The prognostic value of De Ritis (AST/ALT) ratio in patients after surgery for urothelial carcinoma: a systematic review and meta-analysis

Abstract

Background: Recently, the De Ritis (AST/ALT) ratio has been considered as a prognostic biomarker for various malignancies. We conducted this systematic review and meta-analysis to explore the prognostic value of preoperative De Ritis ratio in patients after surgery for urothelial carcinoma. Methods:We searched the online database Embase, PubMed and Cochrane Library up to October 2019. The hazard ratio (HR) and 95% confidence interval (CI) were extracted from the studies. Results:A total of 8 studies incorporating 3949 patients were included in the quantitative synthesis. We observed that elevated preoperative De Ritis ratio is associated with inferior OS (HR = 1.97; 95% CI 1.70-2.28; P < 0.001), CSS (HR = 2.40; 95% CI 2.02-2.86; P < 0.001), RFS (HR = 1.31; 95% CI 1.11-1.54; P = 0.001), PFS (HR = 2.07; 95% CI 1.68-2.56; P < 0.001) and MFS (HR = 2.39; 95% CI 1.16-4.91; P = 0.018). Stratified by diseases, the elevated De Ritis ratio also served as an unfavorable factor. Conclusion:The elevated preoperative De Ritis ratio is an unfavorable factor for patients with urothelial carcinoma. In patients with BC and UTUC, the elevated preoperative De Ritis ratio is also associated with poor prognosis. But De Ritis ratio must be validated in large, independent cohorts before it can be applied widely.

The Prognostic Value of the De Ritis Ratio for Progression-Free Survival in Patients with NET Undergoing [177Lu]Lu-DOTATOC-PRRT: A Retrospective Analysis

“…Consequently, an increased AST is not always caused by hepatic pathology, especially if ALT is not comparably and simultaneously elevated [31,33]. It is currently hypothesized that anaerobic glycolysis, which is typical of the metabolism of cancer cells (the "Warburg effect") may explain the prognostic value of the De Ritis ratio [21][22][23][24][26][27][28][29][30]34,35]. In this context, several interactions exist between increased anaerobic glycolysis, an altered NAD+/NADH ratio in the cytoplasm, and AST, which is essential for the function of the malate-aspartate shuttle [31,[36][37][38].…”

“…Furthermore, the Harrell's C index showed that the combined model with a high De Ritis ratio outperformed the prognostic accuracy of clinical factors and high CgA alone. Recently, the De Ritis ratio was introduced as a prognostic parameter of PFS, OS, and other survival outcomes in various tumor types [21][22][23][24][25][26][27][28][29][30]. In particular, Bezan et al firstly attempted a differentiation in low and high De Ritis ratio and demonstrated the prognostic capability of the De Ritis ratio in patients with localized renal cell carcinoma (OS: De Ritis ≥1.26, HR = 1.76, p < 0.001) [21].…”

“…Comparing the cut-off levels, differences could be caused by the different tumor entities, clinical settings and treatment strategies as well as different patterns of metastases, especially with respect to the hepatic metastasis burden [21][22][23][24][25][26][27][28][29][30]. Furthermore, prospective validation of cut-offs was generally not reported, potentially limiting their comparability [21][22][23][24][25][26][27][28][29][30].…”

“…The ratio of aspartate aminotransferase [AST]/alanine aminotransferase [ALT] in the pretherapeutic blood serum or heparin plasma, the so-called ''De Ritis ratio" [20], has been recently reported to be a valuable and independent prognostic factor in the treatment of different tumor entities [21][22][23][24][25][26][27][28][29]. Furthermore, a representative meta-analysis, which included 9400 patients with different types of cancer, demonstrated that a high AST/ALT ratio was associated with an impaired overall survival (OS) [30].…”

The AST/ALT (De Ritis) Ratio Independently Predicts Adverse Outcomes in Patients with Pyogenic Liver Abscess

“…AST/ALT was then employed for estimating the occurrence of progressive fibrosis in chronic hepatic B cases and negative surviving state in chronic viral hepatitis C [14]. AST/ALT recently appears as a prognosisrelated biomarker in certain types of malignant tumor and a conducive predicting element in terms of non-hepatic diseases [15][16][17]. For instance, in a general European cohort of nonmetastatic renal cell carcinoma cases, Bezan and colleagues detected pre-operating AST/ALT as a predicting element of a unfavorable clinics-related consequence [15].…”