Preoperative AST/ALT (De Ritis) Ratio as a Prognostic Factor in a Cohort of Patients who underwent radical cystectomy
Abstract
Aim:
This study aims to evaluate the prognostic significance of the preoperative
aspartate aminotransferase (AST) / alanine aminotransferase (ALT) (De Ritis)
ratio in bladder cancer (BC) patients who underwent radical cystectomy (RC).
Materials-Method:
We evaluated the clinical and histopathological data of 58 patients who had
undergone RC between January 2008-August 2018 at our tertiary hospital. The
potential prognostic value of the De Ritis ratio with regard to BC was evaluated using
ROC curve analysis. The effect of the De Ritis ratio on disease specific survival (DSS)
and overall survival (OS) was analyzed using the Kaplan-Meier method and
multivariate Cox regression models.
Results:
A total of fifty-eight patients underwent RC and 95.6% were male (M/F:56/2).
Mean age of the patients was 68.6±
11,56. The cut-off value of the De Ritis ratio for DSS was
calculated as 1.417 in the ROC analysis. In Kaplan-Meier analyses, the group
with a higher De Ritis ratio
presented a more unfavorable progression in terms of DSS and OS (p=0.004).
Based on the Cox regression models adjusted for clinical and pathological
parameters, for DSS, the De Ritis
ratio (HR 2.70, 95% CI 2.34-3.05 p=0.005),
pathological T stage (HR 3.36, 95% CI 2.91-3.82, p =0.007), and age (HR 1,038
95% CI 1,02-1,05; p=0.015) were determined as independent prognostic factors;
and for OS, the De Ritis ratio
(HR 2.71, 95% CI 2.33 -3.09; p =0.005), pathological T stage (HR 4.36, 95% CI
3.87–4.85; p=0.007) and
age (HR 1.04, 95% CI 1.03-1.06; p = 0.015) were determined as independent
prognostic factors.
Türkçe özet
Amaç: Radikal
sistektomi (RC) uygulanan mesane kanseri (BC) hastalarında preoperatif olarak
değerlendirilen aspartat aminotransaminaz (AST) / alanin aminotransferaz (ALT)
(De Ritis) oranının prognostik önemini değerlendirmeyi amaçladık.
Materyal-Metod:
Ocak 2008 ile Ağustos 2018 tarihleri
arasında üçüncü basamak hastanemizde RS uygulanan 58 hastanın klinik ve histopatolojik
verilerini inceledik. De Ritis oranının BC üzerindeki potansiyel prognostik
değeri ROC eğrisi analizi kullanılarak değerlendirildi. Hastalığa bağlı sağ kalım
(DSS) ve genel sağ kalım (OAS) da De Ritis oranının etkisi, Kaplan-Meier
yöntemi ve multivariate Cox regresyon modelleri ile analiz edildi.
Bulgular: RC
uygulanan toplamda ellisekiz hastanın 95.6% erkek (E/K:56/2) idi. Hastaların yaş
ortalaması 68.6± 11,56 idi. ROC analizine göre DSS için De Ritis oranının
cut-off değeri 1.417 olarak saptandı. Kaplan-Meier analizlerinde yüksek De
Ritis oranı görülen grupta DSS ve OAS için daha kötü progresyon gösterdi
(p =0.004). Klinik ve patolojik parametrelerin Cox regresyon modellerinde DSS için
De Ritis oranı (HR 2.70, 95% CI 2.34-3.05 p=0.005), patolojik T evresi (HR 3.36,
95% CI 2.91-3.82, p =0.007) ve yaş (HR 1,038 95% CI 1,02-1,05;
p=0.015) iken OAS için De
Ritis oranı (HR 2.71, 95% CI 2.33 -3.09; p =0.005), patolojik T evresi (HR
4.36, 95% CI 3.87–4.85; p=0.007) ve yaş (HR 1.04, 95% CI 1.03-1.06; p = 0.015)
bağımsız prognostik faktörler olarak belirlendi.
