Prognostic Significance of Serum Lactate Dehydrogenase in Patients with Osteosarcoma of the Extremities

Abstract

Six hundred and fifty-six patients with osteosarcoma of the extremities (107 metastatic and 549 with localized disease) were followed from 2.5 to 20 years (average: 10 years) to evaluate whether their pretreatment serum lactate dehydrogenase (LDH) enzyme levels had a clinical value in predicting the course of the disease. The percentage of patients who had an elevated serum LDH at the time of diagnosis was significantly higher in those patients with metastatic disease than those who had localized disease (64% versus 33%, p < 0.0001). For those who presented with localized disease and had an increased serum LDH level, far more ultimately developed a relapse of disease (60% versus 38%, p < 0.0001) than those patients with a normal pre-treatment value. The prognostic significance of the serum LDH was more pronounced for the 247 patients treated with adjuvant chemotherapy (relapse rate of 72% versus 48%; p < 0.0002) than the 271 patients treated with neoadjuvant chemotherapy (relapse rate: 46% versus 28%, p < 0.005). Following treatment, serum LDH levels almost uniformly returned to normal and no correlation between postoperative levels and relapse of disease could be identified. We have demonstrated that in patients with osteosarcoma of the extremities, pretreatment serum LDH levels have a definite prognostic value which should be considered when comparing the results achieved with different therapeutic protocols and in planning new randomized clinical trials.

Osteosarcoma: improvement in survival limited to high-grade patients only

“…Other possible prognostic impact factors include older (Saeter et al 1997) or younger age (French Bone Tumor Study Group 1988), patient gender (Saeter et al 1997), tumor size (Bieling et al 1996) and proximal location (Goorin et al 1987;Provisor et al 1997), high alkaline phosphatase (Bacci et al 1993;Meyers et al 1992), and high lactate dehydrogenase (Bacci et al 1994;Meyers et al 1992) …”

Prognostic Factors in High-Grade Osteosarcoma of the Extremities or Trunk: An Analysis of 1,702 Patients Treated on Neoadjuvant Cooperative Osteosarcoma Study Group Protocols

“…25,27 Other variables with possible prognostic impact include tumor size, 28 patient sex, 29 older 29 or younger age, 8,30 proximal tumor site, 6,13 high alkaline phosphatase, 10,31 and high lactate dehydrogenase values. 10,32 More recently, prognostic significance was claimed for multidrug resistance status, 33 loss of heterozygosity of the RB gene, 34 and HER2/erbB-2 expression, 35,36 but these claims have yet to be substantiated by large-scale prospective studies.…”

Pre-treatment serum lactate dehydrogenase level is an important prognostic factor in high-grade extremity osteosarcoma

“…Many studies have suggested a poorer outcome for patients with high LDH [21][22][23], whereas others do not [24]. Two large series have reported a disease-free survival benefi t, but with no OS benefi t. The Rizzoli Institute [25,26] studied the prognostic value of LDH in 1421 patients treated in the last 30 years. A higher level of LDH was observed more frequently in metastatic osteosarcoma than in patients with localised disease, and was associated with shorter disease-free survival.…”

“…The largest study evaluating the prognostic signifi cance was performed by the Rizzoli Institute in 1222 patients with localised disease. Serum LDH correlated with 5-year disease-free survival, as determined by univariate analysis, but this signifi cance was lost when multivariate analysis, including the response to chemotherapy and overall survival (OS), was used for evaluation [25,26]. Studies correlating LDH with OS are scarce [27] and the most important prognostic series [20] do not include serum LDH among the analysed prognostic factors.…”