Skip to main content

Advertisement

Springer Nature Link
Log in

The significance of De Ritis (aspartate transaminase/alanine transaminase) ratio in predicting pathological outcomes and prognosis in localized prostate cancer patients

  • Urology – Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To illustrate whether De Ritis (aspartate transaminase-AST/alanine transaminase-ALT) ratio is useful in risk stratification of localized prostate cancer and propose an easy predictive model for biochemical recurrence-free survival (BCRFS).

Methods

In total, 438 patients who underwent radical prostatectomy were included in this study. Blood samples including AST and ALT were collected 1–7 days before surgery. An elevated AST and ALT value was defined as over 40 or 56 IU/L.

Results

The median AST and ALT value was 18.5 (16–22) and 14 (11–18) IU/L. In total, 15 patients (3.4%) and 9 patients (2.1%) exhibited elevated AST value and ALT value. The median De Ritis ratio was 1.33 (1.11–1.60), and ROC curve indicated the best cutoff of 1.325 in predicting the occurrence of biochemical recurrence. Higher De Ritis ratio was found to be related to older age (p < 0.001), higher tumor stages (p < 0.001) and Gleason Score (p < 0.001), presence of seminal invasion (p < 0.001), positive surgical margin (p < 0.001) and lymph node metastasis (p = 0.003). Multivariate logistic regression confirmed that De Ritis ratio was an independent predictor for final Gleason Score (p < 0.001), and multivariate Cox regression demonstrated De Ritis ratio as an independent risk factor for BCRFS. A simple predictive model which incorporated De Ritis ratio, pathological tumor stage and final Gleason Score could help risk stratification for BCRFS.

Conclusion

Higher De Ritis ratio could be predictive for worse pathological outcomes and higher BCR in localized prostate cancer patients. A predictive model which incorporates De Ritis ratio, Gleason Score and pathological tumor stage could help risk stratification for BCRFS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

References

  1. Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66(1):7–30

    Article  PubMed  Google Scholar 

  2. Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, Mottet N, Schmid HP, van der Kwast T, Wiegel T, Zattoni F, European Association of U (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59(1):61–71

    Article  PubMed  Google Scholar 

  3. Vagnoni V, Bianchi L, Borghesi M, Pultrone CV, Dababneh H, Chessa F, La Manna G, Rizzi S, Porreca A, Brunocilla E, Martorana G, Schiavina R (2016) Adverse features and competing risk mortality in patients with high-risk prostate cancer. Clin Genitourin Cancer 15:e239–e248

    Article  PubMed  Google Scholar 

  4. Aoun F, Albisinni S, Henriet B, Tombal B, Van Velthoven R, Roumeguere T (2017) Predictive factors associated with biochemical recurrence following radical prostatectomy for pathological T2 prostate cancer with negative surgical margins. Scand J Urol 51(1):20–26

    Article  CAS  PubMed  Google Scholar 

  5. Gu X, Gao X, Li X, Qi X, Ma M, Qin S, Yu H, Sun S, Zhou D, Wang W (2016) Prognostic significance of neutrophil-to-lymphocyte ratio in prostate cancer: evidence from 16,266 patients. Sci Rep 6:22089

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Lee H, Jeong SJ, Hong SK, Byun SS, Lee SE, Oh JJ (2016) High preoperative neutrophil-lymphocyte ratio predicts biochemical recurrence in patients with localized prostate cancer after radical prostatectomy. World J Urol 34(6):821–827

    Article  CAS  PubMed  Google Scholar 

  7. Botros M, Sikaris KA (2013) The De Ritis ratio: the test of time. Clin Biochem Rev 34(3):117–130

    PubMed  PubMed Central  Google Scholar 

  8. Banez LL, Loftis RM, Freedland SJ, Presti JC Jr, Aronson WJ, Amling CL, Kane CJ, Terris MK (2010) The influence of hepatic function on prostate cancer outcomes after radical prostatectomy. Prostate Cancer Prostatic Dis 13(2):173–177

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. De Ritis F, Coltorti M, Giusti G (1957) An enzymic test for the diagnosis of viral hepatitis; the transaminase serum activities. Clin Chim Acta 2(1):70–74

    Article  Google Scholar 

  10. Takenaka Y, Takemoto N, Yasui T, Yamamoto Y, Uno A, Miyabe H, Ashida N, Shimizu K, Nakahara S, Hanamoto A, Fukusumi T, Michiba T, Cho H, Yamamoto M, Inohara H (2016) Transaminase activity predicts survival in patients with head and neck cancer. PLoS ONE 11(10):e0164057

    Article  PubMed  PubMed Central  Google Scholar 

  11. Zoppini G, Cacciatori V, Negri C, Stoico V, Lippi G, Targher G, Bonora E (2016) The aspartate aminotransferase-to-alanine aminotransferase ratio predicts all-cause and cardiovascular mortality in patients with type 2 diabetes. Medicine 95(43):e4821

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Lee H, Lee SE, Byun SS, Kim HH, Kwak C, Hong SK (2017) 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 119(2):261–267

    Article  CAS  PubMed  Google Scholar 

  13. Bezan A, Mrsic E, Krieger D, Stojakovic T, Pummer K, Zigeuner R, Hutterer GC, Pichler M (2015) The preoperative AST/ALT (De Ritis) ratio represents a poor prognostic factor in a cohort of patients with nonmetastatic renal cell carcinoma. J Urol 194(1):30–35

