De Ritis ratio (aspartate transaminase/alanine transaminase ratio) as a significant prognostic factor after surgical treatment in patients with clear‐cell localized renal cell carcinoma: a propensity score‐matched study

Objective To evaluate the associations of preoperative De Ritis ratio (aspartate transaminase [ AST ]/alanine transaminase [ ALT ]) with postoperative clinical outcomes after surgical treatment of localized RCC . Materials and Methods We retrospectively reviewed data from 2 965 patients surgically treated for non‐metastatic RCC . Propensity scores for high AST / ALT ratio were calculated and 430 patients with a high AST / ALT ratio were matched to 1 117 patients with a low AST / ALT ratio. The association between AST / ALT ratio and postoperative outcomes was tested. Multivariate Cox analyses were performed to identify the independent predictors of progression‐free ( PFS ), overall ( OS ) and cancer‐specific survival ( CSS ). Results According to the receiver‐operating curve of AST / ALT for cancer‐specific mortality, we stratified the patients into two groups using a threshold of 1.5. Before matching, patients with a high AST / ALT ratio had worse PFS , OS and CSS (all P < 0.001). In the propensity score‐matched cohort with 1 547 patients, patients with a high AST / ALT ratio had inferior PFS , OS and CSS outcomes (all P < 0.001). Multivariate analysis showed that a high AST / ALT ratio was an independent predictor of disease progression (hazard ratio [ HR ] 1.372, 95% CI 1.003–1.882; P = 0.048), overall mortality ( HR 1.559, 95% CI 1.069–2.272; P = 0.021), and cancer‐specific mortality ( HR 1.974, 95% CI 1.250–3.118; P = 0.004). In a subgroup analysis according to tumour histology, high AST / ALT had a significant association with postoperative survival in clear‐cell renal cell carcinoma ( RCC ), but not in non‐clear‐cell RCC . Conclusion An elevated AST / ALT ratio was significantly associated with worse postoperative survival in patients surgically treated for localized clear‐cell RCC . Further prospective studies are needed to understand the prognostic value of preoperative AST / ALT ratio.