Is Aspartate Aminotransferase to Alanine Aminotransferase (De Ritis Ratio) Helpful in Predicting Breast Cancer?

Abstract

Aim: De Ritis ratio (aspartate transaminase/alanine transaminase) may be a useful prognostic biomarker for certain malignant tumors. However, the predictive value of the De Ritis ratio before treatment in preoperative staging in patients with breast cancer is unknown. This study aimed to evaluate the De Ritis ratio in benign and malignant breast diseases and investigate the predictive value of it for breast cancer. Methods: Retrospective analysis was made of the clinicopathological data of 301 patients with benign breast disease and breast cancer treated between April 2017 and April 2020 in a single center. 64 Patients were excluded from the study due to chronic illness or incomplete data. The relationship between the De Ritis ratio and clinicopathological findings before treatment was evaluated in patients. The Mann Whitney U test and Kruskal Wallis test were used in the comparisons between groups. Results: Of the total 237 patients, the number of patients with benign breast disease was 96 and the number of the patients with breast cancer was 141. No statistically significant results were determined between the benign breast disease and breast cancer groups, in respect of pre-treatment evaluation of the De Ritis ratio and as a predictive factor for preoperative staging in molecular subtyping, tumor diameter, lymph node metastasis, and Ki 67 index. Conclusion: It was concluded that the De Ritis ratio examined before treatment was not an independent predictive factor in breast cancer diagnosis and staging.

Keywords

• De ritis ratio
• aspartate transaminase
• alanine transaminase
• breast cancer
• predictive factor

Aspartat Aminotransferaz/Alanin Aminotransferaz (De Ritis Oranı) Oranı Meme Kanserini Tahmin Etmede Yardımcı Olur mu?

Abstract

Amaç: De Ritis oranı (aspartat transaminaz / alanin transaminaz) belirli malign tümörler için yararlı bir prognostik biyobelirteç olabilir. Bununla birlikte, meme kanseri olan hastalarda tedavi öncesi incelenen De Ritis oranının preop evrelemede prediktif değeri büyük ölçüde bilinmemektedir. Bu çalışmanın amacı, benign ve malign meme hastalıklarında De Ritis oranını değerlendirmek ve bunun meme kanseri için prediktif değerini araştırmaktır. Yöntemler: Nisan 2017- nisan 2020 yılları arasında benign meme hastalığı ve meme kanserli 301 hastanın klinikopatolojik verileri tek bir merkezde retrospektif olarak analiz edildi. Kronik hastalığı olan veya veri eksiği olan 64 hasta çalışmadan çıkarıldı. De Ritis oranının tedavi öncesi değeri ile, hastaların klinikopatolojik bulguları arasındaki ilişki değerlendirildi. Gruplar arası karşılaştırmalarda Mann Whitney U testi ve Kruskal Wallis testi kullanıldı. Bulgular: 237 hastada, benign meme hastalığı olan 96, meme kanseri olan hasta sayısı ise 141 idi. De ritis oranın tedavi öncesi değeri ile, benign meme hastalığı ve meme kanseri arasında, ayrıca meme kanserinde prognostik faktör olan moleküler subtiplendirme, tümör çapı, lenf nodu metastazı ve Ki 67 indeksinde preoperatif evrelemede prediktif faktör olarak istatisksel anlamlı sonuçlara ulaşılamadı. Sonuç: Tedavi öncesi incelenen De ritis oranın meme kanseri evrelemesinde bağımsız prediktif faktör olmadığı sonucuna ulaşıldı.

Keywords

• De Ritis oranı
• aspartat transaminaz
• alanin transaminaz
• meme kanseri
• prediktif faktör

References

1. 1. Sharma R. Breast cancer incidence, mortality and mortality-to-incidence ratio (MIR) are associated with human development, 1990-2016: evidence from Global Burden of Disease Study 2016. Breast cancer (Tokyo, Japan). 2019;26(4):428-45 (doi:10.1007/s12282-018-00941-4).
2. 2. Cardoso F, Saghatchian M, Thompson A, Rutgers E, Committee TCS. Inconsistent criteria used in American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 2008;26(12):2058-9; author reply 60-1 (doi:10.1200/JCO.2007.15.6638).
3. 3. Harris L, Fritsche H, Mennel R, et al. American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 2007;25(33):5287-312 (doi:10.1200/JCO.2007.14.2364).
4. 4. Thriveni K JR KL, Deshmane V, Bapsy P, Ramaswamy G. Serum Transaminases Ratio in Breast Cancer Patients.Austral-Asian Journal of Cancer 2009. 8; 4:207-209.
5. 5. Moss and Henderson, A.R. Clinical Enzymology. In: Burtis, C.A. and Ashwood, E.R., editors. Tietz Textbook of Clinical Chemistry. 3rd ed. Saunders: Philadephia;1999.p.617-77.
6. 6. De Ritis F, Coltorti M, Giusti G. An enzymic test for the diagnosis of viral hepatitis; the transaminase serum activities. Clin Chim Acta. 1957;2(1):70-4 (doi:10.1016/0009-8981(57)90027-x).
7. 7. Bezan A, Mrsic E, Krieger D, et al. The Preoperative AST/ALT (De Ritis) Ratio Represents a Poor Prognostic Factor in a Cohort of Patients with Nonmetastatic Renal Cell Carcinoma. J Urol. 2015;194(1):30-5 (doi:10.1016/j.juro.2015.01.083).
8. 8. Thornburg JM, Nelson KK, Clem BF, et al. Targeting aspartate aminotransferase in breast cancer. Breast Cancer Res. 2008;10(5):R84 (doi:10.1186/bcr2154).

