Association of De Ritis ratio with oncological outcomes in patients with non-muscle invasive bladder cancer (NMIBC).

The De Ritis ratio (aspartate aminotransferase/alanine aminotransferase, DRR) has been linked to oncological outcomes in several cancers. We aimed to assess the association of DRR with recurrence-free survival (RFS) and progression-free survival (PFS) in patients with non-muscle-invasive bladder cancer (NMIBC).

We conducted a retrospective analysis of 1117 patients diagnosed with NMIBC originating from an established multicenter database. To define the optimal pretreatment DRR cut-off value, we determined a value of 1.2 as having a maximum Youden index value. The overall population was therefore divided into two De Ritis ratio groups using this cut-off (lower, < 1.2 vs. higher, ≥ 1.2). Univariable and multivariable Cox regression analyses were used to investigate the association of DRR with RFS and PFS. The discrimination of the model was evaluated with the Harrel's concordance index (C-index).

Overall, 405 (36%) patients had a DRR ≥ 1.2. On univariable Cox regression analysis, DRR was significantly associated with RFS (HR: 1.23, 95% CI 1.02-1.47, p = 0.03), but not with PFS (HR: 0.96, 95% CI 0.65-1.44, p = 0.9). On multivariable Cox regression analysis, which adjusted for the effect of established clinicopathologic features, DRR ≥ 1.2 remained significantly associated with worse RFS (HR:1.21, 95% CI 1.00-1.46, p = 0.04). The addition of DRR only minimally improved the discrimination of a base model that included established clinicopathologic features (C-index = 0.683 vs. C-index = 0.681). On DCA the inclusion of DRR did not improve the net-benefit of the prognostic model.

Despite the statistically significant association of the DRR with RFS in patients with NMIBC, it does not seem to add any prognostic or clinical benefit beyond that of currently available clinical factors.

World journal of urology. 2020 Aug 17 [Epub ahead of print]

Ekaterina Laukhtina, Hadi Mostafaei, David D'Andrea, Benjamin Pradere, Fahad Quhal, Keiichiro Mori, Noriyoshi Miura, Victor M Schuettfort, Reza Sari Motlagh, Abdulmajeed Aydh, Mohammad Abufaraj, Pierre I Karakiewicz, Dmitry Enikeev, Shoji Kimura, Shahrokh F Shariat

Department of Urology, Comprehensive Cancer Center, Vienna General Hospital Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada., Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Comprehensive Cancer Center, Vienna General Hospital Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .