<p>Prognostic value of aspartate transaminase to alanine transaminase (De Ritis) ratio in solid tumors: a pooled analysis of 9,400 patients</p>

Abstract

Background Numerous studies have reported the association between pretreatment serum aspartate transaminase to alanine transaminase (AST/ALT) ratio and prognosis in multiple cancers. However, the results remain controversial and no consensus has been reached. Thus, we conducted this meta-analysis to quantitatively assess the prognostic value of pretreatment AST/ALT ratio in solid tumors. Methods A systematic literature search was conducted by using PubMed, EMBASE, Web of Science, Cochrane Library, and Wanfang databases, as well as several trial registry platforms, including ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Chinese Clinical Trial Registry, up to April 5, 2019. HR and 95% CI for overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were calculated to estimate the effect size. Results A total of 18 studies with 9,400 patients were included. Overall, a high level of pretreatment AST/ALT ratio was significantly associated with worse OS (pooled HR=1.70, 95% CI=1.38–2.09). The statistical significance was observed in all cancer types, including renal cell carcinoma (pooled HR=1.64, 95% CI=1.30–2.05), liver cancer (pooled HR=1.16, 95% CI=1.04–1.29), urinary tract urothelial carcinoma (pooled HR=1.96, 95% CI=1.53–2.51), bladder cancer (pooled HR =2.66, 95% CI=1.69–4.20), and other cancers (pooled HR=1.44, 95% CI=1.18–1.76). Moreover, an increased level of serum AST/ALT ratio predicted unfavorable CSS (pooled HR=2.07, 95% CI=1.74–2.46) and RFS (pooled HR=1.51, 95% CI=1.15–1.99). Conclusion Elevated level of serum AST/ALT ratio before treatment is significantly associated with poor clinical outcomes of OS, CSS, and RFS in patients with solid tumors. Pretreatment AST/ALT ratio can serve as a useful prognostic predictor for malignant patients.

<p>Pretreatment Aspartate Aminotransferase-to-Alanine Aminotransferase (De Ritis) Ratio Predicts the Prognosis of Nonmetastatic Nasopharyngeal Carcinoma</p>

“…For the purposes of clinical practice, a predictive parameter would generally have great potential if it can be easily obtained at a low cost through routine measures. Nevertheless, although the single measures of AST or ALT are associated with the prognosis of patients with various cancer types, they are not perfect predictors because they are sensitive to various other nontumor-related factors, such as chronic hepatitis, coronary heart disease, renal function damage, and drugs 19. By contrary, the De Ritis ratio reflects the combination of AST and ALT, and is stable because it has counteracted the effects of other factors 20.…”

“…AST has a vital role in aerobic glycolysis through the malate-aspartate shuffle pathway. The pathological conditions associated with cancer progression, such as rapidly growing cancer tissues and normal tissue damage, can lead result in the higher activation of AST than that of ALT 19. In vitro experiments have shown that decreased ALT level is more likely observed in more invasive cancer cells than in less invasive cancer cells, and more invasive cancer cells consume glucose to a greater extent 27.…”

Prognostic Role of Pretreatment De Ritis Ratio (Aspartate Transaminase/Alanine Transaminase Ratio) in Urological Cancers: A Systematic Review and Meta-Analysis

“…More recently, a meta-analysis has studied De Ritis ratio as prognosis predictor in solid cancers. They have found that a higher level of AST/ALT ratio was significantly correlated with poor OS, CSS, and RFS in all cancer types (25). However, there were several limitations for this study.…”

Carotenoid isolates ofSpondias mombindemonstrate anticancer effects in DMBA‐induced breast cancer in Wistar rats through X‐linked inhibitor of apoptosis protein (XIAP) antagonism and anti‐inflammation

“…Alanine aminotransferase (ALT) catalyzes the transfer of amino groups to form oxaloacetate (Kim et al., 2008). Increased level of serum ALT expression is connected to the worst clinical outcomes in solid tumor (Wu et al., 2019).…”