The effect of AST/ALT (De Ritis) ratio on survival and its relation to tumor histopathological variables in patients with localized renal cell carcinoma
Vol. 43 (x): 2017 November 11.[Ahead of print]
Lütfi Canat 1, Hasan Anil Ataly 1, Samir Agalarov 1, İlter Alkan 1, Fatih Alturende 1
1 Department of Urology, Okmeydani Training and Research Hospital, Istanbul, Turkey
Purpose: To assess the relationship between De Ritis (aspartate aminotransaminase [AST]/Alanine aminotransaminase [ALT]) ratio and pathological variables and whether it is an independent prognostic factor.
Materials and Methods: We analyzed 298 consecutive patients who underwent radical or partial nephrectomy for non-metastatic renal cell carcinoma (RCC) between 2006 and 2015. The association between De Ritis ratio and pathological variables including tumor size, presence of renal vein invasion, vena cava invasion, renal capsule infiltration, Gerota fascia invasion, renal sinus involvement, renal pelvic invasion, angiolymphatic invasion, adrenal gland involvement, lymph node involvement, tumor necrosis, and Fuhrman’s grade was tested. Multivariable Cox analysis was performed to evaluate the impact of this ratio on overall survival and cancer-specific survival.
Results: An increased preoperative De Ritis ratio was significantly associated with renal vein invasion, renal capsule infiltration and renal pelvis involvement (p<0.05) in non-metastatic RCC. On multivariate analysis we found that tumor size, Fuhrman grade and lymph node involvement were independent prognostic factors for cancerspecific survival. AST/ALT ratio had no influence on the risk of overall and cancerspecific survival.
Conclusion: An increased preoperative AST/ALT ratio had a significant association with renal vein...Read More
Efficacy of targeted therapy for advanced renal cell carcinoma: a systematic review and meta-analysis of randomized controlled trials
Vol. 43 (x): 2017 November 11.[Ahead of print]
Chao Wei 1, 2, Shen Wang 1 ,2, Zhangqun Ye 1, 2, Zhiqiang Chen 1, 2
1 Department of Urology and 2 Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
We conducted a systematic review and meta-analysis of the literature on the efficacy of the targeted therapies in the treatment of advanced RCC and, via an indirect comparison, to provide an optimal treatment among these agents. A systematic search of Medline, Scopus, Cochrane Library and Clinical Trials unpublished was performed up to Jan 1, 2015 to identify eligible randomized trials. Outcomes of interest assessing a targeted agent included progression free survival (PFS), overall survival (OS) and objective response rate (ORR). Thirty eligible randomized controlled studies, total twenty-fourth trails (5110 cases and 4626 controls) were identified. Compared with placebo and IFN-α, single vascular epithelial growth factor (receptor) tyrosine kinase inhibitor and mammalian target of rapamycin agent (VEGF(r)-TKI & mTOR inhibitor) were associated with improved PFS, improved OS and higher ORR, respectively. Comparing sorafenib combination vs sorafenib, there was no significant difference with regard to PFS and OS, but with a higher ORR. Comparing single or combination VEGF(r)-TKI & mTOR inhibitor vs BEV + IFN-α, there was no significant difference with regard to PFS, OS, or ORR. Our network ITC meta-analysis also indicated a superior PFS of axitinib and everolimus compared to sorafenib. Our data suggest that targeted therapy with VEGF(r)-TKI & mTOR inhibitor is associated with superior efficacy for treating advanced RCC with improved PFS, OS and higher ORR compared to placebo and...Read More
Vol. 43 (6): 1012-1012, November – December, 2017
EDITORIAL in This Issue
In November, 5th, 2017, on the day Dr. Anthony J. Thomas Jr. would turn 74, he passed away. He was an internationally recognized reputed urologist, that popularized microsurgery in the urological community.
Tony was a great friend of Brazilian Urology. He opened the doors of the Cleveland Clinic Foundation to Brazilian urologists. When he introduced me to his colleagues during meetings, he always stressed that I was his first fellow at Cleveland Clinic; he joined the Clinic in 1982, and worked there for more than 30 years. During that period, many other Brazilians attended fellowship under his guidance.
He always supported SBU and many times helped us bring several American experts to our Congresses without costs. He himself attended several Brazilian Congresses of Urology, and many national courses on Infertility.
But Tony’s main quality was that he was a Family man. He involved his heart in all his actions. His patients firstly were persons that deserved his greater respect. He was a very thoughtful person, always with a nice and pleasant word for all. His concern with his fellows was touching. My car was very old, and he always would catch me when we had meetings together, since he was afraid that I would not make it due to mechanical problems. And I lived in the other side of the city! Probably he was the most honest, ethical and professional man that I have ever met.