The Preoperative AST/ALT (De Ritis) Ratio Represents a Poor Prognostic Factor in a Cohort of Patients with Nonmetastatic Renal Cell Carcinoma

J Urol. 2015 Jul;194(1):30-5. doi: 10.1016/j.juro.2015.01.083. Epub 2015 Jan 23.


Purpose: Aminotransaminases, which are strongly involved in cellular metabolism and cancer cell turnover, represent easily measureable, potential blood based biomarkers. We evaluated the prognostic value of the preoperatively assessed AST/ALT (De Ritis) ratio on clinically meaningful end points in a large European cohort of patients with nonmetastatic renal cell carcinoma.

Materials and methods: We retrospectively evaluated clinicopathological data on 698 patients with nonmetastatic renal cell carcinoma operated on between 2005 and 2013 at a single tertiary academic center. The potential prognostic value of the AST/ALT ratio was analyzed using the Kaplan-Meier method, and univariate and multivariate Cox proportional regression models. The impact of the ratio on the predictive accuracy of the Leibovich prognosis score was determined by the Harrell c-index.

Results: An increased (1.26 or greater) preoperative AST/ALT ratio was statistically significantly associated with several well established prognostic factors, including pathological T stage, as well as with histological tumor necrosis (p <0.05). On multivariate analysis an increased preoperative AST/ALT ratio was an independent prognostic factor for metastasis-free survival (HR 1.61, 95% CI 1.25-2.07, p <0.001) and overall survival (HR 1.76, 95% CI 1.34-2.32, p <0.001). The Harrell c-index was 0.77 using the Leibovich prognosis score and 0.81 when AST/ALT was added.

Conclusions: In our study cohort with nonmetastatic renal cell carcinoma the preoperatively assessed AST/ALT ratio represented an independent prognostic factor. This ratio might further improve the predictive accuracy of well established prognosis scores.

Keywords: biological markers; carcinoma; kidney; prognosis; renal cell; transaminases.

MeSH terms

  • Aged
  • Alanine Transaminase / blood*
  • Aspartate Aminotransferases / blood*
  • Carcinoma, Renal Cell / blood*
  • Carcinoma, Renal Cell / surgery*
  • Cohort Studies
  • Female
  • Humans
  • Kidney Neoplasms / blood*
  • Kidney Neoplasms / surgery*
  • Male
  • Middle Aged
  • Preoperative Period
  • Prognosis
  • Retrospective Studies


  • Aspartate Aminotransferases
  • Alanine Transaminase