The effect of AST/ALT (De Ritis) ratio on survival and its relation to tumor histopathological variables in patients with localized renal cell carcinoma

ABSTRACT Purpose To assess the relationship between De Ritis (aspartate aminotransaminase [AST]/Alanine aminotransaminase [ALT]) ratio and pathological variables and whether it is an independent prognostic factor. Materials and Methods We analyzed 298 consecutive patients who underwent radical or partial nephrectomy for non-metastatic renal cell carcinoma (RCC) between 2006 and 2015. The association between De Ritis ratio and pathological variables including tumor size, presence of renal vein invasion, vena cava invasion, renal capsule infiltration, Gerota fascia invasion, renal sinus involvement, renal pelvic invasion, angiolymphatic invasion, adrenal gland involvement, lymph node involvement, tumor necrosis, and Fuhrman's grade was tested. Multivariable Cox analysis was performed to evaluate the impact of this ratio on overall survival and cancer-specific survival. Results An increased preoperative De Ritis ratio was significantly associated with renal vein invasion, renal capsule infiltration and renal pelvis involvement (p<0.05) in non-metastatic RCC. On multivariate analysis we found that tumor size, Fuhrman grade and lymph node involvement were independent prognostic factors for cancer-specific survival. AST/ALT ratio had no influence on the risk of overall and cancer-specific survival. Conclusion An increased preoperative AST/ALT ratio had a significant association with renal vein invasion, renal capsule infiltration and renal pelvis involvement in patients with non-metastatic RCC. However, it does not appear to be an independent prognostic marker in non-metastatic RCC.

摘要
研究目的 评估De Ritis比值（即天冬氨酸氨基转移酶[aspartate aminotransaminase, AST]/丙氨酸氨基转移酶[alanine aminotransaminase, ALT]比值）与病理参数的关联，以及其是否可作为独立预后因素。
材料与方法 本研究纳入2006年至2015年间，因非转移性肾细胞癌（renal cell carcinoma, RCC）接受根治性肾切除术或肾部分切除术的298例连续入组患者。分析De Ritis比值与各项病理参数的相关性，包括肿瘤直径、肾静脉侵犯、腔静脉侵犯、肾包膜浸润、Gerota筋膜侵犯、肾窦受累、肾盂侵犯、血管淋巴管侵犯、肾上腺受累、淋巴结受累、肿瘤坏死及Fuhrman分级。采用多变量Cox分析，评估该比值对总生存期与癌症特异性生存期的影响。
结果 在非转移性肾细胞癌患者中，术前升高的De Ritis比值与肾静脉侵犯、肾包膜浸润及肾盂受累显著相关（p<0.05）。多变量分析显示，肿瘤直径、Fuhrman分级及淋巴结受累为癌症特异性生存期的独立预后因素；AST/ALT比值对总生存期及癌症特异性生存期的风险无显著影响。
结论 非转移性肾细胞癌患者术前升高的AST/ALT比值与肾静脉侵犯、肾包膜浸润及肾盂受累显著相关。然而，该比值似乎并非非转移性肾细胞癌的独立预后标志物。