Preoperative AST / ALT ratio predicts long-term survival after radical nephroureterectomy in patients with upper tract urothelial carcinoma

Purpose: We evaluated the association between preoperative AST/ALT ratio and postoperative survival in patients with upper tract urothelial carcinoma following radical nephroureterectomy. Materials and methods: We included 259 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy from March 2005 to August 2015. The potential effect of the preoperative AST/ALT ratio on overall survival, progressionfree survival, cancer-specific survival, and bladder-recurrence-free survival was analyzed using the Kaplan-Meier method, univariate and multivariate Cox proportional regression models, and followed by competing-risk analysis. Results: The higher preoperative AST/ALT ratio (1.3 or greater) was significantly associated with several unfavorable parameters, including elderly age (P < 0.05), and pathologic T stage (P < 0.05). Multivariate analysis identified higher preoperative AST/ALT ratio as an independent risk factor for overall survival (HR = 1.972, P = 0.005), progressionfree survival (HR = 2.286, P = 0.002) and cancer-specific survival (HR = 2.146, P = 0.006), while preoperative AST/ ALT ratio was not statistically correlated with bladder-recurrence-free survival on univariate analysis (P = 0.668). The subdistribution HR (SHR) of higher AST/ALT ratio for progression-free survival and cancer-specific survival (competing event: death from another cause) was 2.118 (P = 0.004) and 2.069 (P = 0.010), respectively. Conclusions: Higher preoperative AST/ALT ratio was significantly associated with poor overall survival, progression-free survival, and cancer-specific survival, rather than bladder-recurrence-free survival after radical nephroureterectomy for upper tract urothelial carcinoma.