Sonuç:
Preoperatif artmış De Ritis oranı; RC uygulanan BC hastalarında bağımsız bir
prognostik faktör olarak değerlendirilebilir. Sonuçlarımızın geniş ve uygun
şekilde tasarlanmış prospektif, randomize çalışmalarla doğrulanması ve desteklenmesi gerekmektedir
Keywords
References
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- 10. Stocken DD, Hassan AB, Altman DG, Billingham LJ, Bramhall SR, Johnson PJ, et al. Modelling prognostic factors in advanced pancreatic cancer. Br J Cancer. 2008; 99(6):883–93.
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- 12. Bezan A, Mrsic E, Krieger D, Stojakovic T, Pummer K, Zigeuner R, et al. The Preoperative AST/ALT (De Ritis) Ratio Represents a Poor Prognostic Factor in a Cohort of Patients with Nonmetastatic Renal Cell Carcinoma. J Urol. 2015; 194(1):30–5.
- 13. Lee H, Lee SE, Byun S-S, Kim HH, Kwak C, Hong SK. 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. BJU Int. 2017 119(2):261–7.
- 14. Poon RT, Fan ST, Lo CM, Liu CL, Ng IO, Wong J. Long-term prognosis after resection of hepatocellular carcinoma associated with hepatitis B-related cirrhosis. J Clin Oncol. 2000; 18(5):1094–101.
- 15. Zoppini G, Cacciatori V, Negri C, Stoico V, Lippi G, Targher G, et al. The aspartate aminotransferase-to-alanine aminotransferase ratio predicts all-cause and cardiovascular mortality in patients with type 2 diabetes. Medicine (Baltimore). 2016 Oct; 95(43):e4821.
- 16. O’Reilly SM, Richards MA, Rubens RD. Liver metastases from breast cancer: the relationship between clinical, biochemical and pathological features and survival. Eur J Cancer . 1990; 26(5):574–7.
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- 18. Tan X, Xiao K, Liu W, Chang S, Zhang T, Tang H. Prognostic factors of distal cholangiocarcinoma after curative surgery: a series of 84 cases. Hepatogastroenterology. 2013; 60(128):1892–5.
- 19. Takenaka Y, Takemoto N, Yasui T, Yamamoto Y, Uno A, Miyabe H, et al. Transaminase Activity Predicts Survival in Patients with Head and Neck Cancer. Langevin SM, editor. PLoS One. 2016; 11(10):e0164057.
- 20. Chen S-L, Li J-P, Li L-F, Zeng T, He X. Elevated Preoperative Serum Alanine Aminotransferase/Aspartate Aminotransferase (ALT/AST) Ratio Is Associated with Better Prognosis in Patients Undergoing Curative Treatment for Gastric Adenocarcinoma. Int J Mol Sci. 2016; 917(6):911. doi: 10.3390/ijms17060911.
- 21. Lee H, Choi YH, Sung HH, Han DH, Jeon HG, Chang Jeong B, et al. De Ritis Ratio (AST/ALT) as a Significant Prognostic Factor in Patients With Upper Tract Urothelial Cancer Treated With Surgery. Clin Genitourin Cancer. 2017 Jun;15(3):e379–85.
- 22. Wang H, Fang K, Zhang J, Jiang Y, Wang G, Zhang H, et al. The significance of De Ritis (aspartate transaminase/alanine transaminase) ratio in predicting pathological outcomes and prognosis in localized prostate cancer patients. Int Urol Nephrol. 2017; 49(8):1391–8.
- 23. Tai Y-S, Chen C-H, Huang C-Y, Tai H-C, Wang S-M, Pu Y-S. Diabetes mellitus with poor glycemic control increases bladder cancer recurrence risk in patients with upper urinary tract urothelial carcinoma. Diabetes Metab Res Rev. 2015 Mar; 31(3):307–14.
- 24. Whyard T, Waltzer WC, Waltzer D, Romanov V. Metabolic alterations in bladder cancer: applications for cancer imaging. Exp Cell Res. 2016 Feb 1;341(1):77–83.
