Preoperative AST/ALT (De Ritis) Ratio as a Prognostic Factor in a Cohort of Patients who underwent radical cystectomy

Aim: This study aims to evaluate the prognostic significance of the preoperative aspartate aminotransferase (AST) / alanine aminotransferase (ALT) (De Ritis) ratio in bladder cancer (BC) patients who underwent radical cystectomy (RC). Materials-Method: We evaluated the clinical and histopathological data of 58 patients who had undergone RC between January 2008-August 2018 at our tertiary hospital. The potential prognostic value of the De Ritis ratio with regard to BC was evaluated using ROC curve analysis. The effect of the De Ritis ratio on disease specific survival (DSS) and overall survival (OS) was analyzed using the Kaplan-Meier method and multivariate Cox regression models. Results: A total of fifty-eight patients underwent RC and 95.6% were male (M/F:56/2). Mean age of the patients was 68.6 ± 11,56. The cut-off value of the De Ritis ratio for DSS was calculated as 1.417 in the ROC analysis. In Kaplan-Meier analyses, the group with a higher De Ritis ratio presented a more unfavorable progression in terms of DSS and OS (p=0.004). Based on the Cox regression models adjusted for clinical and pathological parameters, for DSS, the De Ritis ratio (HR 2.70, 95% CI 2.34-3.05 p=0.005) , pathological T stage (HR 3.36, 95% CI 2.91-3.82, p =0.007), and age (HR 1,038 95% CI 1,02-1,05; p=0.015) were determined as independent prognostic factors; and for OS, the De Ritis ratio (HR 2.71, 95% CI 2.33 -3.09; p =0.005), pathological T stage (HR 4.36, 95% CI 3.87 – 4.85; p=0.007) and age (HR 1.04, 95% CI 1.03-1.06; p = 0.015) were determined as independent prognostic factors. Turkce ozet Amac: Radikal sistektomi (RC) uygulanan mesane kanseri (BC) hastalarinda preoperatif olarak degerlendirilen aspartat aminotransaminaz (AST) / alanin aminotransferaz (ALT) (De Ritis) oraninin prognostik onemini degerlendirmeyi amacladik. Materyal-Metod: Ocak 2008 ile Agustos 2018 tarihleri arasinda ucuncu basamak hastanemizde RS uygulanan 58 hastanin klinik ve histopatolojik verilerini inceledik. De Ritis oraninin BC uzerindeki potansiyel prognostik degeri ROC egrisi analizi kullanilarak degerlendirildi. Hastaliga bagli sag kalim (DSS) ve genel sag kalim (OAS) da De Ritis oraninin etkisi, Kaplan-Meier yontemi ve multivariate Cox regresyon modelleri ile analiz edildi. Bulgular: RC uygulanan toplamda ellisekiz hastanin 95.6% erkek (E/K:56/2) idi. Hastalarin yas ortalamasi 68.6± 11,56 idi. ROC analizine gore DSS icin De Ritis oraninin cut-off degeri 1.417 olarak saptandi. Kaplan-Meier analizlerinde yuksek De Ritis orani gorulen grupta DSS ve OAS icin daha kotu progresyon gosterdi (p =0.004). Klinik ve patolojik parametrelerin Cox regresyon modellerinde DSS icin De Ritis orani (HR 2.70, 95% CI 2.34-3.05 p=0.005), patolojik T evresi (HR 3.36, 95% CI 2.91-3.82, p =0.007) ve yas (HR 1,038 95% CI 1,02-1,05; p=0.015) iken OAS icin De Ritis orani (HR 2.71, 95% CI 2.33 -3.09; p =0.005), patolojik T evresi (HR 4.36, 95% CI 3.87–4.85; p=0.007) ve yas (HR 1.04, 95% CI 1.03-1.06; p = 0.015) bagimsiz prognostik faktorler olarak belirlendi. Sonuc : Preoperatif artmis De Ritis orani; RC uygulanan BC hastalarinda bagimsiz bir prognostik faktor olarak degerlendirilebilir. Sonuclarimizin genis ve uygun sekilde tasarlanmis prospektif, randomize calismalarla dogrulanmasi ve desteklenmesi gerekmektedir