nonmetastatic renal cell carcinoma the preoperatively assessed AST/ALT ratio represented an independent prognostic factor. This ratio might further improve the predictive accuracy of well established prognosis scores.
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Angelika
authors.initials: A
authors.lastname: Bezan
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Edvin
authors.initials: E
authors.lastname: Mrsic
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Krieger
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Stojakovic
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: Karl
authors.initials: K
authors.lastname: Pummer
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria. Electronic address: g.hutterer@gmail.com.
authors.forename: Georg C
authors.initials: GC
authors.lastname: Hutterer
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Experimental Therapeutics, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Martin
authors.initials: M
authors.lastname: Pichler
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: biological markers; carcinoma; kidney; prognosis; renal cell; transaminases