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

作　　者：鲍正清 刘振华 夏海缀 王杰 李贵忠 王建伟 BAO Zhengqing;LIU Zhenhua;XIA Haizhui;WANG Jie;LI Guizhong;WANG Jianwei(Department of Urology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院泌尿外科,北京100035

出　　处：《现代泌尿外科杂志》2025年第2期161-167,共7页Journal of Modern Urology

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。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 

分 类 号：R737.14[医药卫生—肿瘤]