AN EVALUATION OF THE AST/ALT RATIO IN PATIENTS WITH MYCOSIS FUNGOIDES AND ITS ASSOCIATION WITH THE SEVERITY OF CUTANEOUS INVOLVEMENT

Öz

Objective: Mycosis fungoides (MF) is the most common T-cell skin lymphoma, and a simple and applicable parameter is need ed to monitor the prognosis of the disease. We investigated the ratio of aspartate aminotransferase (AST) and alanine amino transferase (ALT) in patients with MF. Material and Methods: The research involved a retrospective, cross-sectional study. The records of MF patients were analysed. AST and ALT levels were recorded and the AST/ALT ratio was calculated and compared with the control group. Results: Eighty-five MF patients and 85 healthy controls were included in the study. Males accounted for 56.5% (n=48) of MF patients and 57.6 % (n=49) of healthy group, with no sig nificant difference (p>0.05) between them. AST levels were notably elevated in the MF group compared with the healthy group (p<0.001). Furthermore, there was a significant differ ence in the AST/ALT ratio between the two groups (p=0.005). The AST/ALT ratio cut-off value was 1.067. The AST value in the patients with abnormal lymphadenopathy (LAP) on ultra sonography (USG) was higher than in those with reactive LAP. The AST values of the patients with LAP with fluorodeoxyglu cose (FDG) involvement on positron emission tomography (PET)/computed tomography (CT) were significantly higher than those of the patients without abnormal LAPs (p<0.05). The AST/ALT ratio was weakly positively correlated with the disease stage (p=0.018). Conclusion: AST values and AST/ALT ratios of patients with MF were significantly higher than those of the control group. The AST/ALT ratio can be used as an independent factor in monitor ing the prognosis of patients with MF.

Anahtar Kelimeler

• Mycosis fungoides
• aspartate aminotransferase (AST)
• alanine aminotransferase (ALT)
• AST/ALT ratio
• prog nostic factor

Etik Beyan

Following permission from the local ethics committee, the study was performed in compliance with the Helsinki Declaration Rules (approval no. 192, dated 29.03.2024).

MİKOZİS FUNGOİDES HASTALARINDA AST/ALT ORANININ DEĞERLENDİRİLMESİ VE KUTANÖZ TUTULUMUN ŞİDDETİ İLE İLİŞKİSİ

Öz

Amaç: Mikozis fungoides (MF), derinin en sık görülen T hücreli lenfoması olup hastalığın prognozunu takip etmede kullanışlı, basit parametrelere ihtiyaç duyulmaktadır. Çalışmamızda son za manlarda birçok malignitede prognostik faktör olarak araştırılan aspartat aminotransaminaz (AST) ve alanin aminotransaminaz (ALT) oranının bir deri lenfoması olan MF’de değerlendirilmesini amaçladık. Gereç ve Yöntem: Çalışmamız retrospektif kesitsel bir çalışma dır. Çalışmada MF tanısı alan hastaların dosya taraması yapıldı. AST, ALT değerleri kaydedilerek AST/ALT oranı hesaplanıp, kontrol grubu ile istatistiksel olarak karşılaştırıldı. Bulgular: Çalışmaya 85 MF hastası ve 85 sağlıklı kontrol olmak üzere toplam 170 kişi dahil edildi. Buna göre, MF grubunun %56,5'i (n=48) ve sağlıklı kontrol grubunun %57.6 (n=49)'sı erkek idi ve gruplar arası anlamlı farklılık bulunmuyordu (p>0,05). MF grubunun AST değeri sağlıklı gruba göre daha yüksekti ve istatistiksel anlamlı farklılık saptandı (p<0,001). AST/ALT oranı her iki grup arasında istatistiksel olarak anlam lı farklılık saptandı (p=0,005). AST/ALT oranı cut-off değeri ise 1,067 bulunmuştur. USG’de anormal LAP saptanan hastalarda AST değeri reaktif LAP olanlara göre daha yüksek bulundu. PET CT’de ise, FDG tutulumu olan LAP’ları saptanan hastaların AST değeri, anormal LAP’ları olmayan hastalardan anlamlı yüksek olarak saptandı (p<0,05). AST/ALT oranı ise hastalık evresi ile zayıf pozitif korele bulundu (p=0,018). Sonuç: Çalışmamızın sonucunda, MF’li hastaların AST değeri ve AST/ALT oranı sağlıklı kontrol grubuna göre istatistiksel olarak anlamlı yüksek bulunmuştur. MF hastalarının prognozunun taki binde AST/ALT oranı bağımsız bir faktör olarak kullanılabilir.

