Purpose: To validate the predictive and prognostic role of the De Ritis ratio in patients
with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy
in a large multi-institutional cohort. Materials and methods: The preoperative De
Ritis ratio was assessed in a multi-institutional cohort of 2,492 patients. An altered
De Ritis ratio was defined as a ratio > 1.35. Logistic regression analyses were performed
to assess the association of the De Ritis ratio with advanced disease. The association
of the De Ritis ratio with survival outcomes was evaluated using Cox proportional
hazards regression models. Results: An altered De Ritis ratio was observed in 985
(41.5%) patients; it was associated with a more advanced pathological features. In
a preoperative model, the De Ritis ratio was an independent predictive factor for
the presence of lymph node metastasis and muscle-invasive and nonorgan-confined disease
(P < 0.05). Compared to patients with a normal De Ritis ratio, those with an altered
De Ritis ratio had worse recurrence free (P < 0.0001), cancer specific (P = 0.0003),
and overall survival (P = 0.0014) in the Kaplan-Meier analyses. In the multivariable
analyses that was adjusted for the effects of standard clinicopathologic features,
the De Ritis ratio did not retain its independent prognostic value. Conclusions: In
UTUC, the preoperative De Ritis ratio is associated with adverse clinicopathologic
features and independently predicts features of biologically and clinically aggressive
UTUC. Therefore, it might be useful to incorporate the De Ritis ratio into prognostic
tools in selecting appropriate treatment strategies. (C) 2020 Elsevier Inc. All rights
reserved.
