De Ritis ratio (aspartate transaminase/alanine transaminase ratio) as a significant prognostic factor after surgical treatment in patients with clear-cell localized renal cell carcinoma: a propensity score-matched study
De Ritis ratio (aspartate transaminase/alanine transaminase ratio) as a significant prognostic factor after surgical treatment in patients with clear-cell localized renal cell carcinoma: a propensity score-matched study
复制标题
DOI：
10.1111/bju.13545
复制
发表时间：
2017-02-01
影响因子：
4.5
通讯作者：
Hong, Sung Kyu
中科院分区：
文献类型：
--
作者：
Lee, Hakmin;Lee, Sang Eun;Hong, Sung Kyu
目的探讨局限性肾细胞癌术前德炎比值（谷草转氨酶[AST]/丙氨酸转氨酶[ALT]）与术后临床预后的关系。材料和方法回顾性分析了2965例手术治疗的非转移性肾细胞癌患者的资料。计算高AST/ALT比值倾向得分，430例高AST/ALT比值患者与1117例低AST/ALT比值患者进行匹配。检测AST/ALT比值与术后预后的关系。进行多变量Cox分析以确定无进展（PFS）、总体（OS）和癌症特异性生存（CSS）的独立预测因子。结果根据AST/ALT治疗肿瘤特异性死亡率的受体-操作曲线，采用1.5的阈值将患者分为两组。匹配前，AST/ALT比值高的患者PFS、OS和CSS较差（P < 0.001）。在倾向评分匹配的1547例患者中，AST/ALT比值高的患者PFS、OS和CSS结果较差（均P < 0.001）。多因素分析显示，高AST/ALT比值是疾病进展（危险比[HR] 1.372, 95% CI 1.003-1.882; P = 0.048）、总死亡率（危险比[HR] 1.559, 95% CI 1.069-2.272; P = 0.021）和癌症特异性死亡率（危险比[HR] 1.974, 95% CI 1.250-3.118; P = 0.004）的独立预测因子。在肿瘤组织学亚组分析中，高AST/ALT与透明细胞肾细胞癌（RCC）的术后生存率显著相关，但与非透明细胞肾细胞癌无关。结论局部透明细胞肾细胞癌手术治疗患者AST/ALT比值升高与较差的术后生存率显著相关。术前AST/ALT比值的预后价值有待进一步的前瞻性研究。
ObjectiveTo evaluate the associations of preoperative De Ritis ratio (aspartate transaminase [AST]/alanine transaminase [ALT]) with postoperative clinical outcomes after surgical treatment of localized RCC.Materials and MethodsWe retrospectively reviewed data from 2 965 patients surgically treated for non-metastatic RCC. Propensity scores for high AST/ALT ratio were calculated and 430 patients with a high AST/ALT ratio were matched to 1 117 patients with a low AST/ALT ratio. The association between AST/ALT ratio and postoperative outcomes was tested. Multivariate Cox analyses were performed to identify the independent predictors of progression-free (PFS), overall (OS) and cancer-specific survival (CSS).ResultsAccording to the receiver-operating curve of AST/ALT for cancer-specific mortality, we stratified the patients into two groups using a threshold of 1.5. Before matching, patients with a high AST/ALT ratio had worse PFS, OS and CSS (all P < 0.001). In the propensity score-matched cohort with 1 547 patients, patients with a high AST/ALT ratio had inferior PFS, OS and CSS outcomes (all P < 0.001). Multivariate analysis showed that a high AST/ALT ratio was an independent predictor of disease progression (hazard ratio [HR] 1.372, 95% CI 1.003-1.882; P = 0.048), overall mortality (HR 1.559, 95% CI 1.069-2.272; P = 0.021), and cancer-specific mortality (HR 1.974, 95% CI 1.250-3.118; P = 0.004). In a subgroup analysis according to tumour histology, high AST/ALT had a significant association with postoperative survival in clear-cell renal cell carcinoma (RCC), but not in non-clear-cell RCC.ConclusionAn elevated AST/ALT ratio was significantly associated with worse postoperative survival in patients surgically treated for localized clear-cell RCC. Further prospective studies are needed to understand the prognostic value of preoperative AST/ALT ratio.