Abstract
PurposeTo evaluate the prognostic value of the aspartate transaminase/alanine transaminase (AST/ALT) ratio in primary non-muscle-invasive bladder cancer (NMIBC) using propensity score matching (PSM) analysis.MethodsWe retrospectively collected the clinical and pathological data from 314 patients with primary NMIBC who underwent transurethral resection of bladder tumor. The full cohorts were divided into a low AST/ALT ratio group and a high AST/ALT ratio group according to the optimal cut-off value which was obtained based on the analysis of the receiver operating characteristic curve for the 3-year recurrence-free survival (RFS). After 1:1 PSM, the correlation between preoperative AST/ALT ratio and survival prognosis was evaluated by Kaplan–Meier analysis with log-rank tests. The independent prognostic factors for RFS and progression-free survival (PFS) were also analyzed.ResultsThe optimum cutoff value of the preoperative AST/ALT ratio was 1.40. Before PSM, a high AST/ALT ratio was correlated with the larger proportion of age > 60 years (P = 0.007) and the worse pathological T stage (P < 0.001). After PSM, patients with a high AST/ALT ratio had poorer RFS and PFS than patients with a low AST/ALT ratio (all P < 0.001). In addition, multivariate Cox regression analysis indicated that preoperative AST/ALT ratio was considered as an independent prognostic factor of RFS (HR 2.865; 95%CI 1.873–4.381; P < 0.001) and PFS (HR 4.771; 95%CI 2.607–8.734; P < 0.001) in patients with primary NMIBC.ConclusionsThe high AST/ALT ratio group tended to have poorer RFS and PFS than the low AST/ALT ratio group. Our results also indicated that the elevated preoperative AST/ALT ratio could be seen as a useful prognostic biomarker for predicting early disease recurrence and progression in patients with primary NMIBC.
Highlights
Bladder cancer is one of the most prevalent cancers in the urinary tract and the seventh most common tumor in the male population worldwide, while it drops to the11th if both genders are considered [1, 2]
According to the receiver operating characteristic curve for 3-year recurrence-free survival, when there is a maximum value of the Youden index, the optimal cutoff value for the Aspartate transaminase (AST)/alanine transaminase (ALT) ratio is 1.40 (Fig. 2)
Relationship between preoperative AST/ALT ratio and Clinical and pathological characteristics in the full and propensity score matching (PSM) cohorts With regard to the clinical characteristics of the two groups in the full cohorts, there was no statistical difference between the two groups in gender, history of smoking, Re-transurethral resection of bladder tumor (TURBT), tumor size, tumor number, pathological grade, concomitant carcinoma in situ (CIS), and type of intravesical therapy
Summary
Bladder cancer is one of the most prevalent cancers in the urinary tract and the seventh most common tumor in the male population worldwide, while it drops to the11th if both genders are considered [1, 2]. Bladder cancer is one of the most prevalent cancers in the urinary tract and the seventh most common tumor in the male population worldwide, while it drops to the. 75% of patients with bladder cancer present with disease confined to the mucosa or submucosa, which is referred to as non-muscle-invasive bladder cancer (NMIBC) and this proportion is even higher in younger patients (< 40 years) [3]. The standard treatment for NMIBC is transurethral resection of bladder tumor (TURBT), eventually followed by adjuvant intravesical therapy based on. The high recurrence rate of NMIBC patients is as high as 50–70% and one-third of recurrent patients will develop into muscle-invasive bladder cancer (MIBC) and eventually succumb to the disease [5, 6]. Our knowledge of plasma prognostic factors assessed preoperatively in NMIBC remains limited
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