Wu Jiayuan, Chen Lin, Wang Yufeng, Tan Wenkai, Huang Zhe
Clinical Research Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, People's Republic of China.
Department of Cardiac Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, People's Republic of China.
Onco Targets Ther. 2019 Jul 2;12:5201-5213. doi: 10.2147/OTT.S204403. eCollection 2019.
Numerous studies have reported the association between pretreatment serum aspartate transaminase to alanine transaminase (AST/ALT) ratio and prognosis in multiple cancers. However, the results remain controversial and no consensus has been reached. Thus, we conducted this meta-analysis to quantitatively assess the prognostic value of pretreatment AST/ALT ratio in solid tumors.
A systematic literature search was conducted by using PubMed, EMBASE, Web of Science, Cochrane Library, and Wanfang databases, as well as several trial registry platforms, including ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Chinese Clinical Trial Registry, up to April 5, 2019. HR and 95% CI for overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were calculated to estimate the effect size.
A total of 18 studies with 9,400 patients were included. Overall, a high level of pretreatment AST/ALT ratio was significantly associated with worse OS (pooled HR=1.70, 95% CI=1.38-2.09). The statistical significance was observed in all cancer types, including renal cell carcinoma (pooled HR=1.64, 95% CI=1.30-2.05), liver cancer (pooled HR=1.16, 95% CI=1.04-1.29), urinary tract urothelial carcinoma (pooled HR=1.96, 95% CI=1.53-2.51), bladder cancer (pooled HR =2.66, 95% CI=1.69-4.20), and other cancers (pooled HR=1.44, 95% CI=1.18-1.76). Moreover, an increased level of serum AST/ALT ratio predicted unfavorable CSS (pooled HR=2.07, 95% CI=1.74-2.46) and RFS (pooled HR=1.51, 95% CI=1.15-1.99).
Elevated level of serum AST/ALT ratio before treatment is significantly associated with poor clinical outcomes of OS, CSS, and RFS in patients with solid tumors. Pretreatment AST/ALT ratio can serve as a useful prognostic predictor for malignant patients.
众多研究报道了治疗前血清天冬氨酸转氨酶与丙氨酸转氨酶（AST/ALT）比值与多种癌症预后之间的关联。然而，结果仍存在争议，尚未达成共识。因此，我们进行了这项荟萃分析，以定量评估治疗前AST/ALT比值在实体瘤中的预后价值。
使用PubMed、EMBASE、Web of Science、Cochrane图书馆和万方数据库，以及包括ClinicalTrials.gov、世界卫生组织国际临床试验注册平台和中国临床试验注册中心在内的多个试验注册平台，进行系统的文献检索，检索截至2019年4月5日的文献。计算总生存期（OS）、癌症特异性生存期（CSS）和无复发生存期（RFS）的风险比（HR）及95%可信区间（CI），以估计效应大小。
共纳入18项研究，涉及9400例患者。总体而言，治疗前AST/ALT比值较高与较差的总生存期显著相关（合并HR=1.70，95%CI=1.38-2.09）。在所有癌症类型中均观察到统计学显著性，包括肾细胞癌（合并HR=1.64，95%CI=1.30-2.05）、肝癌（合并HR=1.16，95%CI=1.04-1.29）、尿路上皮癌（合并HR=1.96，95%CI=1.53-2.51）、膀胱癌（合并HR =2.66，95%CI=1.69-4.20）和其他癌症（合并HR=1.44，95%CI=1.18-1.76）。此外，血清AST/ALT比值升高预示着不良的癌症特异性生存期（合并HR=2.07，95%CI=1.74-2.46）和无复发生存期（合并HR=1.51，95%CI=1.15-1.99）。
治疗前血清AST/ALT比值升高与实体瘤患者的总生存期、癌症特异性生存期和无复发生存期的不良临床结局显著相关。治疗前AST/ALT比值可作为恶性肿瘤患者有用的预后预测指标。
