Background. This study is aimed at examining the prognostic role of pre-to-postoperative dynamics of De Ritis ratio (aspartate aminotransaminase (AST)/alanine aminotransaminase (ALT)) in patients with nonmetastatic renal cell carcinoma (RCC) following radical nephrectomy. Methods. We retrospectively reviewed the records of 670 patients who underwent radical nephrectomy for nonmetastatic RCC between 1996 and 2012 at our institution. The cutoff points for preoperative (=1.0) and postoperative AST/ALT ratios (=1.12) were assigned based on the median values. We categorized patients into four groups according to the dynamics of AST/ALT ratios: group 1 (lower (≤1.0) ⟶ lower (≤1.12)), group 2 (lower (≤1.0) ⟶ higher (>1.12)), group 3 (higher (>1.0) ⟶ lower (≤1.12)), and group 4 (higher (>1.0) → higher (>1.12)). Results. When grouped by a preoperative AST/ALT ratio alone, the groups were not statistically different in cancer-specific survival (CSS) or overall survival (OS). In contrast, in Kaplan-Meier analysis, CSS () and OS () were both significantly shorter with an increased postoperative AST/ALT ratio. According to the pre-to-postoperative dynamics of the AST/ALT ratio, group 2 (lower (≤1.0) ⟶ higher (>1.12)) had a significantly lower CSS () and OS () than the other groups. On multivariate Cox regression analysis, the pre-to-postoperative dynamics of the AST/ALT ratio were a significant prognostic factor for CSS (hazard ratio, ) and OS (). Conclusion. This study is the first to suggest that the dynamics of the pre-to-postoperative De Ritis ratio represent an independent prognostic factor for RCC patients following nephrectomy.

中文翻译：

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天冬氨酸转氨酶/丙氨酸转氨酶比值在预测肾细胞癌手术治疗后预后中的临床意义。

背景。本研究旨在检查 De Ritis 比值（天冬氨酸氨基转氨酶 (AST)/丙氨酸氨基转氨酶 (ALT)）在根治性肾切除术后非转移性肾细胞癌 (RCC) 患者中的预后作用。方法. 我们回顾性回顾了 1996 年至 2012 年间在我们机构接受根治性肾切除术治疗非转移性 RCC 的 670 例患者的记录。根据中值分配术前 (=1.0) 和术后 AST/ALT 比值 (=1.12) 的截止点。我们根据 AST/ALT 比值的动态将患者分为四组：第 1 组（较低（≤1.0）⟶ 较低（≤1.12）），第 2 组（较低（≤1.0）⟶ 较高（>1.12）），第 3 组（更高 (>1.0) ⟶ 更低 (≤1.12)）和第 4 组（更高 (>1.0) → 更高 (>1.12)）。结果。当仅按术前 AST/ALT 比率分组时，各组在癌症特异性生存期 (CSS) 或总生存期 (OS) 方面没有统计学差异。相反，在 Kaplan-Meier 分析中，CSS ()和操作系统 (）随着术后 AST/ALT 比值的增加而显着缩短。根据 AST/ALT 比率的术前至术后动态，第 2 组（较低 (≤1.0) ⟶ 较高 (>1.12)）的 CSS 显着降低（)和操作系统 ()比其他组。在多变量 Cox 回归分析中，AST/ALT 比率的术前至术后动态是 CSS 的重要预后因素（风险比、)和操作系统 (）。 结论。这项研究首次表明，术前与术后 De Ritis 比率的动态变化代表了肾切除术后 RCC 患者的独立预后因素。