Eyal Jacobi

Background: Sarcopenia is characterized by a loss of muscle mass and function and is often associated with frailty, a syndrome linked to physical disability and shortened survival in various patient populations, including cancer patients. Low serum alanine aminotransferase (ALT) values, serving as a biomarker for sarcopenia, were previously associated with frailty and shortened survival in several cancers. In the current study, we aimed to test the association between low ALT and shorter survival in renal cell carcinoma (RCC) patients and survivors. Methods: This was a retrospective analysis of RCC patients and survivors, both in- and outpatients. We defined patients with sarcopenia as those presenting with ALT < 17 IU/L. Results: We identified records of 3012 RCC patients. The cohort included 1830 patients (mean age 65.6 ± 13.3 years, 68% were men) of whom only 179 underwent surgical treatment. Out of the eligible cohort, 811 patients (44.3%) had ALT < 17 IU/L, with a mean ALT value of patients within the low-ALT group of 11.79 IU/L, while the mean value in the higher ALT level group was 24.44 IU/L (p < 0.001). Patients in the low-ALT group were older (67.9 vs. 63.7 years; p < 0.001) and had lower BMIs (26.6 vs. 28; p < 0.001). In addition, patients with low ALT had lower hemoglobin values (12.14 vs. 12.91 g/dL; p < 0.001), higher serum creatinine (1.49 vs. 1.14; p < 0.001) and higher platelet to lymphocyte ratios (178 vs. 156; p < 0.001). In a univariate analysis, low ALT levels were associated with a 72% increase in mortality (95% CI 1.46–2.02, p < 0.001). In a multivariate model controlled for age, gender, hemoglobin, platelets, LDH, neutrophil to lymphocyte ratios and platelet to lymphocyte ratios, low ALT levels were still associated with a 27% increase in mortality (HR = 1.27, 95% CI 1.08–1.51; p = 0.005). Conclusion. Low ALT values, associated with sarcopenia and frailty, are also associated with shortened survival in RCC patients, and survivors and could potentially be applied for optimizing individual treatment decisions.

Background. Sarcopenia is characterized by progressive loss of muscle mass and function. It is often associated with frailty, a syndrome linked to physical disability and shortened survival in various diseases, including cancer patients. Low serum alanine aminotransferase (ALT) values, representing low muscle mass (sarcopenia), is a routine blood test that was shown to be associated with increased frailty and subsequently shortened survival in several cancers. In the current study, we aimed to test the association between low ALT and shorter survival in renal cell carcinoma (RCC) patients and survivors. Methods. This was a retrospective analysis of RCC patients and survivors, both in and out-patients. We defined patients with sarcopenia as those presenting with ALT < 17 IU/L. Results. We identified records of 3,012 patients diagnosed with RCC. The final cohort included 1,830 eligible patients (mean age 65.6 ± 13.3 years, 68% were men) of whom only 179 underwent surgical treatment. Out of the eligible cohort, 811 patients (44.3% ( had ALT < 17 IU/L. The mean ALT value of patients within the low ALT group was 11.79 IU/L while the mean value in the higher ALT level group was 24.44 IU/L (p < 0.001). Patients in the lower ALT group were older (67.9 vs. 63.7 years; p < 0.001) and had lower BMI (26.6 vs. 28; p < 0.001). In addition, patients with low ALT had lower hemoglobin values (12.14 vs. 12.91 g/dL; p < 0.001), higher serum creatinine (1.49 vs. 1.14; p < 0.001) and higher platelets to lymphocytes ratio (178 vs. 156; p < 0.001). In a univariate analysis, low ALT levels were associated with a 72% increase in mortality (95% CI 1.46-2.02, P < 0.001). In a multivariate model controlled for age, male gender, hemoglobin, platelets, LDH, neutrophil to lymphocytes ratio and platelets to lymphocytes ratio, low ALT levels were associated with a 27% increase in mortality (HR = 1.27, 95% CI 1.08 – 1.51; p = 0.005]. Conclusion. Low ALT values, indicative of sarcopenia and frailty, are associated with shortened survival of RCC patients and survivors and could potentially be applied for optimizing individual treatment decisions.