- 25. DeBerardinis RJ, Mancuso A, Daikhin E, Nissim I, Yudkoff M, Wehrli S, et al. Beyond aerobic glycolysis: transformed cells can engage in glutamine metabolism that exceeds the requirement for protein and nucleotide synthesis. Proc Natl Acad Sci USA . 2007 Dec 4;104(49):19345–50.
- 26. Greenhouse W V, Lehninger AL. Occurrence of the malate-aspartate shuttle in various tumor types. Cancer Res. 1976 Apr; 36(4):1392–6.
- 27. Fantin VR, St-Pierre J, Leder P. Attenuation of LDH-A expression uncovers a link between glycolysis, mitochondrial physiology, and tumor maintenance. Cancer Cell. 2006 Jun; 9(6):425–34.
- 28. Gorgel SN, Kose O, Koc EM, Ates E, Akin Y, Yilmaz Y. The prognostic significance of preoperatively assessed AST/ALT (De Ritis) ratio on survival in patients underwent radical cystectomy. Int Urol Nephrol [Internet]. 2017 Sep; 49(9):1577–83.
Abstract
References
- 1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JWW, Comber H, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. Eur J Cancer. 2013; 49(6):1374–403.
- 2. Burger M, Catto JWF, Dalbagni G, Grossman HB, Herr H, Karakiewicz P, et al. Epidemiology and Risk Factors of Urothelial Bladder Cancer. Eur Urol. 2013; 63(2):234–41.
- 3. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001; 19(3):666–75.
- 4. Jewett HJ. Proceedings: Cancer of the bladder. Diagnosis and staging. Cancer. 1973]; 32(5):1072–4.
- 5. ROSENBERG J, CARROLL P, SMALL E. UPDATE ON CHEMOTHERAPY FOR ADVANCED BLADDER CANCER. J Urol. 2005; 174(1):14–20. 6. Herr HW, Sogani PC. Does early cystectomy improve the survival of patients with high risk superficial bladder tumors? J Urol. 2001; 166(4):1296–9.
- 7. Botros M, Sikaris KA. The De Ritis Ratio: The Test of Time. Vol. 34, Clin Biochem Rev. 2013; 34(3):117-30.
- 8. DE RITIS F, COLTORTI M, GIUSTI G. An enzymic test for the diagnosis of viral hepatitis; the transaminase serum activities. Clin Chim Acta. 1957; 2(1):70–4.
- 9. Thornburg JM, Nelson KK, Clem BF, Lane AN, Arumugam S, Simmons A, et al. Targeting aspartate aminotransferase in breast cancer. Breast Cancer Res. 2008; 10(5):R84.
- 10. Stocken DD, Hassan AB, Altman DG, Billingham LJ, Bramhall SR, Johnson PJ, et al. Modelling prognostic factors in advanced pancreatic cancer. Br J Cancer. 2008; 99(6):883–93.
- 11. Nishikawa M, Miyake H, Fujisawa M. De Ritis (aspartate transaminase/alanine transaminase) ratio as a significant predictor of recurrence-free survival in patients with upper urinary tract urothelial carcinoma following nephroureterectomy. Urol Oncol. 2016; 34(9):417.e9-417.e15.
- 12. Bezan A, Mrsic E, Krieger D, Stojakovic T, Pummer K, Zigeuner R, et al. The Preoperative AST/ALT (De Ritis) Ratio Represents a Poor Prognostic Factor in a Cohort of Patients with Nonmetastatic Renal Cell Carcinoma. J Urol. 2015; 194(1):30–5.
- 13. Lee H, Lee SE, Byun S-S, Kim HH, Kwak C, Hong SK. 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. BJU Int. 2017 119(2):261–7.
- 14. Poon RT, Fan ST, Lo CM, Liu CL, Ng IO, Wong J. Long-term prognosis after resection of hepatocellular carcinoma associated with hepatitis B-related cirrhosis. J Clin Oncol. 2000; 18(5):1094–101.
- 15. Zoppini G, Cacciatori V, Negri C, Stoico V, Lippi G, Targher G, et al. The aspartate aminotransferase-to-alanine aminotransferase ratio predicts all-cause and cardiovascular mortality in patients with type 2 diabetes. Medicine (Baltimore). 2016 Oct; 95(43):e4821.
