Bezan et al. first observed that an elevated preoperative De Ritis ratio was associated with poor metastasis-free survival and OS in patients with nonmetastatic renal cell carcinoma.14 The authors hypothesized that increased tissue damage and high tumor cell turnover affect AST to a larger extent than ALT, which partly explains why an elevated De Ritis ratio is associated with poor survival outcomes. Here, GPT is linked to neoplasm.