    Article  PubMed  Google Scholar 

  14. Nishikawa M, Miyake H, Fujisawa M (2016) 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 34(9):417e9–417e15

    Article  Google Scholar 

  15. Lee H, Choi YH, Sung HH, Han DH, Jeon HG, Chang Jeong B, Seo SI, Jeon SS, Lee HM, Choi HY (2016) De Ritis ratio (AST/ALT) as a significant prognostic factor in patients with upper tract urothelial cancer treated with surgery. Clin Genitourin Cancer S1558–7673(16):30257–30259. doi:10.1016/j.clgc.2016.08.023

  16. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (2010) AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  17. Cronin AM, Godoy G, Vickers AJ (2010) Definition of biochemical recurrence after radical prostatectomy does not substantially impact prognostic factor estimates. J Urol 183(3):984–989

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pratt DS, Kaplan MM (2000) Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 342(17):1266–1271

    Article  CAS  PubMed  Google Scholar 

  19. Tan X, Xiao K, Liu W, Chang S, Zhang T, Tang H (2013) Prognostic factors of distal cholangiocarcinoma after curative surgery: a series of 84 cases. Hepatogastroenterology 60(128):1892–1895

    CAS  PubMed  Google Scholar 

  20. Chen SL, Li JP, Li LF, Zeng T, He X (2016) Elevated preoperative serum alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio is associated with better prognosis in patients undergoing curative treatment for gastric adenocarcinoma. Int J Mol Sci 17(6):911

    Article  PubMed Central  Google Scholar 

  21. Vander Heiden MG, Cantley LC, Thompson CB (2009) Understanding the Warburg effect: the metabolic requirements of cell proliferation. Science 324(5930):1029–1033

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Hsu PP, Sabatini DM (2008) Cancer cell metabolism: Warburg and beyond. Cell 134(5):703–707

    Article  CAS  PubMed  Google Scholar 

  23. Sookoian S, Pirola CJ (2015) Liver enzymes, metabolomics and genome-wide association studies: from systems biology to the personalized medicine. World J Gastroenterol 21(3):711–725

    Article  PubMed  PubMed Central  Google Scholar 

  24. Conde VR, Oliveira PF, Nunes AR, Rocha CS, Ramalhosa E, Pereira JA, Alves MG, Silva BM (2015) 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 335(1):91–98

    Article  CAS  PubMed  Google Scholar 

  25. Thornburg JM, Nelson KK, Clem BF, Lane AN, Arumugam S, Simmons A, Eaton JW, Telang S, Chesney J (2008) Targeting aspartate aminotransferase in breast cancer. Breast Cancer Res 10(5):R84

    Article  PubMed  PubMed Central  Google Scholar 

  26. Glinghammar B, Rafter I, Lindstrom AK, Hedberg JJ, Andersson HB, Lindblom P, Berg AL, Cotgreave I (2009) Detection of the mitochondrial and catalytically active alanine aminotransferase in human tissues and plasma. Int J Mol Med 23(5):621–631

    Article  CAS  PubMed  Google Scholar 

  27. Jiang X, Chang H, Zhou Y (2015) Expression, purification and preliminary crystallographic studies of human glutamate oxaloacetate transaminase 1 (GOT1). Protein Expr Purif 113:102–106

    Article  CAS  PubMed  Google Scholar 

  28. Sripradha R, Sridhar MG, Agrawal A (2010) Can protein carbonyl/glutathione ratio be used as a potential biomarker to assess oxidative stress in alcoholic hepatitis? Indian J Med Sci 64(10):476–483

    Article  PubMed  Google Scholar 

  29. Lv W, Shang H, Pei X, Chen Y, Xie H, He D, Wang X, Li L (2017) A simple prognostic model involving prostate-specific antigen, alkaline phosphatase and albumin for predicting the time required to progress to castration-resistant prostate cancer in patients who received androgen deprivation therapy. Int Urol Nephrol 49(1):61–67

    Article  PubMed  Google Scholar 

  30. Metwalli AR, Rosner IL, Cullen J, Chen Y, Brand T, Brassell SA, Lesperance J, Porter C, Sterbis J, McLeod DG (2014) Elevated alkaline phosphatase velocity strongly predicts overall survival and the risk of bone metastases in castrate-resistant prostate cancer. Urol Oncol 32(6):761–768

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Dadao Road, Kunming, 650101, Yunnan, People’s Republic of China

    Huitao Wang, Kewei Fang, Jinsong Zhang, Yongming Jiang, Guang Wang, Haiyan Zhang, Tao Chen, Xin Shi, Yuhang Li, Fei Duan & Jianhe Liu

Authors
  1. Huitao Wang
    View author publications

    Search author on:PubMed Google Scholar

  2. Kewei Fang
    View author publications

    Search author on:PubMed Google Scholar

  3. Jinsong Zhang
    View author publications

    Search author on:PubMed Google Scholar

  4. Yongming Jiang
    View author publications

    Search author on:PubMed Google Scholar

  5. Guang Wang
    View author publications

    Search author on:PubMed Google Scholar

  6. Haiyan Zhang
    View author publications

    Search author on:PubMed Google Scholar

  7. Tao Chen
    View author publications

    Search author on:PubMed Google Scholar

  8. Xin Shi
    View author publications

    Search author on:PubMed Google Scholar

  9. Yuhang Li
    View author publications

    Search author on:PubMed Google Scholar

  10. Fei Duan
    View author publications

    Search author on:PubMed Google Scholar

  11. Jianhe Liu
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Jianhe Liu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (JPEG 738 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, H., Fang, K., Zhang, J. 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 49, 1391–1398 (2017). https://doi.org/10.1007/s11255-017-1618-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-017-1618-7

Keywords