- 16. O’Reilly SM, Richards MA, Rubens RD. Liver metastases from breast cancer: the relationship between clinical, biochemical and pathological features and survival. Eur J Cancer . 1990; 26(5):574–7.
- 17. Chougule A, Hussain S, Agarwal DP. Prognostic and diagnostic value of serum pseudocholinesterase, serum aspartate transaminase, and serum alinine transaminase in malignancies treated by radiotherapy. J Cancer Res Ther. 2008; 4(1):21–5.
- 18. Tan X, Xiao K, Liu W, Chang S, Zhang T, Tang H. Prognostic factors of distal cholangiocarcinoma after curative surgery: a series of 84 cases. Hepatogastroenterology. 2013; 60(128):1892–5.
- 19. Takenaka Y, Takemoto N, Yasui T, Yamamoto Y, Uno A, Miyabe H, et al. Transaminase Activity Predicts Survival in Patients with Head and Neck Cancer. Langevin SM, editor. PLoS One. 2016; 11(10):e0164057.
- 20. Chen S-L, Li J-P, Li L-F, Zeng T, He X. Elevated Preoperative Serum Alanine Aminotransferase/Aspartate Aminotransferase (ALT/AST) Ratio Is Associated with Better Prognosis in Patients Undergoing Curative Treatment for Gastric Adenocarcinoma. Int J Mol Sci. 2016; 917(6):911. doi: 10.3390/ijms17060911.
- 21. Lee H, Choi YH, Sung HH, Han DH, Jeon HG, Chang Jeong B, et al. De Ritis Ratio (AST/ALT) as a Significant Prognostic Factor in Patients With Upper Tract Urothelial Cancer Treated With Surgery. Clin Genitourin Cancer. 2017 Jun;15(3):e379–85.
- 22. Wang H, Fang K, Zhang J, Jiang Y, Wang G, Zhang H, et al. The significance of De Ritis (aspartate transaminase/alanine transaminase) ratio in predicting pathological outcomes and prognosis in localized prostate cancer patients. Int Urol Nephrol. 2017; 49(8):1391–8.
- 23. Tai Y-S, Chen C-H, Huang C-Y, Tai H-C, Wang S-M, Pu Y-S. Diabetes mellitus with poor glycemic control increases bladder cancer recurrence risk in patients with upper urinary tract urothelial carcinoma. Diabetes Metab Res Rev. 2015 Mar; 31(3):307–14.
- 24. Whyard T, Waltzer WC, Waltzer D, Romanov V. Metabolic alterations in bladder cancer: applications for cancer imaging. Exp Cell Res. 2016 Feb 1;341(1):77–83.
- 25. DeBerardinis RJ, Mancuso A, Daikhin E, Nissim I, Yudkoff M, Wehrli S, et al. Beyond aerobic glycolysis: transformed cells can engage in glutamine metabolism that exceeds the requirement for protein and nucleotide synthesis. Proc Natl Acad Sci USA . 2007 Dec 4;104(49):19345–50.
- 26. Greenhouse W V, Lehninger AL. Occurrence of the malate-aspartate shuttle in various tumor types. Cancer Res. 1976 Apr; 36(4):1392–6.
- 27. Fantin VR, St-Pierre J, Leder P. Attenuation of LDH-A expression uncovers a link between glycolysis, mitochondrial physiology, and tumor maintenance. Cancer Cell. 2006 Jun; 9(6):425–34.
- 28. Gorgel SN, Kose O, Koc EM, Ates E, Akin Y, Yilmaz Y. The prognostic significance of preoperatively assessed AST/ALT (De Ritis) ratio on survival in patients underwent radical cystectomy. Int Urol Nephrol [Internet]. 2017 Sep; 49(9):1577–83.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Surgical Science Research Articles |
| Authors | |
| Publication Date | September 30, 2018 |
| Acceptance Date | September 30, 2018 |
| Published in Issue | Year 2018Volume: 40 Issue: 3 |