PROGNOSTIC VALUE OF AST/ALT AND GGT/ALP RATIOS IN PATIENTS WITH CHOLANGIOCARCINOMA

Introduction and Objectives

Cholangiocarcinoma (CCA), the second most common primary liver cancer, is typically diagnosed at advanced stages, limiting therapeutic options and prognosis. Simple, inexpensive biomarkers such as AST/ALT and GGT/ALP ratios may support early prognostic stratification, but their role in CCA remains insufficiently defined. This study aimed to assess the prognostic value of these serum ratios in patients with CCA.

Materials and Methods

A retrospective, observational, and analytical study was conducted in a cohort of 30 patients diagnosed with cholangiocarcinoma and treated at a tertiary care hospital between 2020 and 2024. AST/ALT and GGT/ALP ratios were calculated from baseline liver function tests. Patients were stratified using established clinical thresholds: >1.5 vs. ≤1.5 for AST/ALT and >1.0 vs. ≤1.0 for GGT/ALP. Overall survival was measured from the time of diagnosis to death or last follow-up. Kaplan-Meier survival curves were constructed, and intergroup differences were assessed with the log-rank test.

Results

Patients with GGT/ALP >1.0 exhibited a sharper decline in survival within the first 20 months and a lower median survival, though the difference was not statistically significant (p = 0.085). The AST/ALT ratio showed no significant survival differences between groups (p = 0.47), with largely overlapping survival curves.

Conclusions

GGT/ALP ratio >1.0 demonstrated a non-significant but clinically suggestive trend toward decreased survival in patients with cholangiocarcinoma. The AST/ALT ratio did not show prognostic relevance. These readily available biomarkers may assist in risk stratification, but further validation in larger cohorts is required.

Conflict of interest: None

Kaplan-Meier survival curve according to the GGT/ALP ratio and AST/ALT ratio