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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Cancer Immunity and Immunotherapy
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1389804

The AST/ALT ratio predicts survival and improves oncological therapy decisions in patients with non-small cell lung cancer receiving immunotherapy with or without radiotherapy

Provisionally accepted
Yanyan Zhang Yanyan Zhang 1Jingxin Zhang Jingxin Zhang 2Shijie Shang Shijie Shang 3Jiachun Ma Jiachun Ma 4Fei Wang Fei Wang 5Meng Wu Meng Wu 5Jinming Yu Jinming Yu 5*Dawei Chen Dawei Chen 5*
  • 1 Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China, Jinan, Shandong Province, China
  • 2 Shandong Cancer Hospital, Shandong University, Jinan, China
  • 3 Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
  • 4 Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
  • 5 Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China, Jinan, China

The final, formatted version of the article will be published soon.

    Abstract Background and purpose Immunotherapy, with or without radiotherapy (iRT or ICIs-nonRT), is the standard treatment for non–small cell lung cancer (NSCLC). Nonetheless, the response to the treatment varies among patients. Given the established role of aspartate aminotransferase/alanine transaminase (AST/ALT) ratio in predicting cancer prognosis, we sought to identify whether the pre-treatment AST/ALT ratio has the potential to serve as a prognostic factor for NSCLC patients receiving ICIs-nonRT and iRT. Materials and Methods We retrospectively analyzed NSCLC patients who received immunotherapy between April 2018 and March 2021. Patients were classified into iRT group and ICIs-nonRT group and further classified based on AST/ALT ratio cut-off values. The Kaplan-Meier (KM) method estimated the time-to-event endpoints (progression-free survival (PFS) and overall survival (OS) Results Of the cohort, 239 underwent ICIs-nonRT and 155 received iRT. Higher AST/ALT ratios correlated with worse outcomes in the ICIs-nonRT group but indicated better outcomes in those who received iRT. Multivariate analysis validated AST/ALT ratio as an independent prognostic factor. For AST/ALT ratios between 0.67-1.7, both ICIs-nonRT and iRT yielded similar treatment outcomes; with AST/ALT ratios greater than 1.7, iRT could be a more favorable treatment option (P=0.038). Conversely, for ratios less than 0.67, ICIs-nonRT could be a more favorable treatment option (P=0.073). Conclusions The pre-treatment AST/ALT ratio demonstrates potential as a prognostic marker for treatment outcomes in NSCLC patients receiving either ICIs-nonRT or iRT. This finding could help guide clinicians in selecting more effective treatment protocols, thereby enhancing patient prognosis. .

    Keywords: Non-small cell lung cancer, aspartate aminotransferase, Alanine Transaminase, AST/ALT ratio, immunotherapy without radiotherapy, immunotherapy combined with radiotherapy

    Received: 22 Feb 2024; Accepted: 31 Jul 2024.

    Copyright: © 2024 Zhang, Zhang, Shang, Ma, Wang, Wu, Yu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Jinming Yu, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China, Jinan, China
    Dawei Chen, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China, Jinan, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.