Predictive Value of Preoperative De-Ritis Ratio at Tumor Staging in Testicular Germ Cell Tumors

Aim:The de-ritis ratio (DRR), which refers to the ratio of aspartate transaminase (AST) to alanine transaminase (ALT), is used in the assessment of several malignancies. Preoperative prediction of tumor anvasiveness remains an important issue. The aim of this study was to investigate the possible association between tumor progression and the DRR (AST/ALT).Methods:The medical records of 103 patients who underwent radical orchiectomy because of testicular cancer between January 2010 and January 2020 in a single tertiary center were retrospectively assessed in this cross-sectional study. Parameters including age, blood parameters including AST, ALT, beta-human chorionic gonadotropin (B-hCG), alpha-fetoprotein, lactate dehydrogenase (LDH), complete blood count, pathology results, treatment schemes, imaging results, preoperative and postoperative DRR (AST/ALT), and tumor stage were noted.Results:The mean age of the 103 patients was 34.9±10.45. The pathological T-stage was T1 for 26 (25.2%), T2 for 65 (63.1%), and T3 for 12 (11.6%). The mean follow-up of the patients was 31.44±10.32 (13-53) months. The risk of retroperitoneal lymph node involvement and metastasis at a DRR was calculated as 1.37 (area under the curve, 0.853 with a sensitivity of 90% and specificity of 89%; 95% confidence interval, 0.689-0.897). Preoperative B-hCG level and LDH were statistically significantly higher in the AST/ALT>1.37 group (p=0.002 and p=0.012). Thirty-five (30.4%) of patients with NSGHT had an AST/ALT>1.37. Seminoma was observed in 25.6% (n=21) of patients with AST/ALT>1.37 (p=0.107). The higher stage was significantly associated with an elevated DRR (p=0.019).Conclusion:The DRR appears to be a useful and cost-effective preoperative marker for predicting localized and non-localized disease in Tca at the time of diagnosis