Research Papers:

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, Reona Nishimura, Koichi Uemura, Kazuhiro Namura, Nobuhiko Mizuno, Masahiro Yao, Hiroji Uemura and Ichiro Ikeda

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Oncotarget. 2021; 12:917-922. https://doi.org/10.18632/oncotarget.27944

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Sachi Fukui-Kawaura1, Takashi Kawahara2, Yushi Araki1, Reona Nishimura1, Koichi Uemura1, Kazuhiro Namura1, Nobuhiko Mizuno1, Masahiro Yao3, Hiroji Uemura2 and Ichiro Ikeda1

1 Department of Urology, Yokohama Minami Kyousai Hospital, Yokohama, Japan

2 Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan

3 Department of Urology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan

Correspondence to:

Takashi Kawahara,email: [email protected]

Keywords: AST; ALT; De Ritis; high risk NMIBC

Received: October 26, 2020     Accepted: March 24, 2021     Published: April 27, 2021

Copyright: © 2021 Fukui-Kawaura et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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.

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