Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Hospital of Tours, Tours, France.
Urol Oncol. 2020 Dec;38(12):936.e7-936.e14. doi: 10.1016/j.urolonc.2020.08.013. Epub 2020 Sep 19.
Identifying which patients are likely to benefit from cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) is important. We tested the association between preoperative serum De Ritis ratio (DRR, Aspartate Aminotransferase/Alanine Aminotransferase) and overall survival (OS) as well as cancer-specific survival (CSS) in mRCC patients treated with CN.
mRCC patients treated with CN at different institutions were included. After assessing for the optimal pretreatment DRR cut-off value, we found 1.2 to have the maximum Youden index value. The overall population was therefore divided into 2 DRR groups using this cut-off (low, <1.2 vs. high, ≥1.2). Univariable and multivariable Cox regression analyses tested the association between DRR and OS as well as CSS. The discrimination of the model was evaluated with the Harrel's concordance index (C-index). The clinical value of the DRR was evaluated with decision curve analysis.
Among 613 mRCC patients, 239 (39%) patients had a DRR ≥1.2. Median follow-up was 31 (IQR 16-58) months. On univariable analysis, high DRR was significantly associated with OS (hazard ratios [HR]: 1.22, 95% confidence interval [CI]: 1.01-1.46, P = 0.04) and CSS (HR: 1.23, 95% CI: 1.02-1.47, P = 0.03). On multivariable analysis, which adjusted for the effect of established clinicopathologic features, high DRR remained significantly associated with both OS (HR: 1.26, 95% CI: 1.04-1.52, P = 0.02) and CSS (HR: 1.26, 95% CI: 1.05-1.53, P = 0.01). The addition of DRR only minimally improved the discrimination of a base model that included established clinicopathologic features (C-index = 0.633 vs. C-index = 0.629). On decision curve analysis, the inclusion of DRR did not improve the net-benefit beyond that obtained by established subgroup analyses stratified by IMDC risk groups, type of systemic therapy, body mass index and sarcomatoid features, did not reveal any prognostic value to DRR.
Despite the statistically significant association between DRR and OS as well as CSS in mRCC patients treated with CN, DRR does not seem to add any further prognostic value beyond that obtained by currently available features.
确定哪些患者可能从转移性肾细胞癌（mRCC）的细胞减灭性肾切除术（CN）中获益是很重要的。我们测试了术前血清 De Ritis 比值（DRR，天冬氨酸氨基转移酶/丙氨酸氨基转移酶）与接受 CN 治疗的 mRCC 患者的总生存期（OS）和癌症特异性生存期（CSS）之间的相关性。
纳入在不同机构接受 CN 治疗的 mRCC 患者。在评估最佳预处理 DRR 截止值后，我们发现 1.2 具有最大的 Youden 指数值。因此，该截止值（低，<1.2 与高，≥1.2）将整个人群分为 2 个 DRR 组。单变量和多变量 Cox 回归分析测试了 DRR 与 OS 以及 CSS 之间的关联。Harrell 一致性指数（C 指数）评估了模型的判别能力。通过决策曲线分析评估了 DRR 的临床价值。
在 613 名 mRCC 患者中，239 名（39%）患者的 DRR≥1.2。中位随访时间为 31（IQR 16-58）个月。单变量分析显示，高 DRR 与 OS（风险比[HR]：1.22，95%置信区间[CI]：1.01-1.46，P=0.04）和 CSS（HR：1.23，95%CI：1.02-1.47，P=0.03）显著相关。多变量分析调整了既定临床病理特征的影响后，高 DRR 仍与 OS（HR：1.26，95%CI：1.04-1.52，P=0.02）和 CSS（HR：1.26，95%CI：1.05-1.53，P=0.01）显著相关。DRR 的加入仅略微提高了包含既定临床病理特征的基础模型的判别能力（C 指数=0.633 与 C 指数=0.629）。在决策曲线分析中，与通过按 IMDC 风险组、全身治疗类型、体重指数和肉瘤样特征分层的既定亚组分析确定的获益相比，纳入 DRR 并未带来任何净获益，也没有显示 DRR 具有任何预后价值。
尽管在接受 CN 治疗的 mRCC 患者中，DRR 与 OS 以及 CSS 之间存在统计学显著关联，但除了目前可用的特征外，DRR 似乎没有提供任何额外的预后价值。
