De Ritis Ratio (AST/ALT) as a Significant Prognostic Factor in Patients With Upper Tract Urothelial Cancer Treated With Surgery.
We investigated the clinical prognostic value of preoperative De Ritis ratio (aspartate aminotransferase [AST]/alanine aminotransferase [ALT]) on postsurgical survival outcomes in patients with upper tract urothelial cancer (UTUC).



We retrospectively analyzed the data of 623 patients who underwent radical nephrouretectomy for UTUC. Multivariate regression tests were performed to identify possible associations between adverse pathologic events and AST/ALT. The risk of postoperative progression and survival were tested using Kaplan-Meier analyses and Cox proportional hazards models.



According to the receiver operator characteristic curve of AST/ALT for cancer-specific mortality, patients with AST/ALT value ≥1.5 were regarded as the high AST/ALT group, and the remaining patients formed the low AST/ALT group. In Kaplan-Meier analyses, the high AST/ALT group showed worse progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (all P < .001). Elevated AST/ALT was associated with higher T stage (hazard ratio [HR], 1.577; 95% confidence interval [CI], 1.077-2.311; P = .033) and higher cellular grade (HR, 1.538; 95% CI, 1.034-2.287; P = .041) in multivariate regression tests. In multivariate Cox analyses, high AST/ALT was revealed as an independent predictor of PFS (HR, 2.335; 95% CI, 1.633-3.340; P < .001), CSS (HR, 2.550; 1.689-3.851; P < .001), and overall survival (HR, 2.069; 95% CI, 1.409-3.038; P < .001).



Elevated preoperative AST/ALT was a significant predictor of worse postoperative survival in patients surgically treated for UTUC. Further large prospective studies are needed for better understanding of the prognostic value of preoperative AST/ALT.
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Hakmin
H
Lee
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Young Hyo
YH
Choi
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Hyun Hwan
HH
Sung
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Deok Hyun
DH
Han
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Hwang Gyun
HG
Jeon
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Byong
B
Chang Jeong
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Seong Il
SI
Seo
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Seong Soo
SS
Jeon
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Hyun Moo
HM
Lee
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: hanyong.choi@samsung.com.
Han Yong
HY
Choi
D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism*; D001219:Aspartate Aminotransferases / Q000378:metabolism*; D014408:Biomarkers, Tumor / Q000378:metabolism; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D000074682:Nephroureterectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000201:enzymology / Q000601:surgery*
D014408:Biomarkers, Tumor; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
ALT; AST; Nephroureterectomy; Survival; Urothelial cell carcinoma