The utility of De Ritis Ratio in predicting prognosis in testicular cancer

 

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Abstract

Objective We aimed to investigate the possible association between testicular cancer prognosis and De Ritis ratio (AST/ALT).

Methods The medical records of all patients who underwent radical inguinal orchiectomy at a single tertiary in Istanbul, Turkey between 2006 and 2017 were retrospectively analyzed. Investigated parameters included patients’ demographics, complete blood count and blood biochemistry results, pathology results, treatment schemes, imaging results, and survival. De Ritis ratio was calculated as follows: AST/ALT.

Results A total of 171 patients with a mean age of 32.6 ± 10.1 years were included in the study. 73 patients had T1, 83 had T2, 13 had T3 and 2 had T4 disease. Rete testis invasion was detected in 74 patients (43.3 %) as well as lymphovascular invasion in 93 (54.4 %) and tunica albuginea invasion in 80 (46.8 %) patients. The cut-off value for AST/ALT was set at 1.35 [Area Under Curve (AUC): 0.791 with a sensitivity of 80 % and specificity of 73 %]. No statistically significance was observed between patients with and without elevated AST/ALT according to rete testis invasion, lymphovascular invasion, tunica albuginea invasion, and tunica vaginalis invasion (p = .25, p = .63, p = 1.0 and p = 1.0, respectively). 28.2 % of patients with seminoma had AST/ALT > 1.35 however 41.9 % of patients with non-seminoma pathology had AST/ALT > 1.35 (p = .078). Mean estimated survival time of patients with AST/ALT > 1.35 was higher than those with AST/ALT < 1.35, 91.8 versus 70.4 months, p < .001). As seen in Kaplan-Meier analysis elevated AST/ALT is associated with early-term mortality.

Conclusion De Ritis ratio was shown to be significantly associated with unfavorable prognosis. De Ritis ratio might serve as a prognostic biomarker in testicular tumor besides well-known tumor markers such as beta-human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH).

Zusammenfassung

Zielsetzung Ziel unserer Studie war es, einen möglichen Zusammenhang zwischen der Prognose bei Hodenkrebs und dem De-Ritis-Quotienten (AST/ALT) zu untersuchen.

Methoden Die Krankenakten aller Patienten, die sich von 2006 bis 2017 in einem einzelnen Krankenhaus der Tertiärversorgung in Istanbul, Türkei, einer radikalen inguinalen Orchiektomie unterzogen, wurden retrospektiv analysiert. Es wurden folgende Parameter untersucht: demografische Patientendaten, Blutbild und biochemische Blutbefunde, Pathologiebefunde, Behandlungsschemata und Überleben. Der De-Ritis-Quotient wurde wie folgt berechnet: AST/ALT.

Ergebnisse Insgesamt wurden 171 Patienten mit einem mittleren Alter von 32,6 ± 10,1 Jahren in die Studie aufgenommen. 73 Patienten hatten eine T1-, 83 eine T2-, 13 eine T3- und 2 eine T4-Erkrankung. Eine Invasion der Rete testis wurde bei 74 Patienten (43,3 %) festgestellt, eine lymphovaskuläre Invasion bei 93 (54,4 %) und eine Invasion der Tunica albuginea bei 80 (46,8 %) Patienten. Der Cut-Off-Wert für AST/ALT wurde bei 1,35 angesetzt [Fläche unter der Kurve (AUC): 0,791 mit einer Sensitivität von 80 % und einer Spezifität von 73 %]. Es fand sich kein statistisch signifikanter Unterschied zwischen Patienten mit und ohne erhöhten AST/ALT-Quotienten in Abhängigkeit von Rete-testis-Invasion, lymphovaskulärer Invasion, Tunica-albuginea-Invasion und Tunica-vaginalis-Invasion (p = 0,25, p = 0,63, p = 1,0 bzw. p = 1,0). 28,2 % der Patienten, die ein Seminom hatten, wiesen einen AST/ALT > 1,35 auf; von den Patienten mit Nicht-Seminom-Pathologie zeigten jedoch 41,9 % einen AST/ALT > 1,35 (p = 0,078). Die geschätzte mittlere Überlebenszeit war bei Patienten mit AST/ALT > 1,35 höher als bei jenen mit AST/ALT < 1,35; 91,8 versus 70,4 Monate, p < 0,001). Wie die Kaplan-Meier-Analyse zeigt, ist ein erhöhter AST/ALT mit vorzeitiger Mortalität assoziiert.

Schlussfolgerung Der De-Ritis-Quotient war signifikant mit einer ungünstigen Prognose assoziiert. Der De-Ritis-Quotient könnte neben den bekannten Tumormarkern wie Beta-humanes Choriongonadotropin (hCG), Alpha-Fetoprotein (AFP) und Laktatdehydrogenase (LDH) ebenfalls als prognostischer Biomarker bei Hodentumoren dienen.

Publication History

Article published online:
05 March 2020

© Georg Thieme Verlag KG
Stuttgart · New York

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