Department of Urology, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea.
Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
Dis Markers. 2019 Aug 27;2019:6702964. doi: 10.1155/2019/6702964. eCollection 2019.
To investigate the correlation between preoperative De Ritis ratio (aspartate transaminase (AST)/alanine transaminase (ALT)) and postoperative outcome in patients with urothelial cell carcinoma (UC) treated with radical cystectomy.
We analyzed the clinical and pathological data of 771 patients who underwent radical cystectomy for bladder UC. Patients were divided into two groups according to the optimal value of AST/ALT ratio. The effect of the AST/ALT ratio was analyzed using the Kaplan-Meier method and Cox regression hazard models for patients' cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS). In addition, propensity score matching of 1 : 1 was performed between the two groups.
Median follow-up was 84.0 (36-275) months. Mean age was 64.8 ± 10.0 years. According to the receiver operating characteristic (ROC) analysis, the optimal threshold of the AST/ALT ratio was 1.1. In Kaplan-Meier analyses, the high AST/ALT group showed worse outcomes in CSS and OS (all < 0.001). Also, RFS ( = 0.001) in the Cox regression models of clinical and pathological parameters was used to predict CSS, OS, and AST/ALT ratio (HR 2.15, 95% CI 1.23-3.73, = 0.007) and pathological T stage (HR 4.80, 95% CI 1.19-19.28, = 0.003). To predict OS and AST/ALT ratio (HR 2.05, 95% CI 1.65-2.56, < 0.001), pathological T stage (HR 2.96, 95% CI 0.57-17.09, = 0.037) and positive lymph node (HR 1.71, 95% CI 1.50-1.91, = 0.021) were determined as independent prognostic factors.
Preoperative AST/ALT ratio could be an independent prognostic factor in patients with UC treated with radical cystectomy.
本研究旨在探讨根治性膀胱切除术治疗尿路上皮癌（UC）患者的术前 De Ritis 比值（天冬氨酸转氨酶（AST）/丙氨酸转氨酶（ALT））与术后结局之间的相关性。
我们分析了 771 例行根治性膀胱切除术的 UC 患者的临床和病理资料。根据 AST/ALT 比值的最佳值，将患者分为两组。采用 Kaplan-Meier 法和 Cox 回归风险模型分析 AST/ALT 比值对患者癌症特异性生存（CSS）、总生存（OS）和无复发生存（RFS）的影响。此外，对两组进行了 1∶1 的倾向评分匹配。
中位随访时间为 84.0（36-275）个月。平均年龄为 64.8±10.0 岁。根据受试者工作特征（ROC）分析，AST/ALT 比值的最佳阈值为 1.1。Kaplan-Meier 分析显示，高 AST/ALT 组 CSS 和 OS 结局较差（均 <0.001）。此外，在临床病理参数的 Cox 回归模型中，RFS（=0.001）也可预测 CSS、OS 和 AST/ALT 比值（HR 2.15，95%CI 1.23-3.73，=0.007）和病理 T 分期（HR 4.80，95%CI 1.19-19.28，=0.003）。预测 OS 和 AST/ALT 比值（HR 2.05，95%CI 1.65-2.56，<0.001）、病理 T 分期（HR 2.96，95%CI 0.57-17.09，=0.037）和阳性淋巴结（HR 1.71，95%CI 1.50-1.91，=0.021）是独立的预后因素。
术前 AST/ALT 比值可能是接受根治性膀胱切除术治疗的 UC 患者的独立预后因素。
