The De Ritis ratio (=aspartate transaminase/alanine transaminase) has shown prognostic value in different cancer types. This is the first such analysis in prostate cancer patients undergoing radioligand therapy (RLT) with [177Lu]Lu-PSMA-617. This retrospective monocentric analysis included 91 patients with a median of 3 RLT cycles (range 1–6) and median cumulative activity of 17.3 GBq. Univariable Cox regression regarding overall survival (OS) included age, different types of previous treatment, metastatic patterns and different laboratory parameters before RLT. Based on multivariable Cox regression, a prognostic score was derived. Seventy-two patients (79%) died (median follow-up in survivors: 19.8 months). A higher number of previous chemotherapy lines, the presence of liver metastases, brain metastases, a higher tumor load on PSMA-PET, a higher prostate-specific antigen (PSA) level, lower red blood cell count, lower hemoglobin, higher neutrophil-lymphocyte ratio and higher De Ritis ratio were associated with shorter OS (eachp< 0.05). In multivariable Cox, a higher number of chemotherapy lines (range, 0–2;p= 0.036), brain metastases (p< 0.001), higher PSA (p= 0.004) and higher De Ritis ratio before RLT (hazard ratio, 1.27 per unit increase;p= 0.023) remained significant. This prognostic score separated five groups with a significantly different median OS ranging from 4.9 to 28.1 months (log-rank test,p< 0.001). If validated independently, the De Ritis ratio could enhance multifactorial models for OS after RLT.
De Ritis比值（=天冬氨酸转氨酶/丙氨酸转氨酶）已在多种癌症类型中显示出预后价值。本研究首次对接受[¹⁷⁷Lu]Lu-PSMA-617放射性配体治疗（RLT）的前列腺癌患者进行此类分析。这项回顾性单中心研究纳入91例患者，中位RLT周期数为3次（范围1-6），中位累积活度为17.3 GBq。针对总生存期（OS）的单变量Cox回归分析涵盖年龄、既往治疗类型、转移模式及RLT前各项实验室参数。基于多变量Cox回归构建了预后评分系统。72例患者（79%）死亡（存活者中位随访时间：19.8个月）。既往化疗线数较多、存在肝转移、脑转移、PSMA-PET显示较高肿瘤负荷、较高前列腺特异性抗原（PSA）水平、较低红细胞计数、较低血红蛋白、较高中性粒细胞-淋巴细胞比值及较高De Ritis比值均与较短OS相关（均p<0.05）。多变量Cox回归显示，较多化疗线数（范围0-2；p=0.036）、脑转移（p<0.001）、较高PSA水平（p=0.004）及RLT前较高De Ritis比值（风险比：每增加1个单位对应1.27；p=0.023）仍保持显著相关性。该预后评分系统将患者分为五组，各组中位OS存在显著差异（4.9至28.1个月，对数秩检验p<0.001）。若经独立验证，De Ritis比值有望优化RLT后OS的多因素预测模型。
肿瘤(癌症)患者之家