Pretreatment serum lactate dehydrogenase is an independent prognostic factor for patients receiving neoadjuvant chemotherapy for locally advanced cervical cancer

Abstract

For locally advanced cervical cancer (LACC), hypoxia is a characteristic property. This study aimed to investigate whether baseline lactic dehydrogenase (LDH) level, which is a marker of hypoxia, had clinical value in determining neoadjuvant chemotherapy (NACT) response and prognosis for LACC patients. The study cohort included 418 patients with a median follow‐up of 37.5 months. Cox proportional hazards models were used to assess the prognostic value of baseline LDH levels. Multivariate logistic regression analysis was performed to identify independent predictors of complete response after NACT. Backward stepwise selection with the Akaike information criterion was used to identify factors that could be entered into the multivariate regression model. Compared with patients with LDH levels <252.0 μ/L, patients with LDH levels ≥252.0 μ/L were more likely to have an elevated level of squamous cell carcinoma antigen, lymphatic vascular space involvement, lymph node metastasis, and positive parametrium and achieved lower complete remission rates. Baseline LDH levels ≥252.0 μ/L was an independent prognosticator for recurrence‐free survival (adjusted hazard ratio [HR], 3.56; 95% confidence interval [CI] 2.22–5.69; P < 0.0001) and cancer‐specific survival (adjusted HR, 3.08; 95% CI, 1.89–5.01; P < 0.0001). The predictive value of baseline LDH value remained significant in the subgroup analysis. LDH level ≥252.0 μ/L was identified as an independent predictor of complete remission after NACT (adjusted odds ratio [OR], 0.29; 95% CI, 0.15–0.58; P < 0.0001). Baseline LDH ≥252.0 μ/L is an independent prognostic predictor for patients receiving neoadjuvant chemotherapy for LACC. It helps distinguish patients with different prognosis and select patients who are more likely to benefit from NACT.

<p>Prognostic Values of LDH and CRP in Cervical Cancer</p>

“…24 Consequently, up regulation of serum LDH levels is tightly associated with poor outcome. 21 Through further analysis, we found that the levels of LDH and CRP were positively correlated with the levels of SCC-Ag, one of the currently used prognostic indicators of cervical cancer. Duk et al found that SCC-Ag is associated with cervical cancer FIGO stage and tumor size, 25 while Guo et al reported that cervical cancer patients with elevated levels of SCC-Ag(>2.75mg/mL) had worse prognosis.…”

“…8 Li et al showed that patients with a high level of LDH (LDH≥252μ/L) had worse recurrence-free survival. 21 An increased serum LDH level leads to a cascade downstream of hypoxia-inducible factor1 (HIF-1), resulting in the secretion of vascular endothelial growth factor (VEGF) by tumor cells. In addition, increased HIF-1 activity further up regulates that of LDH, resulting in the formation of a positive feedback loop, and a tumor microenvironment that is conducive to tumor angiogenesis and metastasis.…”

Prognostic Values of Systemic Inflammation Response (SIR) Parameters in Resectable Cervical Cancer

“…20 A recent study has revealed that a high baseline LDH level was an independent prognostic factor for patients with locally advanced cervical cancer. 21…”

Identification and validation of the role of matrix metalloproteinase-1 in cervical cancer

“…Although radical surgical treatment and radiotherapy are effective treatments, more than a third of these patients will develop progressive or recurrent tumors ( 2 , 3 ). Currently, the International Federation of Obstetricians and Gynecologists (FIGO) staging system, depth of invasion and lymph node (LN) status are recognized prognosis factors in patients with cervical cancer ( 4 – 6 ). Among these factors, the adverse impact of LN metastasis on patients with cervical cancer was confirmed in certain recent clinical studies ( 4 , 7 ).…”