Low Alanine Aminotransferase Blood Activity, a Biomarker of Sarcopenia and Frailty, is Associated With Worse Post-Total Laryngectomy Clinical Outcomes. A Retrospective Analysis of 427 Patients

Introduction: Sarcopenia and frailty status have been shown to be associated with cancer patients' survival. Low alanine aminotransferase (ALT) blood activity was previously shown to be associated with frailty and poor clinical outcomes in cancer patients. This association was not addressed in head and neck cancer patients. Objectives: This was a retrospective study, investigating the possible association between pre-operative low ALT blood levels and clinical outcomes in patients undergoing total laryngectomy due to malignancy. Patients and Methods: We did a retrospective analysis using the largest national Israeli HMO (Clalit health maintenance organization) database, including the demographic, clinical background, laboratory and clinical outcomes of head and neck cancer patients who underwent total laryngectomy. Results: A total of 427 patients were included. Patients were divided into two groups according to their ALT values: low ALT (0–10 IU/L, N = 100) and normal ALT (11–40 IU/L, N = 327). Low ALT levels were associated with significantly longer duration of in-hospital stay (26 ± 17 vs. 23 ± 16 days, respectively; p < 0.001), higher probability of 1-month, post-discharge unplanned visits to the emergency department (RR = 1.66; p < 0.05) and worse 1-year survival rate (67% vs. 77%, respectively; p < 0.05). Conclusions: Low, pre-operative ALT levels are associated with worse prognosis for total laryngectomy patients. ALT levels may be used for better, personalised medicine by surgeons.