Is preoperative serum lactate dehydrogenase useful in predicting the outcomes of patients with upper tract urothelial carcinoma?

Abstract

BackgroundLactate dehydrogenase (LDH) has been proved to be associated with clinical outcomes in various carcinomas; however, limited evidence was available in upper urinary tract urothelial carcinoma (UTUC). Thus, the aim of this study was to evaluate the prognostic impact of LDH in UTUC.Patients and methodsA cohort of 668 patients WERE retrospectively included between 2003 and 2016. Kaplan‐Meier method and Cox proportional hazards regression models were used to evaluate the association of LDH with overall survival (OS), cancer‐specific survival (CSS), disease recurrence‐free survival (RFS), and metastasis‐free survival (MFS). The cutoff level of LDH was set at 220 U/L for the upper limit of normal.ResultsKaplan‐Meier plots showed the group with elevated LDH had significant poor OS (P = 0.003), CSS (P = 0.005), and RFS (P = 0.005), but not MFS (P = 0.099). However, multivariate Cox analysis suggested that LDH was not an independent predictor for CSS (HR 1.50, 95%CI: 0.87‐2.59), OS (HR 1.56, 95%CI: 0.94‐2.58), RFS (HR 1.33, 95%CI: 0.83‐2.12), or MFS (HR 1.16, 95%CI: 0.79‐1.71). Albumin, globulin, and HBDH were also not related to survival outcomes of UTUC patients in multivariate analysis, while higher alkaline phosphatase was associated with worse CSS and OS, and higher white blood cells contributed to poor CSS and RFS. In subgroup analysis, results found higher LDH was associated with poor OS in patients with localized disease (pT ≤ 2) (HR 4.03, 95%CI: 1.37‐11.88).ConclusionThe preoperative LDH was not an independent prognostic factor for patients with UTUC, while elevated LDH was proved to be correlated with worse OS in patients with localized disease.

Prognostic Value of Lymphovascular Invasion in Upper Urinary Tract Urothelial Carcinoma after Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

“…Based on the information obtained from 291 original articles, 56 studies were excluded due to the presence of identical cohorts. Finally, 27 articles were included in this study to explore the prognostic value of LVI in UTUC [10–36], among which 4 articles analyzed LVI as a survival predictor in patients with advanced tumor stages (T3–T4) [10, 13, 16, 26].…”

“…In cancers of the liver, testis, and penis [9], LVI is included in the American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) staging criteria for higher-risk patients, indicating that LVI might have a similar significance in the TNM classification. Many studies have estimated the prognostic influence of LVI in patients with UTUC, but the results remain controversial [10–36]. The European Association of Urology Guidelines indicate that LVI is an independent prognostic predictor of UTUC based on two retrospective studies [1].…”

Low Hemoglobin-to-Red Cell Distribution Width Ratio Is Associated with Disease Progression and Poor Prognosis in Upper Tract Urothelial Carcinoma

“…Therefore, researchers around the world have been searching for useful prognostic indicators to identify suitable candidates for adjunct therapy. Blood cell markers, including white blood cell (WBC) count, platelet count, hemoglobin and red blood cell distribution width (RDW), are routinely available before surgery, and their significance in UTUC has been widely discussed [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Both WBC count and platelet count are closely related to cancer outcomes.…”

“…Hemoglobin and RDW are markers derived from red blood cells. It is believed that they can reflect the oxidative stress [23,24] and inflammation [25,26] and, therefore, are correlated with the prognosis of cancer [9][10][11][12][13][14][15][16][17][18][19][20]. The hemoglobin-to-RDW ratio (HRR) is a novel prognostic marker, and Sun et al conducted the first study linking HRR and cancer [27].…”

Role of a Modified Urothelium Immune Prognostic Index in Patients With Metastatic Urothelial Carcinoma Treated With Anti–PD-1/PD-L1–Based Therapy

“…Recently, elevated baseline LDH levels were been found to be associated with poor survival and a decreased response rate in patients treated with ICIs ( Arora et al, 2019 ). In a cohort of 668 patients with upper tract urothelial carcinoma, preoperative elevated LDH was found to be correlated with worse OS in patients with localized disease ( Tan et al, 2018 ). In the present study, we demonstrated that LDH represents an independent prognostic factor in patients with mUC treated with anti–PD-1/PD-L1–based therapy because normal LDH was associated with significantly improved PFS and treatment response.…”