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We investigated the prognostic significance of De Ritis ratio (aspartate aminotransferase [AST]/alanine aminotransferase [ALT]) in patients with upper tract urothelial cancer (UTUC) after surgical treatment. After retrospective analysis of 623 subjects, the elevated AST/ALT levels showed worse survival outcomes and independently predicted postoperative survival outcomes. The AST/ALT can be a useful biomarker for prediction of postoperative prognosis in patients with localized UTUC.We investigated the clinical prognostic value of preoperative De Ritis ratio (aspartate aminotransferase [AST]/alanine aminotransferase [ALT]) on postsurgical survival outcomes in patients with upper tract urothelial cancer (UTUC).We retrospectively analyzed the data of 623 patients who underwent radical nephrouretectomy for UTUC. Multivariate regression tests were performed to identify possible associations between adverse pathologic events and AST/ALT. The risk of postoperative progression and survival were tested using Kaplan–Meier analyses and Cox proportional hazards models.According to the receiver operator characteristic curve of AST/ALT for cancer-specific mortality, patients with AST/ALT value ≥1.5 were regarded as the high AST/ALT group, and the remaining patients formed the low AST/ALT group. In Kaplan–Meier analyses, the high AST/ALT group showed worse progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (all P < .001). Elevated AST/ALT was associated with higher T stage (hazard ratio [HR], 1.577; 95% confidence interval [CI], 1.077-2.311; P = .033) and higher cellular grade (HR, 1.538; 95% CI, 1.034-2.287; P = .041) in multivariate regression tests. In multivariate Cox analyses, high AST/ALT was revealed as an independent predictor of PFS (HR, 2.335; 95% CI, 1.633-3.340; P < .001), CSS (HR, 2.550; 1.689-3.851; P < .001), and overall survival (HR, 2.069; 95% CI, 1.409-3.038; P < .001).Elevated preoperative AST/ALT was a significant predictor of worse postoperative survival in patients surgically treated for UTUC. Further large prospective studies are needed for better understanding of the prognostic value of preoperative AST/ALT.