Pleural LDH as a prognostic marker in adenocarcinoma lung with malignant pleural effusion

Abstract

To study the performance of serum and pleural lactate dehydrogenase (LDH) level in predicting survival in patients with adenocarcinoma lung presenting with malignant pleural effusions (MPE) at initial diagnosis.Retrospective cohort study of the patient hospitalized for adenocarcinoma lung with MPE in year 2012.Univariate analyses showed lower pleural fluid LDH 667 (313–967) versus 971 (214–3800), P = 0.04, female gender 9 (100%) versus 27 (41.5%), P = 0.009, never smoking status 9 (100%) versus 36 (55.3%), P = 0.009, and epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy 8 (89%) versus 26 (40%), P = 0.009 to correlate with survival of more than 1.7 year versus less than 1.7 year. In multivariate analysis, low pleural fluid LDH and female gender maintained significance. The pleural LDH level of ≤1500 and >1500 U/L discriminated significantly (P = 0.009) between survival.High pleural LDH (>1500 IU/L) predicts shorter survival (less than a year) in patients with adenocarcinoma lung presenting with MPE at the time of initial diagnosis. This marker may be clinically applied for selecting therapeutic modality directed at prevention of reaccumulation of MPE. Patients with low pleural LDH may be considered suitable for measures that provide more sustained effect on prevention of reaccumulation such as chemical pleurodesis or tunneled pleural catheter.

Polyserositis: a diagnostic challenge

“…35 In fact, high pleural LDH levels (>1500 IU/mL) have been recently associated with shorter survival in lung adenocarcinoma. 36 Lung adenocarcinoma, gastrointestinal cancer and lymphomas have been diagnosed in this series. In patients with a history of cancer, the majority of PS represented a recurrence of their cancer.…”

Prognostic value of a new score using serum alkaline phosphatase and pleural effusion lactate dehydrogenase for patients with malignant pleural effusion

“…The metabolic changes of several enzymes, such as ALP and LDH, can be the result of the rapid proliferation and invasion of tumor cells, which might indicate clinical prognosis. It has been reported that the preferential use of anaerobic glycolytic pathway of tumor cells may cause the increase of conversion from pyruvate to lactate.…”

“…The abnormal synthesis of enzymes exists in the process of the transformation from normal to cancer cells and tumor proliferation . Some indicators routinely tested in clinical practice, such as alkaline phosphatase (ALP), adenosine deaminase (ADA) and lactate dehydrogenase (LDH) have been investigated to determine their prognostic values in various malignancies.…”

“…The markers mentioned above from blood or MPE are obtained by routine detection with the advantage of rapid, inexpensive, and convenience in clinical practice. Previous studies have evaluated the prognostic value of serum ALP (sALP) in various cancers and pleural LDH (pLDH) has been reported to be used as a prognostic marker in MPE patients, but the combination of the two markers has not previously been studied. The objective of the current study was to investigate the prognostic value of the combination of serum ALP and pleural effusion LDH (AL score) in patients with MPE by assessing its predictability for overall survival.…”

A laktátdehidrogenáz (LDH) prognosztikai jelentősége az onkológiában

“…Az LDH-emelkedés függvényében rövidebb átlagtúléléseket figyeltek meg (LDH>800 U/l vs. LDH≤800 U/l, 105 vs. 275 nap, p = 0,09; LDH>900 U/l vs. LDH≤900 U/l 93,5 vs. 267 nap, p = 0,09; LDH>1000 U/l vs. LDH≤1000 U/l, 47 vs. 275 nap, p = 0,01). A malignus pleuralis folyadékgyülemből meghatározott LDH-emelkedés mértéke is rövidebb átlag-túléléssel társult (LDH>1000 U/l vs. LDH≤1000 U/l, 189 vs. 321 nap, p = 0,04; LDH>1500 U/l vs. LDH≤1500 U/l, 102,5 vs. 306,5 nap, p = 0,009) [107].…”