Aspartate Aminotransferase/Alanine Aminotransferase Ratio Predicts the Post-surgical Prognosis of Patients with Oral Squamous Cell Carcinoma

Objectives: Survival rates in patients with oral squamous cell carcinoma (OSCC) have failed to improve greatly over time, and novel biomarkers are urgently needed. Therefore, the aim was to evaluate the predictive ability of the pre-treatment serum aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio (SLR) for the prognosis of patients with OSCC. Materials and methods: This cohort study based on a prospectively maintained database included 552 patients who were diagnosed with primary OSCC and underwent surgery between August 2011 and January 2022. The pre-treatment SLR was determined in each patient by dividing the AST levels by the ALT concentrations. Propensity score matching (PSM) analysis was performed to adjust for potential confounders. COX proportional hazards models, as well as generalized boosted regression model (GBM) and random survival forest (RSF) algorithms were used to investigate the predictive value of the SLR in determining the prognosis of patients with OSCC. Results: X-tile software was used to determine the SLR to stratify patients into low-SLR (SLR < 1.50, n = 445) and high-SLR (SLR ≥ 1.50, n = 107). After PSM, all covariates were determined to be well-balanced between the two groups in the matched cohort (all standardized mean differences (SMDs) < 0.1). The high-SLR group exhibited significantly poorer overall survival (OS) compared with that of the low-SLR group based on the multivariate Cox regression modeling in both the original (hazard ratio (HR) = 1.55; 95% confidence interval (CI): 1.02-2.36) and matched (HR = 1.81; 95% CI: 1.13-2.91) cohorts. Furthermore, comparative model analysis demonstrated a moderate improvement in predictive performance when SLR was included in the models (P = .017 in the original cohort; P = .008 in the matched cohort). Conclusions: In conclusion, the pre-treatment SLR serves as an independent prognostic factor for OS in surgical OSCC patients and enhances the performance of prognostic models, indicating its potential as a clinical tool for outcome prediction.