9. 9. Lee H, Lee SE, Byun SS, Kim HH, Kwak C, Hong SK. 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. BJU Int. 2017;119(2):261-7 (doi:10.1111/bju.13545).
10. 10. Gao F, Chen C, Lu J, et al. De Ritis ratio (AST/ALT) as an independent predictor of poor outcome in patients with acute ischemic stroke. Neuropsychiatr Dis Treat. 2017;13:1551-7 (doi:10.2147/NDT.S139316).
11. 11. Liu Y, Zhao P, Cheng M, et al. AST to ALT ratio and arterial stiffness in non-fatty liver Japanese population:a secondary analysis based on a cross-sectional study. Lipids Health Dis. 2018;17(1):275 (doi:10.1186/s12944-018-0920-4).
12. 12. Pilarczyk K, Carstens H, Heckmann J, et al. The aspartate transaminase/alanine transaminase (DeRitis) ratio predicts mid-term mortality and renal and respiratory dysfunction after left ventricular assist device implantation. Eur J Cardiothorac Surg. 2017;52(4):781-8 (doi:10.1093/ejcts/ezx247).
13. 13. Rief P, Pichler M, Raggam R, et al. The AST/ALT (De-Ritis) ratio: A novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. Medicine (Baltimore). 2016;95(24):e3843 (doi:10.1097/MD.0000000000003843).
14. 14. Liu L, Wang W, Zhang Y, et al. Declined Preoperative Aspartate Aminotransferase to Neutrophil Ratio Index Predicts Poor Prognosis in Patients with Intrahepatic Cholangiocarcinoma after Hepatectomy. Cancer Res Treat. 2018;50(2):538-50 (doi:10.4143/crt.2017.106).
15. 15. Mori K, Janisch F, Mostafaei H, et al. Prognostic role of preoperative De Ritis ratio in upper tract urothelial carcinoma treated with nephroureterectomy. Urol Oncol. 2020;38(6):601 e17- e24 (doi:10.1016/j.urolonc.2020.02.008).
16. 16. Ha YS, Kim SW, Chun SY, et al. Association between De Ritis ratio (aspartate aminotransferase/alanine aminotransferase) and oncological outcomes in bladder cancer patients after radical cystectomy. BMC Urol. 2019;19(1):10 (doi:10.1186/s12894-019-0439-7).
17. 17. Wu J, Chen L, Wang Y, Tan W, Huang Z. Prognostic value of aspartate transaminase to alanine transaminase (De Ritis) ratio in solid tumors: a pooled analysis of 9,400 patients. Onco Targets Ther. 2019;12:5201-13 (doi:10.2147/OTT.S204403).
18. 18. Nishikawa M, Miyake H, Fujisawa M. De Ritis (aspartate transaminase/alanine transaminase) ratio as a significant predictor of recurrence-free survival in patients with upper urinary tract urothelial carcinoma following nephroureterectomy. Urol Oncol. 2016;34(9):417 e9- e15 (doi:10.1016/j.urolonc.2016.04.001).
19. 19. Katzke V, Johnson T, Sookthai D, Husing A, Kuhn T, Kaaks R. Circulating liver enzymes and risks of chronic diseases and mortality in the prospective EPIC-Heidelberg case-cohort study. BMJ Open. 2020;10(3):e033532 (doi:10.1136/bmjopen-2019-033532).
20. 20. Dang CV. Links between metabolism and cancer. Genes & development. 2012;26(9):877-90 (doi:10.1101/gad.189365.112).
21. 21. Zheng J, Seier K, Gonen M, et al. Utility of Serum Inflammatory Markers for Predicting Microvascular Invasion and Survival for Patients with Hepatocellular Carcinoma. Ann Surg Oncol. 2017;24(12):3706-14 (doi:10.1245/s10434-017-6060-7).