Diagnosing melanoma patients entering American Joint Committee on Cancer stage IV, C-reactive protein in serum is superior to lactate dehydrogenase

Abstract

Lactate dehydrogenase (LDH) in serum has recently been introduced into the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma because of its prognostic value. We hypothesised LDH to be of value in discriminating melanoma patients entering AJCC stage IV from patients staying in AJCC stages I, II or III. Lactate dehydrogenase was compared to the acute phase protein C-reactive protein (CRP), which we observed to reflect the course of melanoma metastasis in a previous report. In this prospective study, we measured LDH and CRP in the serum of 91 consecutive melanoma patients progressing into AJCC stage IV in comparison to 125 patients staying in AJCC stages I, II or III. Comparing distributions of the parameters by median values and quartiles by Mann -Whitney test, LDH was not significantly elevated in patients entering AJCC stage IV melanoma (P ¼ 0.785), whereas CRP was (Po0.001). Analysing the sensitivity and the specificity jointly by the areas under the receiver operating characteristics curves (ROC-AUC), LDH did not discriminate between the defined groups of patients (AUC ¼ 0.491; 95% confidence interval, 0.410, 0.581), whereas CRP did (AUC ¼ 0.933; 95% confidence interval, 0.900, 0.966; Po0.001). Upon logistic regression analysis to calculate the ROC-AUC values upon the predictive probabilities, LDH provided no additional information to CRP. Choosing a cutoff point of 3.0 mg l À1 , CRP yielded a sensitivity of 0.769 together with a specificity of 0.904 in diagnosing AJCC stage IV entry. Altogether, for first diagnosing AJCC stage IV melanoma, CRP is the superior serum marker when compared to the conventional LDH.

Adoptive Transfer of Tumor-Infiltrating Lymphocytes in Patients with Metastatic Melanoma: Intent-to-Treat Analysis and Efficacy after Failure to Prior Immunotherapies

“…Other published TIL ACT trials did not find this correlation (12,14,15). Elevated serum level of lactate dehydrogenase (LDH), a marker of disease activity and tumor burden (21,22) was negatively correlated with clinical response (P ¼ 0.013; 0.219 OR; 95% CI: 0.061-0.992).…”

Safety and Efficacy of Combination Immunotherapy With Interferon Alfa-2b and Tremelimumab in Patients With Stage IV Melanoma

“…53 The potential role of CRP as a mediator of immune tolerance is also interesting. CRP binds to phosphocholine in damaged membranes where it increases clearance of apoptotic cells and binds to nuclear antigens, and by masking autoantigens from the immune system or enhancing their clearance, CRP may prevent autoimmunity.…”

Melanoma biomarkers: Vox clamantis in deserto (Review)

“…CrP was found to be an independent prognostic factor for survival (86). In one study, CrP was found to be superior to LDH in discriminating melanoma patients entering AJCC stage IV from patients remaining in AJCC stages I, II or III (82). CrP was detected with a sensitivity of 77% and specificity of 90% in determining the progression of disease into stage IV (82).…”

“…This protein is produced as a non-specific acute phase response to almost all forms of inflammation (80). In a study of melanoma, CrP was assayed in human blood using an immunonephelometric technique on a protein system analyzer (82). elevated serum CRP levels along with IL-6 were associated with reduced survival in metastatic melanoma and resistance to IL-2 therapy (82)(83)(84)(85)(86).…”