Elevated baseline serum lactate dehydrogenase indicates a poor prognosis in primary duodenum adenocarcinoma patients

Abstract

Purpose: Tumour cells produce energy through glycolysis and lactate dehydrogenase (LDH) is a key part of glycolysis. Elevation of serum LDH may indicate poor prognosis in primary duodenum adenocarcinoma. We aim to explore the prognostic significance of LDH in this disease.Methods and materials: Two hundred forty-four patients diagnosed with primary duodenum adenocarcinoma who were treated at the Sun Yat-sen Cancer Center from February 1996 to January 2016 were retrospectively analysed. We collected routine clinical data, including baseline LDH. Patients were classified into a normal LDH group (≤ 245U/L) and higher LDH group (>245U/L). Correlations of the LDH level and other clinicopathological characteristics were explored using the Chi-square test. Prognostic factors for overall survival were identified using univariate and multivariate analyses.Results: Two hundred seven patients (84.9%) had normal LDH levels, while 37 patients (15.1%) had abnormally high LDH levels. Higher LDH levels were significantly associated with more distant metastasis, node metastasis, poor differentiation and TNM stage Ⅲ-Ⅳ (P<0.05). Consistently, patients with node metastasis, poor differentiation and TNM stageⅢ-Ⅳ had a significantly higher median LDH level (P<0.05). The median survival of patients in the higher LDH group was significantly shorter than that of the patients in the normal LDH group (16.3 m vs. 42.5 m, P=0.02). Using multivariate analysis, LDH, age and radical surgery were independent prognostic factors associated with overall survival(OS) (HR=1.571, P=0.036 for LDH; HR=1.514, P=0.013 for age; HR=0.248, P<0.0001 for radical surgery, respectively).Conclusions: For the first time, our research suggests that baseline serum LDH is an independent prognostic factor in primary duodenum adenocarcinoma patients and elevated baseline serum LDH indicates a poor prognosis.

The Predictive Value of Albumin-to-Alkaline Phosphatase Ratio for Overall Survival of Hepatocellular Carcinoma Patients Treated with Trans-Catheter Arterial Chemoembolization Therapy

“…Many researchers have set out to identify potential independent prognostic factors in the routine blood tests and biochemical tests of cancer patients for their economical and convenient features. Several serum biomarkers such as the neutrophil to lymphocyte ratio (NLR), lactic dehydrogenase (LDH), ALB, ALP and AAPR have been reported as independent prognostic factors of OS in malignant tumours 19 , 20 .…”

Targeting immune cells for cancer therapy

“…As seen in a melanoma mouse model, tumor-derived lactic acid also prevents NFAT upregulation, leading to diminish IFNγ production [59]. In the clinical setting, high levels of serum lactate dehydrogenase [86,87] or lactic acid [88] predicts poor prognosis in cancer patients. Unlike lactic acid, hypoxia does not suppress CD8 + T cell activity but instead promotes T cell survival and enhances T cell-mediated tumor control.…”

Pre-treatment Serum Lactate Dehydrogenase Predicts Distant Metastasis and Poor Survival in Nasopharyngeal Carcinoma

“…In those metabolic enzymes involved in glycolysis, lactate dehydrogenase (LDH) is the most important one as it can convert pyruvate to lactate at the end of glycolysis 14. LDH has been identified to possess a prognostic role in several kinds of cancers 15-17. The international prognostic index (IPI) is a common clinical tool used to predict outcomes in patients with non-Hodgkin's lymphoma and it contains five risk factors including serum LDH 18.…”