title: De Ritis ratio (aspartate transaminase/alanine transaminase ratio) as a significant prognostic factor after surgical treatment in patients with clear-cell localized renal cell carcinoma: a propensity score-matched study.
abstract: OBJECTIVE
  To evaluate the associations of preoperative De Ritis ratio (aspartate transaminase [AST]/alanine transaminase [ALT]) with postoperative clinical outcomes after surgical treatment of localized RCC.
  
  
  METHODS
  We retrospectively reviewed data from 2 965 patients surgically treated for non-metastatic RCC. Propensity scores for high AST/ALT ratio were calculated and 430 patients with a high AST/ALT ratio were matched to 1 117 patients with a low AST/ALT ratio. The association between AST/ALT ratio and postoperative outcomes was tested. Multivariate Cox analyses were performed to identify the independent predictors of progression-free (PFS), overall (OS) and cancer-specific survival (CSS).
  
  
  RESULTS
  According to the receiver-operating curve of AST/ALT for cancer-specific mortality, we stratified the patients into two groups using a threshold of 1.5. Before matching, patients with a high AST/ALT ratio had worse PFS, OS and CSS (all P < 0.001). In the propensity score-matched cohort with 1 547 patients, patients with a high AST/ALT ratio had inferior PFS, OS and CSS outcomes (all P < 0.001). Multivariate analysis showed that a high AST/ALT ratio was an independent predictor of disease progression (hazard ratio [HR] 1.372, 95% CI 1.003-1.882; P = 0.048), overall mortality (HR 1.559, 95% CI 1.069-2.272; P = 0.021), and cancer-specific mortality (HR 1.974, 95% CI 1.250-3.118; P = 0.004). In a subgroup analysis according to tumour histology, high AST/ALT had a significant association with postoperative survival in clear-cell renal cell carcinoma (RCC), but not in non-clear-cell RCC.
  
  
  CONCLUSIONS
  An elevated AST/ALT ratio was significantly associated with worse postoperative survival in patients surgically treated for localized clear-cell RCC. Further prospective studies are needed to understand the prognostic value of preoperative AST/ALT ratio.
authors.affiliation: Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hakmin
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, Gyunggi-do, Korea.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, Gyunggi-do, Korea.
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, Gyunggi-do, Korea.
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: AST/ALT; prognosis; renal cell carcinoma; survival