Role of Lactate Dehydrogenase in Identifying Relapse for Patients With Stage I Testicular Cancer on Surveillance

Abstract

Purpose:Tumor markers alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase assume a key role in the management of testicular germ cell tumors. While alpha-fetoprotein and human chorionic gonadotropin have modest sensitivity and specificity for germ cell tumors, lactate dehydrogenase has weak sensitivity and specificity. We explored the utility of lactate dehydrogenase in identifying relapse among stage I seminomatous and nonseminomatous germ cell tumors on surveillance.Materials and Methods:Patients with a history of stage I testicular germ cell tumors were identified from a prospectively maintained database at the Princess Margaret Cancer Centre from December 1980 to May 2021 and surveyed according to established institutional algorithm guidelines. The utility of lactate dehydrogenase elevation to independently detect germ cell tumor relapse was examined.Results:Among 1,014 seminoma and 676 nonseminomatous germ cell tumor patients, 176 and 176 patients relapsed with a median time to relapse of 13.6 and 8.9 months, respectively. Imaging alone was the most common mode of relapse detection in 144 and 74 of seminoma and nonseminomatous germ cell tumor patients, respectively. Lactate dehydrogenase was elevated in 49 cases of seminoma and 38 cases of nonseminomatous germ cell tumors at relapse, but was never the sole relapse indicator. Among 350 seminoma and 311 nonseminomatous germ cell tumor patients who never relapsed, 210 and 233, respectively, had at least 1 elevated lactate dehydrogenase value.Conclusions:Lactate dehydrogenase alone did not independently contribute to early relapse detection in stage I seminoma or nonseminomatous germ cell tumor. Elevated lactate dehydrogenase values were documented in a high proportion of nonrelapsing seminoma and nonseminomatous germ cell tumor cases.

Guideline of guidelines: follow‐up after orchidectomy for clinical stage 1 testicular cancer

“…[27] on the reliability of STM in CS1 NSGCT surveillance found that STM were only elevated in 28%–75% of patients at the time of relapse and STM were only the sole indicator of relapse in 4%–39% of cases. Similarly, the utility of LDH has been questioned in CS1 NSGCT surveillance [8,51]. A recently published study demonstrated LDH never was the sole indicator of relapse in 176 relapsing patients with NSGCT and LDH was falsely elevated in 75% of non‐relapsing patients with NSGCT on surveillance [8].…”

“…A recently published study showed that only 28% of relapsing patients with CS1 seminoma on surveillance had an elevated LDH and was falsely elevated in 60% non-relapsing patients. LDH was never the sole indicator of relapse, which raises questions on the utility of LDH as a STM in seminoma surveillance [8].…”

“…Similarly, the utility of LDH has been questioned in CS1 NSGCT surveillance [8,51]. A recently published study demonstrated LDH never was the sole indicator of relapse in 176 relapsing patients with NSGCT and LDH was falsely elevated in 75% of non-relapsing patients with NSGCT on surveillance [8]. Given that over half of relapses are…”

New insights on testicular cancer prevalence with novel diagnostic biomarkers and therapeutic approaches

“…LDH serves as a marker that lacks specificity, although it possesses an autonomous prognostic significance in males afflicted with advanced TC. Literature has documented that LDH accurately mirrors both the rate of tumor expansion and the extent of tumor mass 101 . Elevated concentrations of serum lactate dehydrogenase (LDH) have been documented in roughly 80% of advanced seminomas and approximately 60% of non‐seminomas 101 .…”

“…Literature has documented that LDH accurately mirrors both the rate of tumor expansion and the extent of tumor mass 101 . Elevated concentrations of serum lactate dehydrogenase (LDH) have been documented in roughly 80% of advanced seminomas and approximately 60% of non‐seminomas 101 . While AFP, HCG, and LDH are frequently employed serum markers in the management of TC, their specificity is limited and their detection rate in men with TC is only approximately 60% 102 .…”