Can the de Ritis Ratio (AST/ALT) Be Used to Predict Colon Cancer Stages?

Abstract

Purpose: The De Ritis ratio (Aspartate transaminase/alanine transaminase) is a critical prognostic factor for some kinds of malignant tumors. Nevertheless, the De Ritis ratio’s prognostic value in preoperative colon cancer staging is unclear. The purpose of this research was to determine the De Ritis ratio and its prognostic significance for colon cancer. Materials and Methods: The clinicopathological data of 271 individuals with malign colon cancer were analyzed retrospectively at a single center from January 2010 to January 2018. The relationship between the De Ritis coefficient and clinicopathological findings in patients was evaluated before treatment. To compare the groups, the Mann-Whitney U test and the Kruskal Wallis test were performed. Results: The results indicated that there were no statistically significant differences between the groups in terms of pre-treatment De Ritis ratio assessment as a staging, localization, tumor diameter, lymph node metastasis, age, and overall survival. However, differences in T staging between groups of male participants were shown to be statistically significant. Conclusions: The De Ritis ratio evaluation before treatment was not found as an independent variable prognostic factor for the diagnosis and staging of colon cancer. However, future studies may demonstrate the significance of the De Ritis ratio with more participants.

Keywords

• adenocarcinoma
• survival
• prognosis

De Ritis Oranı (AST/ALT) Kolon Kanseri Evrelerini Tahmin Etmek Için Kullanılabilir Mi?

Abstract

Amaç: De Ritis oranı (Aspartat transaminaz/alanin transaminaz), bazı malign tümör türleri için kritik bir prognostik faktördür. Bununla birlikte, ameliyat öncesi kolon kanseri evrelemesinde De Ritis oranının prognostik değeri belirsizdir. Bu araştırmanın amacı kolon kanserinde De Ritis oranını ve kolon kanseri için prognostik önemini belirlemektir. Araçlar ve Yöntem: Ocak 2010'dan Ocak 2018'e kadar tek merkezde malign kolon kanserli 271 bireyin klinikopatolojik verileri geriye dönük olarak analiz edildi. Ameliyat öncesi dönemde hastaların De Ritis oranı ile klinikopatolojik bulguları arasındaki ilişki değerlendirildi. Grupları karşılaştırmak için Mann-Whitney U testi ve Kruskal Wallis testi yapıldı. Bulgular: Sonuçlar, tedavi öncesi De Ritis oranı değerlendirmesi açısından evreleme, lokalizasyon, tümör çapı, lenf nodu metastazı, yaş ve genel sağkalım açısından gruplar arasında istatistiksel olarak anlamlı bir fark olmadığını gösterdi. Bununla birlikte erkek hastalar arasındaki T evrelemesindeki farklılıkların istatistiksel olarak anlamlı olduğu gösterildi. Sonuç: Tedavi öncesi değerlendirilen De Ritis oranı kolon kanseri tanı ve evrelemesinde bağımsız bir değişken prognostik faktör değildi. Bununla birlikte, gelecekteki çalışmalar, daha fazla katılımcıyla De Ritis oranının önemini gösterebilir.

