859 Background: The De Ritis ratio (aspartate aminotransferase/alanine aminotransferase) has been reported as a prognostic biomarker in various malignancies. Given the role of hepatic glucose metabolism in bladder cancer cells, the De Ritis ratio may also serve as a prognostic indicator in muscle-invasive bladder cancer (MIBC). However, its impact on oncological outcomes and its association with sarcopenia in patients undergoing radical cystectomy (RC) remain poorly understood. Methods: This multicenter retrospective study included 881 patients with MIBC who underwent RC. The De Ritis ratio was measured preoperatively. The optimal cut-off value for recurrence was determined using receiver operating characteristic curve analysis. Patients were stratified into two groups based on the De Ritis ratio: lower and higher. Multivariable Cox proportional hazards regression analyses were conducted to assess the impact of a higher De Ritis ratio on recurrence-free survival (RFS) and overall survival (OS). Muscle quantity was evaluated using the psoas index (PI) derived from preoperative computed tomography images, with lower PI values indicating sarcopenia. The association between the De Ritis ratio and PI was analyzed using Spearman’s rank correlation test. Results: The median age and follow-up duration were 70 years and 55 months, respectively. The optimal cut-off value for the De Ritis ratio was 1.40. Of the 881 patients, 244 (28%) had a higher De Ritis ratio. Both RFS and OS were significantly shorter in the higher De Ritis ratio group compared to the lower group ( P < 0.001 for both). After adjusting for confounding variables, a higher De Ritis ratio remained significantly associated with shorter RFS ( P = 0.017; hazard ratio HR: 1.394; 95% confidence interval CI: 1.060–1.834) and OS ( P < 0.001; HR: 1.548; 95% CI: 1.221–1.961). The De Ritis ratio was not significantly correlated with PI in female patients (ρ = –0.049, P = 0.516), but showed a significant negative correlation in male patients (ρ = –0.233, P < 0.001). Conclusions: The preoperative De Ritis ratio may serve as a prognostic biomarker for oncological outcomes in patients undergoing RC. Additionally, it may function as a simple surrogate marker for sarcopenia in male patients. Multivariable analysis for RFS. Factor P value HR 95% CI Age Continuous 0.866 0.999 0.983–1.015 Performance status Continuous 0.090 1.301 0.960–1.764 NAC Received 0.196 1.203 0.909–1.593 Tumor grade Grade 3 0.075 1.377 0.969–1.957 Pathological T stage ≥ pT3 <0.001 2.504 1.482–2.846 LVI Positive 0.002 1.719 1.223–2.414 Pathological N stage ≥ pN1 0.008 1.583 1.125–2.227 Surgical margin Positive 0.263 1.322 0.811–2.156 Urinary diversion Neobladder 0.041 0.750 0.568–0.989 De Ritis ratio ≥ 1.40 0.017 1.394 1.060–1.834
Fujita et al. (2026) studied this question.