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Published in: BMC Gastroenterology 1/2023

Open Access 01-12-2023 | Hepatocellular Carcinoma | Research

The prognostic role of the AST/ALT ratio in hepatocellular carcinoma patients receiving thermal ablation combined with simultaneous TACE

Authors: Feihang Wang, Shanshan Gao, Mengfei Wu, Danyang Zhao, Huiyi Sun, Sothea Yav, Yi Chen, Zihan Zhang, Minjie Yang, Yi Dong, Jianhua Wang, Xiaolin Wang, Zhiping Yan, Lingxiao Liu

Published in: BMC Gastroenterology | Issue 1/2023

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Abstract

Background

To evaluate the prognostic value of the pre-treatment aspartate transaminase (AST)/alanine transaminase (ALT) ratio in hepatocellular carcinoma (HCC) patients receiving radiofrequency ablation (RFA)/microwave ablation (MWA) combined with simultaneous TACE.

Methods

The data for 117 patients were retrospectively analyzed in this study. The endpoint of prognosis was overall survival (OS). The Youden index was used to choose the optimal cut-off value of the pre-treatment AST/ALT ratio for OS prediction. Univariate and multivariate analyses were used to identify independent risk factors, then integrated to establish the nomogram.

Results

The AST/ALT ratio cut-off value for OS prediction was 0.89, and patients with a higher AST/ALT ratio had poorer OS. The median OS for the high-value AST/ALT group was not reached, while the median OS for the low-value AST/ALT group was 48.5 months (P = 0.0047). The univariate and multivariate analysis showed that AST/ALT ratio, AFP, and tumor numbers were independent prognostic indicators for OS. The integrated nomogram showed higher predictive accuracy for OS (C-index 0.674, 95%CI: 0.600–0.748).

