The AST/ALT (De Ritis) ratio predicts clinical outcome in patients with pancreatic cancer treated with first-line nab-paclitaxel and gemcitabine: post hoc analysis of an Austrian multicenter, noninterventional study
The AST/ALT (De Ritis) ratio predicts clinical outcome in patients with pancreatic cancer treated with first-line nab-paclitaxel and gemcitabine: post hoc analysis of an Austrian multicenter, noninterventional study
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DOI：
10.1177/1758835919900872
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发表时间：
2020-04-01
影响因子：
4.9
通讯作者：
Gerger, Armin
中科院分区：
文献类型：
--
作者：
Riedl, Jakob Michael;Posch, Florian;Gerger, Armin
背景：治疗前的De Ritis比值[天冬氨酸转氨酶(AST)/丙氨酸转氨酶(ALT)]已被证明是多种肿瘤实体的不良预后指标。然而，其与晚期胰腺导管腺癌(PDAC)的相关性尚未被研究。在这项研究中，我们研究了AST/ALT比值作为接受一线吉西他滨/NAB-紫杉醇治疗的晚期PDAC患者的治疗反应和疾病结局的可能预测指标。方法：对一项前瞻性、多中心、非干预性研究进行事后分析。结果：门冬氨酸氨基转移酶/丙氨酸氨基转移酶(AST/ALT)>75%的患者中位无进展生存期为4.8个月，1年无进展生存率为5.1%；AST/ALT<75%的患者中位无进展生存期为6.0月，1年无进展生存期为18.7%(对数等级p=0.004)。在单变量COX回归中，AST/ALT比值加倍与进展或死亡的相对风险增加1.4倍相关[危险比=1.38，95%可信区间：1.06-1.80，p=0.017]。在调整了东部合作肿瘤组的表现状态和肺转移的多变量分析中也发现了预后的关联(每AST/ALT比值加倍的风险比=1.32，95%CI：1.00-1.75，p=0.047)。在治疗反应分析中，AST/ALT比值增加一倍与客观疗效降低0.5倍相关(优势比=0.54，95%可信区间：0.31~0.94，P=0.020)。结论：治疗前血清AST/ALT比值预测了接受吉西他滨/NAB-紫杉醇治疗的晚期PDAC患者较差的疾病结局和应答率，可能是一种新的、廉价的胰腺癌个体化风险评估指标。
Background:The pretreatment De Ritis ratio [aspartate transaminase (AST)/alanine transaminase (ALT)] has been shown to be an adverse prognostic marker in various cancer entities. However, its relevance to advanced pancreatic ductal adenocarcinoma (PDAC) has not yet been studied. In the present study we investigated the AST/ALT ratio as a possible predictor of treatment response and disease outcome in patients with advanced PDAC treated with first-line gemcitabine/nab-paclitaxel.Methods:A post hoc analysis of a prospective, multicenter, noninterventional study was performed. A total of 202 patients with advanced PDAC treated with first-line gemcitabine/nab-paclitaxel for whom the AST/ALT ratio was measured were included in this analysis.Results:Median and 1-year progression-free survival estimates were 4.8 months and 5.1%, respectively in patients with an AST/ALT ratio above the 75th percentile of its distribution, and 6.0 months and 18.7%, respectively in patients with an AST/ALT ratio less than or equal to this cutoff, respectively (log-rank p = 0.004). In univariable Cox regression, a doubling of the AST/ALT ratio was associated with a 1.4-fold higher relative risk of progression or death [hazard ratio = 1.38, 95% confidence interval (CI): 1.06-1.80, p = 0.017]. The prognostic association was also found in multivariable analysis adjusting for Eastern Cooperative Oncology Group performance status and lung metastases (hazard ratio per AST/ALT ratio doubling = 1.32, 95% CI: 1.00-1.75, p = 0.047). In treatment response analysis, a doubling of the AST/ALT ratio was associated with a 0.5-fold lower odds of objective response (odds ratio = 0.54, 95% CI: 0.31-0.94, p = 0.020).Conclusions:The pretreatment serum AST/ALT ratio predicts poor disease outcome and response rate in patients with advanced PDAC treated with gemcitabine/nab-paclitaxel and might represent a novel and inexpensive marker for individual risk assessment in the treatment of pancreatic cancer.