De ritis ratio as a novel prognostic biomarker in atypical meningiomas: a multi-institutional study

Abstract PURPOSE To investigate the impact of prognostic serum biomarkers in newly diagnosed surgically resected intracranial atypical meningiomas. METHODS This multi-institutional study included 523 grade 2 (according to the 4th edition of WHO Classification of Tumors of the Central Nervous System) patients who underwent resection between 1998–2018. The baseline characteristics and serum laboratory data within one week after surgery were obtained for analyses investigating the association with progression/recurrence (P/R) rate or progression-free survival (PFS). Optimal cut-offs were calculated for each serum marker using the maxstat package of R. Nomograms were developed based on the multivariate analyses of statistically significant prognosticators. RESULTS Among 523 patients, 454 patients were included in the multivariate analysis for P/R rate excluding patients with incomplete histopathologic or laboratory data. On multivariable analysis, tumor size >5 cm (HR, 2.18; 95% CI, 1.49–3.19) and subtotal resection (HR, 3.60; 95% CI, 2.37-5.47) were associated with higher P/R rate, whereas adjuvant radiotherapy (HR, 0.32; 95% CI, 0.20-0.53) and postoperative platelet >137 x 103/μL (HR, 0.58; 95% CI, 0.39-0.86) were associated with lower P/R rate. Interestingly, postoperative De Ritis Ratio (aspartate aminotransferase/alanine aminotransferase) >2 proved to be an adverse prognosticator (HR, 1.87; 95% CI, 1.15-3.05). Similarly, patients with De Ritis ratio >2 showed inferior PFS (HR, 1.87; 95% CI, 1.23-2.84). In the subgroup of patients who received adjuvant radiotherapy, tumor size >5 cm and postoperative neutrophil-to-lymphocyte ratio >21 were the only prognosticators and were associated with higher P/R rate. On the other hand, postoperative De Ritis ratio >2 remained to be an adverse prognosticator in patients who did not receive radiotherapy. CONCLUSION Postoperative De Ritis Ratio was unrevealed as a novel serum prognosticator in newly diagnosed atypical meningiomas. Further studies are warranted to validate its clinical significance and biological background.