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

Abstract

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.

Gemcitabine/nab-Paclitaxel versus FOLFIRINOX for palliative first-line treatment of advanced pancreatic cancer: A propensity score analysis

“…In the naive survival analysis, we found slight but insignificant favourable survival outcomes and treatment response rates for FOLFIRINOX compared to GN. The respective median OS of 10.1 months for GN and 11.2 for FOL-FIRINOX is in line with other large-scale retrospective studies reporting real-world outcome data, such as by Hegewisch-Becker et al [18] that alongside other studies confirm the real-world effectiveness of the two treatment regimens [20]. To elucidate potential differences in effectiveness between the respective treatments, a rigorous adjustment for baseline imbalances of patient covariables is necessary to account for the large amount of selection bias likely affecting such analysis.…”

High aspartate aminotransferase to alanine aminotransferase ratio on admission as risk factor for poor prognosis in COVID-19 patients

“…Additionally, the AST/ALT ratio was found to be a risk factor for death in both groups of COVID-19 patients with normal or abnormal AST levels. Besides that, the AST/ALT ratio, for unclear reasons, has some extrahepatic implications, including predicting poor outcomes of pancreatic cancer patients 33 and heart injury in Kawasaki disease 34 . Therefore, the role of the AST/ALT ratio in COVID-19 remains to be further analyzed.…”

High Aspartate Aminotransferase to Alanine Aminotransferase Ratio on Admission as Risk Factor for Poor Prognosis in COVID-19 Patients

“…Therefore, some patients might also suffer from liver injuries even though their liver enzyme levels were within normal ranges. Besides that, the AST/ALT ratio, for unclear reasons, has some extrahepatic implications, including predicting poor outcomes of pancreatic cancer patients 35 and heart injury in Kawasaki disease 36 . Therefore, the role of the AST/ALT ratio in COVID-19 remains to be further analyzed.…”