Introduction

Recently, several studies have shown that the De Ritis (aspartate transaminase/alanine transaminase) ratio can be a useful prognostic biomarker in patients with certain types of malignant tumors. However, the prognostic value of the De Ritis ratio in patients with upper tract urothelial carcinoma remains largely unknown. The aim of the present study was to evaluate the prognostic significance of the De Ritis ratio in patients with upper urinary tract urothelial carcinoma after radical nephroureterectomy (RNU).

Methods

One thousand forty-nine patients who underwent RNU at eight institutions from 2004 to 2015 were retrospectively reviewed. The effect of the De Ritis ratio and conventional clinicopathological parameters were analyzed. Survival analysis was performed using the Kaplan-Meier method and log-rank test. Multivariable analysis was performed using the Cox proportional hazard regression model. Cutoff values of the De Ritis ratio were calculated using a receiver operating characteristic curve (ROC).

Results

According to the ROC curve, the cutoff value for overall death was 1.6 (p=0.002). The cancer-specific survival (CSS) and overall survival (OS) were significantly shorter for patients with a high De Ritis ratio (>1.6). Results of multivariable analysis identified an increased De Ritis ratio (>1.6) as independently related to worse CSS (hazard ratio [HR] 2.49, 95% confidence interval [CI] 1.70-3.64; p=0.001) and OS (HR 1.84, 95% CI 1.34-2.52; p=0.001).

Conclusions

Our results suggest that the De Ritis ratio can be a significant predictor of oncological outcomes in patients with upper urinary tract urothelial carcinoma after surgery.

Funding

none