术前天冬氨酸转氨酶/丙氨酸转氨酶比值预测尿路上皮癌预后的Meta分析

The prognostic value of preoperative aspartate transaminase to alanine transaminase ratio in urothelial cancer: a systematic review and Meta-analysis

摘要

目的 探讨尿路上皮癌（UC）患者术前天冬氨酸转氨酶/丙氨酸转氨酶（AST/ALT）比值与预后的关系。方法 系统检索Web of Science、PubMed和Embase数据库，收集2024年8月前发表的关于术前AST/ALT预测UC预后的相关研究，根据纳入排除标准筛选文献，提取数据后使用STATA 15.0软件分析患者总生存期（OS）、肿瘤特异性生存期（CSS）和无复发生存期（RFS）的风险比（HR）及其95%可信区间（CI）。结果 共纳入14篇文献，涉及8190例患者。术前AST/ALT比值升高的UC患者OS（合并HR=1.92，95%CI：1.38～2.67，P＜0.001）、CSS（合并HR=2.12，95%CI：1.48～3.05，P＜0.001）和RFS（合并HR=1.63，95%CI：1.27～2.10，P＜0.001）均较差。在亚组分析中，相对于上尿路尿路上皮癌（UTUC），术前AST/ALT比值对膀胱癌（BCa）患者的OS、CSS和RFS有更高的预测价值（P≤0.001）；而与高加索人群相比，术前AST/ALT比值对亚洲人群的OS、CSS和RFS有更高的预测价值（P＜0.001）。结论 在UC患者中，特别是亚洲UC患者，术前较高的AST/ALT比值与不良的OS、CSS和RFS显著相关。

Abstract

Objective To explore the association between preoperative aspartate transaminase to alanine transaminase (AST/ALT) ratio and the outcomes of urothelial cancers. Methods After a systematic search of Web of Science, PubMed and Embase before Aug. 2024, 14 studies were included in the Meta-analysis. The hazard ratios (HRs) with 95% confidence interval (CI) for overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were analyzed using STATA 15.0 software. Results The Meta-analysis included a total of 8190 patients. Urothelial cancer patients with an elevated preoperative AST/ALT ratio had worse OS (HR=1.92, 95%CI: 1.38-2.67, P<0.001), CSS (HR=2.12, 95%CI: 1.48-3.05, P<0.001), and RFS (HR=1.63, 95%CI: 1.27-2.10, P<0.001). In subgroup analyses, preoperative AST/ALT ratio had a better predictive value for OS, CSS, and RFS in patients with bladder cancer than in patients with upper tract urothelial carcinoma, and a better predictive value in Asian population than in Caucasian population (P<0.001). Conclusion A high preoperative AST/ALT ratio is associated with poor OS, CSS and RFS in urothelial cancers, particularly among the Asian population.

关键词

Meta分析 / 尿路上皮癌 / 亚洲人群 / 天冬氨酸转氨酶/丙氨酸转氨酶比值 / 预后 / 上尿路尿路上皮癌 / 膀胱癌

Key words

Meta-analysis / urothelial cancer / Asian population / aspartate transaminase to alanine transaminase ratio / prognosis / upper tract urothelial carcinoma / bladder cancer

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