Conclusions

The preoperative AST/ALT ratio could be a prognostic indicator for HCC patients receiving thermal ablation combined with simultaneous TACE.
Literature
1.
go back to reference Wang W, Wei C. Advances in the early diagnosis of hepatocellular carcinoma. Genes Dis. 2020;7(308):319. Wang W, Wei C. Advances in the early diagnosis of hepatocellular carcinoma. Genes Dis. 2020;7(308):319.
2.
go back to reference Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol. 2022;76:681–93.CrossRefPubMed Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol. 2022;76:681–93.CrossRefPubMed
3.
go back to reference Xu Z, Xie H, Zhou L, Chen X, Zheng S. The combination strategy of transarterial chemoembolization and radiofrequency ablation or microwave ablation against hepatocellular carcinoma. Anal Cell Pathol (Amst). 2019;2019:8619096.PubMedPubMedCentral Xu Z, Xie H, Zhou L, Chen X, Zheng S. The combination strategy of transarterial chemoembolization and radiofrequency ablation or microwave ablation against hepatocellular carcinoma. Anal Cell Pathol (Amst). 2019;2019:8619096.PubMedPubMedCentral
4.
go back to reference Li W, Ni CF. Current status of the combination therapy of transarterial chemoembolization and local ablation for hepatocellular carcinoma. Abdom Radiol (NY). 2019;44:2268–75.CrossRefPubMed Li W, Ni CF. Current status of the combination therapy of transarterial chemoembolization and local ablation for hepatocellular carcinoma. Abdom Radiol (NY). 2019;44:2268–75.CrossRefPubMed
5.
go back to reference Lencioni R, Crocetti L. Local-regional treatment of hepatocellular carcinoma. Radiology. 2012;262:43–58.CrossRefPubMed Lencioni R, Crocetti L. Local-regional treatment of hepatocellular carcinoma. Radiology. 2012;262:43–58.CrossRefPubMed
6.
go back to reference Gui CH, Baey S, D’cruz RT, Shelat VG. Trans-arterial chemoembolization + radiofrequency ablation versus surgical resection in hepatocellular carcinoma - A meta-analysis. Eur J Surg Oncol. 2020;46:763–71.CrossRefPubMed Gui CH, Baey S, D’cruz RT, Shelat VG. Trans-arterial chemoembolization + radiofrequency ablation versus surgical resection in hepatocellular carcinoma - A meta-analysis. Eur J Surg Oncol. 2020;46:763–71.CrossRefPubMed
7.
go back to reference Wu M, Gao S, Song H, et al. Percutaneous thermal ablation combined with simultaneous transarterial chemoembolization for hepatocellular carcinoma </=5 cm. J Cancer Res Ther. 2019;15:766–72.CrossRefPubMed Wu M, Gao S, Song H, et al. Percutaneous thermal ablation combined with simultaneous transarterial chemoembolization for hepatocellular carcinoma </=5 cm. J Cancer Res Ther. 2019;15:766–72.CrossRefPubMed
8.
go back to reference Bezan A, Mrsic E, Krieger D, et al. 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;194:30–5.CrossRefPubMed Bezan A, Mrsic E, Krieger D, et al. 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;194:30–5.CrossRefPubMed
10.
go back to reference Knittelfelder O, Delago D, Jakse G, et al. The AST/ALT (De Ritis) ratio predicts survival in patients with oral and oropharyngeal cancer. Diagnostics (Basel). 2020;10(11):973.CrossRefPubMedPubMedCentral Knittelfelder O, Delago D, Jakse G, et al. The AST/ALT (De Ritis) ratio predicts survival in patients with oral and oropharyngeal cancer. Diagnostics (Basel). 2020;10(11):973.CrossRefPubMedPubMedCentral
11.
go back to reference Scheipner L, Smolle MA, Barth D, et al. The AST/ALT ratio is an independent prognostic marker for disease-free survival in stage II and III colorectal carcinoma. Anticancer Res. 2021;41:429–36.CrossRefPubMed Scheipner L, Smolle MA, Barth D, et al. The AST/ALT ratio is an independent prognostic marker for disease-free survival in stage II and III colorectal carcinoma. Anticancer Res. 2021;41:429–36.CrossRefPubMed
12.
go back to reference Zhang LX, Lv Y, Xu AM, Wang HZ. The prognostic significance of serum gamma-glutamyltransferase levels and AST/ALT in primary hepatic carcinoma. BMC Cancer. 2019;19:841.CrossRefPubMedPubMedCentral Zhang LX, Lv Y, Xu AM, Wang HZ. The prognostic significance of serum gamma-glutamyltransferase levels and AST/ALT in primary hepatic carcinoma. BMC Cancer. 2019;19:841.CrossRefPubMedPubMedCentral
13.
go back to reference Liu C, Jia BS, Zou BW, et al. Neutrophil-to-lymphocyte and aspartate-to-alanine aminotransferase ratios predict hepatocellular carcinoma prognosis after transarterial embolization. Medicine (Baltimore). 2017;96: e8512.CrossRefPubMed Liu C, Jia BS, Zou BW, et al. Neutrophil-to-lymphocyte and aspartate-to-alanine aminotransferase ratios predict hepatocellular carcinoma prognosis after transarterial embolization. Medicine (Baltimore). 2017;96: e8512.CrossRefPubMed
14.
go back to reference Ritis de F, Coltorti M, Giusti G. An enzymic test for the diagnosis of viral hepatitis; the transaminase serum activities. Clin Chim Acta. 1957;2:70–4.CrossRef Ritis de F, Coltorti M, Giusti G. An enzymic test for the diagnosis of viral hepatitis; the transaminase serum activities. Clin Chim Acta. 1957;2:70–4.CrossRef
