An analysis of lactate dehydrogenase (LDH) levels in advanced stage IV melanoma of the skin: prognostic capabilities and demographic variability

Abstract

BackgroundDespite its limitations, in part due to decreased speci city in advanced disease, serum lactate dehydrogenase (LDH) is one of few serum factors used in cancer staging. ObjectivesThis study quanti es the predictive capabilities of LDH in stage IV melanoma of the skin and explores the validity of suggested demographic discrepancies which may exist in its use. MethodsThe 1975-2017 Surveillance Epidemiology and End Results (SEER) database was queried for stage IV cutaneous melanoma cases. Demographic characteristics were compared between LDH groups using chi-square and t-tests. Subsequent Cox multivariable regression was performed to assess survival differences. Results334 cases of stage IV cutaneous melanoma (average age: 63.0 years) with measured serum LDH levels were identi ed. Of these patients, 150 (44.9%) had normal LDH, 112 (33.5%) had LDH < 1.5x upper limit of normal (ULN), 57 (17.1%) had LDH 1.5-10x ULN, and 15 (4.5%) had LDH > 10x ULN. Lower incomes were associated with higher LDH; individuals with incomes <$50,000 had the greatest proportion of LDH 10x ULN (19.2%; p = 0.0031). LDH > 10x ULN also had the lowest proportion of White patients (p = 0.04). On Cox multivariable survival analysis, increasing LDH levels showed increased risk of death (LDH < 1.5x ULN: HR = 2.05, p = 0.01; LDH 1.5-10x ULN: HR = 1.46, p < 0.001; LDH > 10x ULN: HR = 5.91, p < 0.001). ConclusionThis study rea rms the utility of LDH as a signi cant predictor of mortality with incremental severity, suggesting possible use for mortality projections. We note that Black patients and those with lower incomes may be more likely to have an elevated LDH. Older age groups and presence of ulceration among patients with stage IV melanoma were also associated with a greater risk of mortality.

Combined anti-PD-1 and anti-CTLA-4 Treatment in Stage IV Melanoma Patients: Bicentric Analysis of Real-world Data

“…LDH levels can be a useful tool in the initial diagnostic work-up for skin melanoma patients, as presented in our result patients that have three or more sites of metastasis have a higher chance of having higher serum LDH levels, our findings being in consensus with the literature on this matter [9]. But this marker has its limitations, for example LDH levels do not associate as well as S-100B with metabolic active tumor volume (evaluated via 18F-FDG PET/CT scans) [16].There is also the problem of racial disparities between the expression of this marker [17,18] and other confounding factor and comorbidities that can cause high serum LDH levels for example other malignancies: lymphomas, pancreatic carcinoma, various liver metastases etc. [19] and other diseases myocardial infarction, obstructive jaundice, acute hepatitis etc.…”

Combined Anti-PD-1 and Anti-CTLA-4 Treatment in Stage IV Melanoma Patients: A Bicentric Analysis of Real-World Data and a Modern Treatment Scenario Proving Lactate Dehydrogenase’s Usefulness

“…However, this marker has its limitations; for example, LDH levels do not associate as well as S-100B with the metabolic active tumor volume (evaluated via 18F-FDG PET/CT scans) [ 15 ]. There is also the problem of racial disparities between the expression of this marker [ 16 , 17 ] and other confounding factors and comorbidities that can cause high serum LDH levels, for example, other malignancies: lymphomas, pancreatic carcinoma, various liver metastases, etc., [ 18 ], and other diseases such as myocardial infarction, obstructive jaundice, acute hepatitis, etc., [ 18 , 19 , 20 , 21 ].…”

Impact of changes in serum lactate dehydrogenase levels on pathological response after neoadjuvant chemotherapy in patients with breast cancer

“…Serum LDH levels are associated with prognosis in patients with a variety of malignant tumors, including lung, cervical, colorectal, gastric, and melanoma 20,21,22,23,24 . In BC, the relationship between serum LDH levels and clinical outcomes has also been extensively studied; however, to the best of our knowledge, the clinical signi cance of serum LDH levels in patients with BC undergoing NAC remains unknown, and the results of the current study are con icting.…”

“…Zhang conducted a meta-analysis, and they identi ed a total of 68 eligible studies, including 31,857 BC patients. The experts found high serum LDH levels were inversely associated with patients' OS, but changes in the serum LDH cut-off did not affect patients' prognosis 19 .Serum LDH levels are associated with prognosis in patients with a variety of malignant tumors, including lung, cervical, colorectal, gastric, and melanoma 20,21,22,23,24 . In BC, the relationship between serum LDH levels and clinical outcomes has also been extensively studied; however, to the best of our knowledge, the clinical signi cance of serum LDH levels in patients with BC undergoing NAC remains unknown, and the results of the current study are con icting.…”