Association of Preoperative De Ritis Ratio (Aspartate Amino Transferase/Alanine Amino Transferase) and Tumour Histology in Patients with Primary Bladder Cancer

Özet

Objective: De Ritis ratio, defined as the ratio of serum aspartate amino transferase (AST) and alanine amino transferase (ALT), has been demonstrated to be an independent prognostic marker in bladder cancer (BC) patients who underwent radical cystectomy. We aimed to investigate the relationship between preoperative De Ritis ratio and tumour histology prior to transurethral resection of bladder tumour (TUR-BT) in patients newly diagnosed with BC. Materials and Methods: Data of the patients who underwent TUR-BT between May 2016 and August 2019 at two tertiary hospitals were evaluated, retrospectively. The patients were grouped as either non-muscle invasive BC (NMIBC) or muscle invasive BC (MIBC), and as grade (G) 1, 2 and 3 according to pathological and histological G, respectively. Further, patients were classified as low, intermediate or high risk according to risk group stratification. Demographic features of the patients including age and gender were recorded. Pre-treatment biochemical indices including serum levels of AST and ALT were recorded. P value <0.05 was considered significant. Results: Mean age of patients (156) included in this study was 67.10±10.15. Exactly 104 (66.7%) patients were placed in the NMIBC group, while the remaining 52 (33.3%) patients were placed in the MIBC group. De Ritis ratio was lower in the NMIBC group than in the MIBC group (p=0.014). Also, there was a significantly difference in De Ritis ratio between G1 and G3 carcinomas (p=0.040). According to receiver operating characteristics analysis, the cut-off threshold of De Ritis ratio for clinically predicting MIBC and high-G carcinoma was 1.21 and 1.20, respectively. Based on Spearman’s correlation analysis, a weak positive correlation was found between De Ritis ratio and MIBC (p=0.036), and G of tumour (p=0.009). Conclusion: This study demonstrated that an increase in De Ritis ratio, which can be easily determined from the peripheral blood in preoperative period, may be associated with muscle invasion (T2) and high tumour G of BC.