Hakmin Lee1, Sang Eun Lee2, Seok-Soo Byun2, Hyeon Hoe Kim3, Cheol Kwak3, Sung Kyu Hong2. 1. Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea. 2. Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, Gyunggi-do, Korea. 3. Department of Urology, Seoul National University Hospital, Seoul, Korea.
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. MATERIALS AND 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. CONCLUSION: 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.
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. MATERIALS AND 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. CONCLUSION: 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: Yang Hyun Cho; Jun Eul Hwang; Ho Seok Chung; Myung Soo Kim; Eu Chang Hwang; Seung Il Jung; Taek Won Kang; Dong Deuk Kwon; Seock Hwan Choi; Hyun Tae Kim; Tae-Hwan Kim; Tae Gyun Kwon; Joon Hwa Noh; Myung Ki Kim; Chul-Sung Kim; Sung Gu Kang; Seok Ho Kang; Jun Cheon; Chan Ho Lee; Ja Yoon Ku; Hong Koo Ha; Bum Sik Tae; Chang Wook Jeong; Ja Hyeon Ku; Cheol Kwak; Hyeon Hoe Kim Journal: Int Urol Nephrol Date: 2017-05-08 Impact factor: 2.370