15.
go back to reference Shijo H, Okazaki M. Prediction of portal vein invasion by hepatocellular carcinoma: a correlations between portal vein tumor thrombus and biochemical tests. Jpn J Clin Oncol. 1991;21:94–9.CrossRefPubMed Shijo H, Okazaki M. Prediction of portal vein invasion by hepatocellular carcinoma: a correlations between portal vein tumor thrombus and biochemical tests. Jpn J Clin Oncol. 1991;21:94–9.CrossRefPubMed
16.
go back to reference Shen J, Dai J, Zhang Y, et al. Baseline HBV-DNA load plus AST/ALT ratio predicts prognosis of HBV-related hepatocellular carcinoma after hepatectomy: a multicentre study. J Viral Hepat. 2021;28:1587–96.CrossRefPubMed Shen J, Dai J, Zhang Y, et al. Baseline HBV-DNA load plus AST/ALT ratio predicts prognosis of HBV-related hepatocellular carcinoma after hepatectomy: a multicentre study. J Viral Hepat. 2021;28:1587–96.CrossRefPubMed
17.
go back to reference Granito A, Facciorusso A, Sacco R, et al. TRANS-TACE: prognostic role of the transient hypertransaminasemia after conventional chemoembolization for hepatocellular carcinoma. J Pers Med. 2021;11(10):1041.CrossRefPubMedPubMedCentral Granito A, Facciorusso A, Sacco R, et al. TRANS-TACE: prognostic role of the transient hypertransaminasemia after conventional chemoembolization for hepatocellular carcinoma. J Pers Med. 2021;11(10):1041.CrossRefPubMedPubMedCentral
18.
go back to reference Wu J, Chen L, Wang Y, Tan W, Huang Z. Prognostic value of aspartate transaminase to alanine transaminase (De Ritis) ratio in solid tumors: a pooled analysis of 9,400 patients. Onco Targets Ther. 2019;12:5201–13.CrossRefPubMedPubMedCentral Wu J, Chen L, Wang Y, Tan W, Huang Z. Prognostic value of aspartate transaminase to alanine transaminase (De Ritis) ratio in solid tumors: a pooled analysis of 9,400 patients. Onco Targets Ther. 2019;12:5201–13.CrossRefPubMedPubMedCentral
20.
go back to reference Sookoian S, Pirola CJ. Liver enzymes, metabolomics and genome-wide association studies: from systems biology to the personalized medicine. World J Gastroenterol. 2015;21:711–25.CrossRefPubMedPubMedCentral Sookoian S, Pirola CJ. Liver enzymes, metabolomics and genome-wide association studies: from systems biology to the personalized medicine. World J Gastroenterol. 2015;21:711–25.CrossRefPubMedPubMedCentral
21.
go back to reference Friday E, Oliver R 3rd, Welbourne T, Turturro F. Glutaminolysis and glycolysis regulation by troglitazone in breast cancer cells: relationship to mitochondrial membrane potential. J Cell Physiol. 2011;226(511):519. Friday E, Oliver R 3rd, Welbourne T, Turturro F. Glutaminolysis and glycolysis regulation by troglitazone in breast cancer cells: relationship to mitochondrial membrane potential. J Cell Physiol. 2011;226(511):519.
24.
go back to reference Galle PR, Foerster F, Kudo M, et al. Biology and significance of alpha-fetoprotein in hepatocellular carcinoma. Liver Int. 2019;39:2214–29.CrossRefPubMed Galle PR, Foerster F, Kudo M, et al. Biology and significance of alpha-fetoprotein in hepatocellular carcinoma. Liver Int. 2019;39:2214–29.CrossRefPubMed
25.
go back to reference Peng SY, Chen WJ, Lai PL, Jeng YM, Sheu JC, Hsu HC. High alpha-fetoprotein level correlates with high stage, early recurrence and poor prognosis of hepatocellular carcinoma: significance of hepatitis virus infection, age, p53 and beta-catenin mutations. Int J Cancer. 2004;112:44–50.CrossRefPubMed Peng SY, Chen WJ, Lai PL, Jeng YM, Sheu JC, Hsu HC. High alpha-fetoprotein level correlates with high stage, early recurrence and poor prognosis of hepatocellular carcinoma: significance of hepatitis virus infection, age, p53 and beta-catenin mutations. Int J Cancer. 2004;112:44–50.CrossRefPubMed
26.
go back to reference Cabibbo G, Maida M, Genco C, et al. Natural history of untreatable hepatocellular carcinoma: a retrospective cohort study. World J Hepatol. 2012;4:256–61.CrossRefPubMedPubMedCentral Cabibbo G, Maida M, Genco C, et al. Natural history of untreatable hepatocellular carcinoma: a retrospective cohort study. World J Hepatol. 2012;4:256–61.CrossRefPubMedPubMedCentral
27.
go back to reference Trevisani F, Garuti F, Neri A,. Alpha-fetoprotein for diagnosis, prognosis, and transplant selection. Semin Liver Dis. 2019;39:163–77.CrossRefPubMed Trevisani F, Garuti F, Neri A,. Alpha-fetoprotein for diagnosis, prognosis, and transplant selection. Semin Liver Dis. 2019;39:163–77.CrossRefPubMed
Metadata
Title
The prognostic role of the AST/ALT ratio in hepatocellular carcinoma patients receiving thermal ablation combined with simultaneous TACE
Authors
Feihang Wang
Shanshan Gao
Mengfei Wu
Danyang Zhao
Huiyi Sun
Sothea Yav
Yi Chen
Zihan Zhang
Minjie Yang
Yi Dong
Jianhua Wang
Xiaolin Wang
Zhiping Yan
Lingxiao Liu
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2023
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-023-02719-1

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