Evaluation of Lactate Dehydrogenase and Alkaline Phosphatase as Predictive Biomarkers in the Prognosis of Hepatocellular Carcinoma and Development of a New Nomogram

Abstract

Background Tumor proliferation is frequently accompanied by aberrant enzyme production. We aim to investigate the potential predictive value of both plasma alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) in patients with HCC and to develop a nomogram to assess the prognosis of HCC. Methods The trial involved 2327 patients between May 2015 and March 2022. Within 7 days of enrollment, the levels of ALP and LDH were measured, and their association with survival was assessed. And we had developed and validated a new nomogram based on ALD and ALP. Results Using X-tile software, the optimal cut-off values were determined to be ALP = 172 U/L and LDH = 241 U/L. The high ALP (≥ 172), LDH (≥ 241), and ALP/LDH (≥ 0.91) groups had lower median overall survival (mOS) than low ALP (< 172), LDH (< 241), and ALP/LDH (< 0.91) groups (all p < 0.001). In addition, elevated ALP and LDH levels are independent negative prognostic indicators. Moreover, we established that the area under the curve (AUC) values of the predicted 1-, 2-, and 3-year survival rates of receiver operating characteristic curve (ROC) based on the nomogram were 0.79, 0.77, and 0.74, respectively. In addition, the calibration curves and decision curve analyses (DCA) demonstrated that this model possessed strong predictive capability. Conclusion ALP, LDH and ALP/LDH can be employed as biomarkers for predicting the prognosis of HCC. Furthermore, the nomograph based on ALH and ALP demonstrates good HCC prediction performance. For HCC patients with high ALH or ALP or ALP/LDH, close surveillance program and adjuvant therapy should be considered.

Macroscopic Characterization of Hepatocellular Carcinoma: An Underexploited Source of Prognostic Factors

“…Such scores should be thereafter tested in multivariable models including variables such as the Child-Pugh score and other biomarkers or scores. 49–51 …”

A dynamic study of VEGF-A siDOX-EVs trafficking through the in-vitro insert co-culture blood-brain barrier model by digital holographic microscopy

“…Moreover, using this blood-tumor barrier (BTB) model could aid the introduction of novel therapeutic biomarkers that predict optimized response to therapy. Prediction of therapeutic responses for oncologic purposes possesses great significance when translated into clinical stages for all types of cancers ( 54 , 55 ). this model could serve as a future backbone for studies focusing on the interactions of the therapies on BTB and the biomarkers predicting tumoral cell death and therapy success in future oncological practice.…”

Cancer Development in Hepatocytes by Long-Term Induction of Hypoxic Hepatocellular Carcinoma Cell (HCC)-Derived Exosomes In Vivo and In Vitro

“…Therefore, HSP90α and TK1 are considered as potential tumor markers, and their combined detection with AFP significantly improved the sensitivity of diagnosing HCC . ALP and γ-GT play important roles in the cell cycle regulation, cell proliferation, and tumor formation, and both of them are clinical prognostic markers for various malignant tumors, including HCC. , The increase secretion of AST and ALT is associated with cancer-related metabolic disorders . The increase of AST/ALT (De Ritis) ratio reflects the development of tumors, which is related to the poor prognosis of various cancers, including HCC .…”