Anahtar Kelimeler

• Mikozis fungoides
• aspartat aminotransfe raz (AST)
• alanin aminoaminotransferaz (ALT)
• AST/ALT oranı
• prognostik faktör

Kaynakça

1. Jawed SI, Myskowski PL, Horwitz S, Moskowitz A, Querfeld C. Primary cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome): part II. Prognosis, management, and future directions. J Am Acad Dermatol 2014;70(2):223.e1-42 [CrossRef] google scholar
2. Quaglino P, Pimpinelli N, Berti E, Calzavara-Pinton P, Alfonso Lombardo G, Rupoli S, et al. Gruppo Italiano Linfomi Cutanei. Time course, clinical pathways, and long-term hazards risk trends of disease progression in patients with classic mycosis fungoides: a multicenter, retrospective follow-up study from the Italian Group of Cutaneous Lymphomas. Cancer 2012;118(23):5830-9. [CrossRef] google scholar
3. Olsen E, Vonderheid E, Pimpinelli N, Willemze R, Kim Y, Knobler R, et al. ISCL/EORTC. Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC). Blood 2007;110(6):1713-22. [CrossRef] google scholar
4. Agar NS, Wedgeworth E, Crichton S, Mitchell TJ, Cox M, Ferreira S, et al. Survival outcomes and prognostic factors in mycosis fungoides/sezary syndrome: validation of the revised international society for cutaneous lymphomas/ european organisation for research and treatment of cancer staging proposal. Clin Oncol 2010;28(31):4730-9. [CrossRef] google scholar
5. Kolahdoozan S, Mirminachi B, Sepanlou SG, Malekzadeh R, Merat S, Poustchi H. Upper normal limits of serum alanine aminotransferase in healthy population: A Systematic Review. Middle East J Dig Dis 2020;12(3):194-205. [CrossRef] google scholar
6. Botros M, Sikaris KA. The de ritis ratio: The test of time. Clin Biochem. Rev 2013;34(3):117-130. google scholar
7. Giannini E, Botta F, Testa E, Romagnoli P, Polegato S, Malfatti F, et al. The 1-year and 3-month prognostic utility of the AST/ALT ratio and model for end-stage liver disease score in patients with viral liver cirrhosis. Am J Gastroenterol 2002;97(11):2855-60. [CrossRef] google scholar
8. 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.e9-15. [CrossRef] google scholar

9. Moore RA, Popowicz P, Burns B. Rule of Nines. In: StatPearls. Treasure Island. StatPearls Publishing. 2024 Feb 12 (cited 2025 January 7). https://www.ncbi.nlm.nih.gov/ books/NBK513287. google scholar
10. De Ritis F, Coltorti M, Giusti G. An enzymic test for the diagnosis of viral hepatitis; the transaminase serum activities. Clin Chimi Acta 1957;2(1):70-4. [CrossRef] google scholar
11. Conde VR, Oliveira PF, Nunes AR, Rocha CS, Ramalhosa E, Pereira JA, et al. The progression from a lower to a higher invasive stage of bladder cancer is associated with severe alterations in glucose and pyruvate metabolism. Exp Cell Res 2015;335(1):91-8. [CrossRef] google scholar
12. Wang H, Fang K, Zhang J, Jiang Y, Wang G, Zhang H, et al. The significance of De Ritis (aspartate transaminase/alanine transaminase) ratio in predicting pathological outcomes and prognosis in localized prostate cancer patients. Int Urol Nephrol 2017;49(8):1391-8. [CrossRef] google scholar
13. Ha YS, Kim SW, Chun SY, Chung JW, Choi SH, Lee JN, 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. [CrossRef] google scholar
14. Ishihara H, Kondo T, Yoshida K, Omae K, Takagi T, Iizuka J, et al. Evaluation of preoperative aspartate transaminase/alanine transaminase ratio as an independent predictive biomarker in patients with metastatic renal cell carcinoma undergoing cytoreductive nephrectomy: A propensity score matching study. Clin Genitourin Cancer 2017;15(5):598-604. [CrossRef] google scholar
15. Tan X, Xiao K, Liu W, Chang S, Zhang T, Tang H. Prognostic factors of distal cholangiocarcinoma after curative surgery: a series of 84 cases. Hepatogastroenterology 2013;60(128):1892-5. google scholar
16. Stocken DD, Hassan AB, Altman DG, Billingham LJ, Bramhall SR, Johnson PJ, et al. Modelling prognostic factors in advanced pancreatic cancer. Br J Cancer 2008;99(6):883-93. [CrossRef] google scholar
17. Willemze R, Cerroni L, Kempf W, Berti E, Facchetti F, Swerdlow SH, et al. The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas. Blood 2019;133(16):1703-14. [CrossRef] google scholar
18. van Beek JH, de Moor MH, de Geus EJ, Lubke GH, Vink JM, Willemsen G, et al. The genetic architecture of liver enzyme levels: GGT, ALT and AST. Behav Genet 2013;43(4):329-39. [CrossRef] google scholar