Keywords

• adenokarsinom
• sağkalım
• prognoz

References

1. 1. Chen SL, Li JP, Li LF, Zeng T, He X. Elevated Preoperative Serum Alanine Aminotransferase / Aspartate Aminotransferase (ALT/AST) Ratio Is Associated with Better Prognosis in Patients Un-dergoing Curative Treatment for Gastric Adeno-carcinoma. Int J Mol Sci. 2016;17(6):911.
2. 2. Bezan A, Mrsic E, Krieger D, et al. The Pre-operative 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):30-35.
3. 3. Varol U, Kaya E, Oflazoglu U, et al. Prognostic role of De Ritis and basal neutrophil to lympho-cyte ratio in patients with advanced stage pancre-atic cancer [IzmirOncologyGroup (IZOG) Study]. J BUON. 2020;25(2):1063-1069.
4. 4. Knittelfelder O, Delago D, Jakse G, et al. The AST/ALT (De Ritis) Ratio Predicts Survival in Patients with Oral and Oropharyngeal Can-cer. Diagnostics (Basel). 2020;10(11):973.
5. 5. Wu J, Chen L, Wang Y, Tan W, Huang Z. Prog-nostic value of aspartate transaminase to alanine transaminase (De Ritis) ratio in solid tumors: a pooled analysis of 9,400 patients. Onco Targets Ther. 2019;12:5201-5213.
6. 6. Liu L, Wang W, Zhang Y, et al. Declined Pre-operative Aspartate Aminotransferase to Neutro-phil Ratio Index Predicts Poor Prognosis in Pa-tients with Intrahepatic Cholangiocarcinoma after Hepatectomy. Cancer Res Treat. 2018;50(2):538-550.
7. 7. Mori K, Janisch F, Mostafaei H, et al. Prognostic role of preoperative De Ritis ratio in upper tract urothelial carcinoma treated with nephroureterec-tomy. Urol Oncol. 2020;38(6):601.e17-601.e24.
8. 8. Ha YS, Kim SW, Chun SY, et al. Association be-tween De Ritis ratio (aspartateaminotransferase / alanineaminotransferase) and oncological out-comes in bladder cancer patients after radical cystectomy. BMC Urol. 2019;19(1):10.

9. 9. Zhang LX, Lv Y, Xu AM, Wang HZ. The prog-nostic significance of serum gamma-glutamyl transferase levels and AST/ALT in primary he-patic carcinoma. BMC Cancer. 2019;19(1):1-9.
10. 10. Thornburg JM, Nelson KK, Clem BF, et al. Tar-geting aspartate aminotransferase in breast can-cer. Breast Cancer Res. 2008;10(5):1-12.
11. 11. Lee H, Lee SE, Byun SS, Kim HH, Kwak C, Hong SK. De Ritis ratio (aspartatetransaminase / alaninetransaminaseratio) as a significant prog-nostic factor after surgical treatment in patients with clear-cell localized renal cell carcinoma: a propensity score-matched study. BJU Int. 2017;119(2):261-267.
12. 12. Li Y, Fang D, Bao Z, et al. High aspartatetrans-aminase / alaninetransaminase ratio predicts poor prognosis in patients with localized upper tract urothelial cancer: a propensity score-matched study in a large Chinese center. Onco Targets Ther. 2019;12:2635-2648.
13. 13. Durhan A, Şenlikci A, Ergüder E. et al. Is Aspar-tate Aminotransferase to Alanine Aminotransfer-ase (De Ritis Ratio) Helpful in Predicting Breast Cancer? Arch Clin Exp Med. 2021;6(1):13-16.
14. 14. Stocken DD, Hassan AB, Altman DG, et al. Modelling prognostic factors in advanced pan-creatic cancer. Br J Cancer. 2008;99(6):883-893.
15. 15. Tan X, Xiao K, Liu W, Chang S, Zhang T, Tang H. Prognostic factors of distal cholangiocarci-noma after curative surgery: a series of 84 cas-es. Hepatogastroenterology. 2013;60(128):1892-1895.
16. 16. Canat L, Ataly HA, Agalarov S, Alkan I, Altun-rende F. The effect of AST/ALT (De Ritis) ratio on survival and its relation to tumor histopatho-logical variables in patients with localized renal cell carcinoma. Int Braz J Urol. 2018;44(2):288-295.
17. 17. Zhou J, He Z, Ma S, Liu R. AST/ALT ratio as a significant predictor of the incidence risk of prostate cancer. Cancer Med. 2020;9(15):5672-5677.
18. 18. Ahn HJ, Oh HS, Ahn Y, et al. Prognostic Impli-cations of Primary Tumor Resection in Stage IV B Colorectal Cancer in Elderly Patients. Ann Coloproctol. 2014;30(4):175-181.
19. 19. 19. Scheipner L, Smolle MA, Barth D, et al. The AST/ALT Ratio Is an Independent Prognostic Marker for Disease-free Survival in Stage II and III Colorectal Carcinoma. Anti cancer Res. 2021;41(1): 429-436.