A higher De Ritis ratio (AST/ALT) is a risk factor for progression in high-risk non-muscle invasive bladder cancer.

Sachi Fukui-Kawaura,Takashi Kawahara,Yushi Araki,Masahiro Yao,Nobuhiko Mizuno,Hiroji Uemura,Reona Nishimura,Ichiro Ikeda,Koichi Uemura,Kazuhiro Namura

doi:10.18632/oncotarget.27944

Abstract

Background: High-risk non-muscle invasive bladder cancer (NMIBC) is thought to be associated with a higher risk of recurrence and progression. A recent study revealed that a high De Ritis ratio was a risk factor in some solid malignancies. This study examined the importance of the De Ritis ratio as a prognostic marker in high-risk NMIBC.Materials and Methods: A total of 138 patients who were initially diagnosed with high-risk NMIBC between January 2012 to December 2016 were enrolled in this study. The criteria for the high-risk classification followed the EAU guidelines. The recurrence-free and progression-free survival of the higher and lower De Ritis ratio groups were compared. The cut-off value of the De Ritis ratio was set at 1.35, based on a receiver operator curve analysis.Results: The median observation period was 50.3 months. Among these patients, 32 (23.1%) patients developed recurrent disease and 15 (10.9%) patients showed progression. A multivariate analysis revealed that non-BCG treatment was an independent risk factor for recurrence, and a higher De Ritis ratio was an independent risk factor for cancer progression.Conclusions: The De Ritis ratio might be a risk factor for progression in high-risk NMIBC.

Highlights

Bladder cancer is the eleventh most common malignant disease in the world, and non-muscle invasive bladder cancer (NMIBC) accounts for 75% of all bladder cancer cases [1]
A multivariate analysis revealed that non-BCG treatment was an independent risk factor for recurrence, and a higher De Ritis ratio was an independent risk factor for cancer progression
NMIBC is treated by trans-urethral endoscopic surgery, high-risk NMIBC progresses to MIBC and shows a high rate of recurrence [2, 3]

Summary

Introduction

Bladder cancer is the eleventh most common malignant disease in the world, and non-muscle invasive bladder cancer (NMIBC) accounts for 75% of all bladder cancer cases [1]. The recommended standard treatments for highrisk NMIBC, which is defined by the NCCN and EAU guidelines, include intra-vesicle BCG or repeat TUR-Bt [4]. These are considered to be intensive treatments, the rates of recurrence and progression are still high. A high De Ritis ratio was reported to be a poor prognostic marker in some solid malignancies [7]. A high De Ritis ratio was reported to be a poor prognostic marker in prostate, renal, and urothelial carcinoma. In other solid malignancies including breast and lung cancer, a high De Ritis ratio was reported to be a poor prognostic marker.

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Results

Conclusion