Pre-treatment De Ritis ratio serves as a potential prognostic biomarker in renal cell carcinoma: a systematic review and meta-analysis

Abstract Background Previous studies have evaluated the associations of aspartate transaminase to alanine transaminase (De Ritis) ratio with clinical outcome of renal cell carcinoma (RCC), but the findings are inconsistent. We therefore performed this meta-analysis to explore the prognostic value of the pre-treatment De Ritis ratio in patients with RCC.Methods PubMed, EMBASE, Science and Cochrane Library were searched systematically to identify all eligible studies as of February 2020. The hazard ratio (HR) with 95% confidence interval (CI) were extracted to evaluate their correlation.Results A total of 5,025 patients from 8 studies were included in the meta-analysis. Patients with an increased pre-treatment De Ritis ratio had worse overall survival (HR = 1.52, 95% CI 1.27 to 1.82, P < 0.001), cancer-specific survival (HR = 1.81, 95% CI 1.47 to 2.23, P < 0.001), progression-free survival (HR = 1.24, 95% CI 1.05 to 1.47, P = 0.011), and metastasis-free survival (HR = 1.61, 95% CI 1.25 to 2.07, P < 0.001). Subgroup analysis according to disease stage and cut-of value revealed that De Ritis ratio had a significant prognostic value for OS and PFS in all subgroups.Conclusion The available evidence suggests that an increased De Ritis ratio was significantly correlated with worse survival in patients with RCC. Pre-treatment De Ritis ratio may serve as a potential prognostic biomarker in patients with RCC, but further studies are warranted to support these results.