A New Risk Score Model Based on Lactate Dehydrogenase Predicting Prognosis in Esophageal Squamous Cell Carcinoma Treated With Chemoradiotherapy

Abstract

Purpose: The current study was to assess the prognostic value of the lactate dehydrogenase (LDH) in esophageal squamous cell cancer (ESCC) patients and to generate a risk score model to predict prognosis in patients who undergone chemoradiotherapy. Patients and Methods: 614 ESCC patients who received chemoradiotherapy were performed from 2012 to 2016.The optimal cutoff points for continuous variables were calculated by the X-tile program. We analyzed the association between LDH level and clinicopathological characteristics. And a 1:3 propensity score matching analysis was used to compensate for differences in baseline characteristics. The Kaplan-Meier methods and Cox regression models were used to explore the prognostic factors for overall survival (OS) and progression-free survival (PFS). Based on the results, we developed a corresponding risk score model and assessed its predictive capacity in the subgroups. Results: The optimal cutoff points of age, CEA, Cyfra21-1, tumor length, total dose and LDH were defined as follows:69 years, 2.4 ng/ml, 6.4 ng/ml, 6.5 cm, 58.8Gy and 134 U/L, respectively. A high level of LDH was associated with advanced M stage (p=0.005) and larger tumor length (p=0.026). Patients in the high-LDH group had shorter PFS and worse OS than those in the low-LDH group. Multivariate survival analysis indicated that pretreatment serum LDH level (p=0.039)，Cyfra21-1 level (p=0.003), tumor length (p=0.013), clinical N stage (p=0.047) and clinical M stage (p=0.011) were independent predictors for OS. Furthermore, a risk score model based on these five prognostic factors was established to divide patients into three groups with obvious prognosis (χ2 = 20.53, p< 0.0001). Conclusion: Pretreatment serum LDH levels may be a reliable factor in predicting the therapeutic effect of chemoradiotherapy in ESCC. A risk score model combined LDH, Cyfra21-1 and other prognostic factors could help to guide a personalized management. Further validation is needed before widely used in clinical practice.

Efficacy and safety of camrelizumab in patients with esophageal squamous cell carcinoma: A multicenter, prospective, real-world study

“…Lactate dehydrogenase (LDH) is a crucial glycolysis enzyme [25][26][27]. In ammatory-based prognostic factors, such as neutrophil-to-lymphocyte ratio (NLR) and serum LDH, are associated with a poor prognosis and have shown potential value to predict prognosis in patients with several cancer types [28][29][30][31][32]. However, whether pretreatment in ammatory marker and serum LDH levels can be treated as predictors of bene ts from ICIs remains unclear.…”

Efficacy and safety of camrelizumab in patients with first-line and second- line therapy for esophageal squamous cell carcinoma: A multicenter, prospective, real-world study

“…In ammatoty-based prognostic factors, such as neutrophil-to-lymphocyte ratio (NLR) and serum LDH, are associated with a poor prognosis and have shown potential value to predict prognosis in patients with several cancer types [28][29][30][31][32]. However, whether pretreatment in ammatory marker and serum LDH levels can be treated as predictors of bene ts from ICIs remains unclear.…”