Elevated lactic acid is a negative prognostic factor in metastatic lung cancer

Vlachostergios, Panagiotis J.; Oikonomou, Katerina; Gibilaro, Eugene; Apergis, George

doi:10.3233/cbm-150514

Cited by 57 publications

(43 citation statements)

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“…High lactate level in type B lactic acidosis has been documented as being associated with significantly shorter overall survival [7]. Similarly, lactate resolution has been noted after the initiation of chemotherapy.…”

Section: Discussionmentioning

confidence: 98%

Refractory Lactic Acidosis in Small Cell Carcinoma of the Lung

Dinerman

Matthews

et al. 2017

Case Reports in Critical Care

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Background Elevated lactate levels in critically ill patients are most often thought to be indicative of relative tissue hypoxia or type A lactic acidosis. Shock, severe anemia, and thromboembolic events can all cause elevated lactate due to tissue hypoperfusion, as well as the mitochondrial dysfunction thought to occur in sepsis and other critically ill states. Malignancy can also lead to elevation in lactate, a phenomenon described as type B lactic acidosis, which is much less commonly encountered in the critically ill. Case Presentation We present the case of a 73-year-old Caucasian woman with type 2 diabetes and hypertension who presented with abdominal pain, nausea, vomiting, nonbloody diarrhea, and weight loss over five weeks and was found to have unexplained refractory lactic acidosis despite fluids and antibiotics. She was later diagnosed with small cell carcinoma of the lung. Conclusions In this case report, we describe a critically ill patient whose elevated lactate was incorrectly attributed to her acute illness, when in truth it was an indicator of an underlying, as yet undiagnosed, malignancy. We believe this case is instructive to the critical care clinician as a reminder of the importance of considering malignancy on the differential diagnosis of a patient presenting with elevated lactate out of proportion to their critical illness.

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Section: Discussionmentioning

confidence: 98%

Refractory Lactic Acidosis in Small Cell Carcinoma of the Lung

Dinerman

Matthews

et al. 2017

Case Reports in Critical Care

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“…The different policies between hospitals and departments reflect the controversy regarding the usefulness of the blood sample (1). Lately, interesting papers about blood lactate level as a predictor of clinical outcomes have been published, but if we consider the whole literature scenario we do not have enough data to consider lactate a totally reliable prognostic index, or at least not in all the clinical settings (2)(3)(4)(5)(6)(7)(8). Lactic acid is normally considered a molecule with an excellent sensitivity for the cellular damage caused by anaerobiosis due to an oxygen debit during a shock status.…”

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confidence: 99%

Serum lactate level as a useful predictor of clinical outcome after surgery: an unfulfilled potential?

Cobianchi¹,

Peloso²,

Filisetti³

et al. 2016

J. Thorac. Dis.

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“…13,14 Accordingly, lactate levels have been suggested as a prognostic biomarker in high-grade primary brain tumors and metastatic lung cancer where elevated pretreatment serum lactate levels were associated with worse progression free survival. 15,16 Bringing an additional layer of complexity, in the "Reverse Warburg…”

Section: His Toric Al Timeline-the Warburg Effec T Then and Nowmentioning

confidence: 99%

“…In tumors with extremely high glycolytic activity, elevated lactate levels can also be detected in sera of tumor patients . Accordingly, lactate levels have been suggested as a prognostic biomarker in high‐grade primary brain tumors and metastatic lung cancer where elevated pretreatment serum lactate levels were associated with worse progression free survival . Bringing an additional layer of complexity, in the “Reverse Warburg Effect” stromal cells such as fibroblasts or macrophages undergo “aerobic glycolysis” and produce lactic acid which can either accumulate or be utilized by cancer cells for mitochondrial oxidative phosphorylation (OXPHOS) .…”

Section: Historical Timeline—the Warburg Effect Then and Nowmentioning

confidence: 99%

The immunological Warburg effect: Can a metabolic‐tumor‐stroma score (MeTS) guide cancer immunotherapy?

Siska

Singer

Evert

et al. 2020

Immunological Reviews

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The "glycolytic switch" also known as the "Warburg effect" is a key feature of tumor cells and leads to the accumulation of lactate and protons in the tumor environment.Intriguingly, non-malignant lymphocytes or stromal cells such as tumor-associated macrophages and cancer-associated fibroblasts contribute to the lactate accumulation in the tumor environment, a phenomenon described as the "Reverse Warburg effect." Localized lactic acidosis has a strong immunosuppressive effect and mediates an immune escape of tumors. However, some tumors do not display the Warburg phenotype and either rely on respiration or appear as a mosaic of cells with different metabolic properties. Based on these findings and on the knowledge that T cell infiltration is predictive for patient outcome, we suggest a metabolic-tumor-stroma score to determine the likelihood of a successful anti-tumor immune response: (a) a respiring tumor with high T cell infiltration ("hot"); (b) a reverse Warburg type with respiring tumor cells but glycolytic stromal cells; (c) a mixed type with glycolytic and respiring compartments; and (d) a glycolytic (Warburg) tumor with low T cell infiltration ("cold"). Here, we provide evidence that these types can be independent of the organ of origin, prognostically relevant and might help select the appropriate immunotherapy approach. K E Y W O R D Sacidification, GLUT, immunotherapies, lactate, T cell, Warburg

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Elevated lactic acid is a negative prognostic factor in metastatic lung cancer

Cited by 57 publications

References 0 publications

Refractory Lactic Acidosis in Small Cell Carcinoma of the Lung

Refractory Lactic Acidosis in Small Cell Carcinoma of the Lung

Serum lactate level as a useful predictor of clinical outcome after surgery: an unfulfilled potential?

The immunological Warburg effect: Can a metabolic‐tumor‐stroma score (MeTS) guide cancer immunotherapy?

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