Erken Evre Differansiye Tiroid Kanserlerinde AST/ALT (De Ritis) Oranı

Abstract

Amaç: Diferansiye tiroid kanserleri, endokrin kanserler arasında en sık olarak görülendir ve görüntüleme olanaklarının artması ile de sıklığı giderek artmaktadır. Çeşitli malignitelerde; karaciğer metastazı olmasa bile, artmış metabolizmaya, doku zedelenmesine ve hızlı tümör döngüsüne bağlı olarak AST değerinin ALT’ ye oranla arttığpı saptanmıştır. Bu oran De Ritis oranı olarak bilinmekte olup çalışmamızda erken evre tiroid kanserlerinde histopatalojik alt tip, multifokalite, hastalığın evresi ve risk grubu ile AST/ALT (De Ritis) oranı arasında bir ilişki olup olmadığını değerlendirmeyi planladık. Yöntem: Kliniğimizde 2016-2019 yılları arasında diferansiye tiroid kanseri tanısı almış 154 hasta çalışmaya dahil edildi. Hastaların preoperatif dönemdeki AST/ALT oranları kaydedildi. Postoperatif patoloji raporları değerlendirilerek her hastanın tümör evrelemesi Amerikan Ortak Kanser Komitesi (AJCC) 8‘e göre yapıldı. Hastaların operasyon öncesi De Ritis oranları ile postoperatif evreleme arasındaki korelasyon değerlendirildi. Bulgular: Çalışmamızda hastaların De Ritis değerinin ortalaması 1,18 olarak saptandı. De Ritis oranı ≥1,5 olan hasta oranı %15,9 idi. Preoperatif De Ritis oranı ile histopatolojik alt tip, vasküler invazyon, kapsül invazyonu, tümör çapı, lenf nodu tutulumu ve tümör evresi ile arasında istatistiksel olarak anlamlı fark saptanmadı. Sonuç: Çalışmamızda preoperatif De Ritis oranının, erken evre diferansiye tiroid kanserlerinde hastalık evresi ve risk durumuyla ilişkisi olmadığını saptadık. İleri evre diferansiye tiroid kanserlerindeki önemi için ek çalışmalara ihtiyaç vardır.

Keywords

• Diferansiye tiroid kanseri
• AST/ALT
• De Ritis oranı

AST/ALT (De Ritis) Ratio in Early Stage Differentiated Thyroid Cancer

Abstract

Objective: Differentiated thyroid cancers are the most common endocrine cancers and their frequency is increasing with the increase in imaging possibilities. In various malignancies; Even in the absence of liver metastases, it was determined that AST value increased compared to ALT due to increased metabolism, tissue damage and rapid tumor turnover. This rate is known as the De Ritis rate, and in our study, we planned to evaluate whether there is a relationship between histopathological subtype, multifocality, disease stage and risk group and AST/ALT (De Ritis) ratio in early stage thyroid cancers. Method: A total of 154 patients diagnosed with differentiated thyroid cancer in our clinic between 2016 and 2019 were included in the study. The AST/ALT ratios of the patients in the preoperative period were recorded. Tumor staging of each patient was performed according to the American Joint Cancer Committee (AJCC) 8 by evaluating the postoperative pathology reports. The correlation between the patients' preoperative De Ritis rates and postoperative staging was evaluated. Results: In our study, the mean De Ritis value of the patients was found to be 1.18. The rate of patients with De Ritis rate ≥1.5 was 15.9%. There was no statistically significant difference between preoperative De Ritis rate and histopathological subtype, vascular invasion, capsule invasion, tumor diameter, lymph node involvement and tumor stage. Conclusion: In our study it was found that preoperative De Ritis ratio was not associated with disease stage and risk status in early stage differentiated thyroid cancers. Additional studies are needed for its importance in advanced differentiated thyroid cancers.

Keywords

• Differentiated thyroid cancer
• De Ritis ratio
• AST/ALT

References

1. Sherman SI. Thyroid carcinoma. Lancet. 2003;361:501-511.
2. Kitahara CM, Sosa JA. The changing incidence of thyroid cancer. Nat Rev Endocrinol. 2016 Nov;12(11):646-653. doi: 10.1038/nrendo.2016.110.
3. Ravetto C, Colombo L, Dottorini ME. Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients. Cancer. 2000;25;90(6):357-363.
4. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;6(1):1-133. doi: 10.1089/thy.2015.0020.
5. Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 1988; 104(6):947-953.
6. Hay ID, Bergstralh EJ, Goellner JR, et al. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery. 1993;114 (6):1050-1058.
7. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM. Ann Surg Oncol. 2010;17(6):1471-1474.
8. Tuttle RM, Tala H, Shah J, et al. Estimating risk of recurrence in differentiated cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid. 2010;20(12):1341-1349.

9. Pitoia F, Bueno F, Urcluoli C, et al. Outcome of patients with differentiated thyroid cancer risk stratified according to the American Thyroid Association and Latin-American Thyroid Society risk of recurrence classification systems. Thyroid. 2013;23(11):1401-1407.
10. 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.
11. Moss and Henderson, A.R. Clinical Enzymology. In: Burtis, C.A. and Ashwood, E.R., Eds., Tietz Textbook of Clinical Chemistry, 3rd Edition. Philadephia: Saunders; 1999:617-677.
12. 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):70-74.
13. 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):303-305.
14. Thornburg JM, Nelson KK, Clem BF, et al. Targeting aspartate aminotransferase in breast cancer. Breast Cancer Res. 2008;10(5):84.
15. 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):261-267.
16. Canat L, Ataly HA, Agalarov S, Alkan I, Altunrende F. The effect of AST/ALT (De Ritis) ratio on survival and its relation to tumor histopathological variables in patients with localized renal cell carcinoma. Int Braz J Urol. 2018;44(2):288-295. doi:10.1590/S1677-5538.IBJU.2017.0173.
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;2(12):5201-5213.
18. 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.
19. Durhan A, Şenlikci A, Ergüder E, et al. Is Aspartate Aminotransferase to Alanine Aminotransferase (De Ritis Ratio) Helpful in Predicting Breast Cancer? Archives of Clinical and Experimental Medicine. 2021;6(1):13-16. doi: 10.25000/acem.854289.
20. Dang CV. Links between metabolism and cancer. Genes Dev. 2012;26(9):877-890.