Gökhan GÖKÇE, Kaan GÖKÇEN, Resul ÇİÇEK, Emre KIRAÇ, Pınar GÖKÇEN

Radikal sistektomi uygulanan hastalarda preoperatif AST/ALT (De Ritis) oranlarının prognostik önemi

Amaç: Radikal sistektomi (RC) uygulanan mesane kanseri (BC) hastalarında preoperatif olarak değerlendirilen aspartat aminotransaminaz (AST) / alanin aminotransferaz (ALT) (De Ritis) oranının prognostik önemini değerlendirmeyi amaçladık. Yöntem: Ocak 2008 ile Ağustos 2018 tarihleri arasında üçüncü basamak hastanemizde RS uygulanan 58 hastanın klinik ve histopatolojik verilerini inceledik. De Ritis oranının BC üzerindeki potansiyel prognostik değeri ROC eğrisi analizi kullanılarak değerlendirildi. Hastalığa bağlı sağ kalım (DSS) ve genel sağ kalım (OAS) da De Ritis oranının etkisi, Kaplan-Meier yöntemi ve multivariate Cox regresyon modelleri ile analiz edildi. Bulgular: RC uygulanan toplamda ellisekiz hastanın 95.6% erkek (E/K:56/2) idi. Hastaların yaş ortalaması 68.6± 11,56 idi. ROC analizine göre DSS için De Ritis oranının cut-off değeri 1.417 olarak saptandı. Kaplan-Meier analizlerinde yüksek De Ritis oran grubu DSS ve OAS'de daha kötü progresyon gösterdi (p =0.004). Klinik ve patolojik parametrelerin Cox regresyon modellerinde DSS için De Ritis oranı (HR 2.70, 95% CI 2.34-3.05 p=0.005), patolojik T evresi (HR 3.36, 95% CI 2.91-3.82, p =0.007) ve yaş (HR 1,038 95% CI 1,02-1,05; p=0.015) iken OAS için De Ritis oranı (HR 2.71, 95% CI 2.33 -3.09; p =0.005), patolojik T evresi (HR 4.36, 95% CI 3.87–4.85; p=0.007) ve yaş (HR 1.4 , 95% CI 1.03-1.06; p = 0.015) bağımsız prognostik faktörler olarak belirlendi. Sonuç: Preoperatif artmış De Ritis oranı; RC uygulanan BC hastalarında bağımsız bir prognostik faktör olarak değerlendirilebilir. Sonuçlarımızın geniş ve uygun şekilde tasarlanmış prospektif, randomize çalışmalarla doğrulanması ve desteklenmesi gerekmektedir.

Preoperative AST/ALT (De Ritis) Ratio as a Prognostic Factor in a Cohort of Patients who underwent radical cystectomy

Objective: This study aims to evaluate the prognostic significance of the preoperative aspartate aminotransferase (AST)/ alanine aminotransferase (ALT) (De Ritis) ratio in bladder cancer (BC) patients who underwent radical cystectomy(RC).Method: We evaluated the clinical and histopathological data of 58 patients who had undergone RC between January2008-August 2018 at our tertiary hospital. The potential prognostic value of the De Ritis ratio with regard to BC wasevaluated using ROC curve analysis. The effect of the De Ritis ratio on disease specific survival (DSS) and overallsurvival (OS) was analyzed using the Kaplan-Meier method and multivariate Cox regression models.Results: A total of fifty-eight patients underwent RC and 95.6% were male (M/F:56/2). Mean age of the patients was68.6± 11,56. The cut-off value of the De Ritis ratio for DSS was calculated as 1.417 in the ROC analysis. In Kaplan-Meier analyses, the group with a higher De Ritis ratio presented a more unfavorable progression in terms of DSS andOS (p=0.004). Based on the Cox regression models adjusted for clinical and pathological parameters, for DSS, the DeRitis ratio (HR 2.70, 95% CI 2.34-3.05 p=0.005), pathological T stage (HR 3.36, 95% CI 2.91-3.82, p =0.007), and age(HR 1,038 95% CI 1,02-1,05; p=0.015) were determined as independent prognostic factors; and for OS, the De Ritisratio (HR 2.71, 95% CI 2.33 -3.09; p =0.005), pathological T stage (HR 4.36, 95% CI 3.87–4.85; p=0.007) and age (HR1.04, 95% CI 1.03-1.06; p = 0.015) were determined as independent prognostic factors.Conclusions: A higher preoperative De Ritis ratio can be considered as an independent prognostic factor in BC patientswho underwent RC. Our results need to be confirmed and corroborated by comprehensive prospective randomizedstudies with an appropriate design.

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