Transaminase Activity Predicts Survival in Patients with Head and Neck Cancer

Abstract

Various serum biomarkers have been developed for predicting head and neck squamous cell carcinoma (HNSCC) prognosis. However, none of them have been proven to be clinically significant. A recent study reported that the ratio of aspartate aminotransaminase (AST) to alanine aminotransaminase (ALT) had a prognostic effect on non-metastatic cancers. This study aimed to examine the effect of the AST/ALT ratio on the survival of patients with HNSCC. Clinical data of 356 patients with locoregionally advanced HNSCC were collected. The effect of the AST/ALT ratio on overall survival was analyzed using a Cox proportional hazard model. Moreover, recursive partitioning analysis (RPA) was used to divide the patients into groups on the basis of the clinical stage and AST/ALT ratio. The prognostic ability of this grouping was validated using an independent data set (N = 167). The AST/ALT ratio ranged from 0.42 to 4.30 (median, 1.42) and was a prognostic factor for overall survival that was independent of age, primary sites, and tumor stage (hazard ratio: 1.36, confidence interval: 1.08−1.68, P = 0.010). RPA divided patients with stage IVA into the following two subgroups: high AST/ALT (≥2.3) and low AST/ALT (<2.3) subgroups. The 5-year survival rate for patients with stage III, stage IVA with a low AST/ALT ratio, stage IVA with a high AST/ALT ratio, and stage IVB were 64.8%, 49.2%, 28.6%, and 33.3%, respectively (p < 0.001). Compared with the low AST/ALT group, the adjusted hazard ratio for death was 2.17 for high AST/ALT group (confidence interval: 1.02–.22 P = 0.045). The AST/ALT ratio was demonstrated to be a prognostic factor of HNSCC. The ratio subdivided patients with stage IVA into low- and high-risk groups. Moreover, intensified treatment for the high-risk group may be considered.

The effect of AST/ALT (De Ritis) ratio on survival and its relation to tumor histopathological variables in patients with localized renal cell carcinoma

“…Plasma AST level and AST/ALT ratio were defined previously as a convenient markers for hepatocellular carcinoma and they were associated with poor prognosis ( 18 , 19 ). Additionally, some previous studies have demonstrated that this ratio to be a significant prognostic factor in several malignancies ( 11 , 12 , 20 , 21 ). Recently, two similar studies reported that an elevated AST/ALT ratio was significantly associated with poor survival outcomes which were not in line with our results ( 14 , 15 ).…”

“…Fernando De Ritis described the ratio of AST and ALT firstly, in 1957 and this ratio has been known ever since as the De Ritis ratio ( 10 ). Previous studies have demonstrated that this ratio to be crucial prognostic factors in different malignancies ( 11 - 13 ). Bezan et al and Lee et al reported that this ratio can predict survival outcomes in patients with non-metastatic RCC and they found that an elevated AST/ALT ratio was significantly associated with inferior survival outcomes ( 14 , 15 ).…”

Platelet count and platelet‐lymphocyte ratio as prognostic markers for head and neck squamous cell carcinoma: Meta‐analysis

“…10 Previous studies have demonstrated the utility of numerous blood markers as prognostic factors for HNSCC, including serum squamous cell carcinoma (SCC) antigen, 11 C-reactive protein, 12 serum transaminase, 13 and hematologic markers. Tissue specimens allow for the direct examination of tumor and stromal cells.…”

“…Moreover, blood markers are not affected by any heterogeneity within the tumor. 10 Previous studies have demonstrated the utility of numerous blood markers as prognostic factors for HNSCC, including serum squamous cell carcinoma (SCC) antigen, 11 C-reactive protein, 12 serum transaminase, 13 and hematologic markers. 14 Platelet count and plateletlymphocyte ratio (PLR) are hematologic makers that have shown prognostic abilities across many types of cancers.…”

Prognostic Role of Pretreatment De Ritis Ratio (Aspartate Transaminase/Alanine Transaminase Ratio) in Urological Cancers: A Systematic Review and Meta-Analysis

“…The De Ritis ratio (AST/ALT) was firstly introduced by De Ritis et al ( 6 ) to distinguish etiology of acute hepatitis about 50 years ago, and then became effective biomarker for kinds of hepatic diseases ( 7 ). Moreover, increasing evidence identified that De Ritis ratio can be an independent prognosis predictor for many kinds of malignances, such as hepatocellular carcinoma ( 8 ), head and neck cancer ( 9 ). More recently, the prognostic role of De Ritis ratio in genitourinary malignances has gained a lot of interest, and De Ritis ratio has been identified to be correlated with oncological outcomes for urological cancers.…”