The prognostic significance of pretreatment serum lactate dehydrogenase in patients with small-cell lung cancer.

Abstract

Pretreatment serum lactate dehydrogenase (LDH) levels were assayed in 288 patients presenting with small-cell lung cancer (SCLC) between 1976 and 1985. Patients were routinely staged by physical examination, chest x-ray, bone, brain, and liver scans, and bone marrow evaluation. Clinical response and survival were assessed following treatment with combination chemotherapy as part of four clinical trials. Patients with extensive disease (ED) presented with a higher incidence (108 of 147, 73%) of abnormally elevated LDH (greater than 193 IU/L) than those (65 of 141, 46%) with limited disease (LD) (P = 2 x 10(-6)). Forty percent of patients had an initial normal LDH level and a higher response rate (89 of 108, 82%; complete response [CR], 47%) than those with elevated values of LDH (119 of 156, 76%; CR, 29%). The CR rate varied inversely with the level of LDH in patients with LD (P = .026) but not in those with ED (P = .300). The median survival time and 1-year and 2-year survival rates for patients with elevated LDH were 39 weeks and 33% and 6%, respectively, whereas for those with a normal LDH level these were 53 weeks and 54% and 16%, respectively. Patients with LD and elevated levels of LDH manifested a higher relative death rate (1.63:1) when compared with patients with LD and LDH in the normal range (P = .0083). The survival of patients with ED did not differ between those with normal and elevated levels of LDH (P = .273). A significant survival advantage persisted for patients with LDH in the normal range following adjustments for extent of disease, performance status (PS), and treatment protocol (P = .044, log-rank analysis). In conclusion, serum LDH appears to be a significant independent pretreatment prognostic factor in patients with SCLC that correlates with stage of disease, response to treatment, and survival.

Monoclonal antibodies in the detection of bone marrow metastases in small cell lung cancer

“…The significant difference in dissemination of the disease and the levels of serum LDH in the two groups of pts are in agreement with previous studies (Sagman et al, 1991).…”

The Relationship between Prognostic Factors and Overall Survival in Small Cell Lung Cancer Patients: a Single Centre Experience

“…In another study, elevated level of LDH in patient with LSD predicted poorer survival relative to those with LDH in normal range. A possible explanation of this relationship may be that, LDH estimates tumor burden in patient with LSD and suggests that LDH identifies occult disease not detected by current staging investigation [6]. Ray et al [16] documented that weight loss, high LDH level was accepted as prognostic factors for SCLC, but not achieving complete response to treatment.…”

“…Without treatment, median survival after diagnosis is 1 to 3 months. However, with combination chemotherapy, it is found as 14 to 16 months for limited stage disease (LSD) and 8 to 11 months for extensive stage disease (ESD) [2,3,6]. It is an aggressive tumor that often metastasizes before the primary cancer is diagnosed [7].…”

Serum neuron specific enolase (NSE) is a determinant of response duration in small cell lung cancer (SCLC)

“…Among 38 LD patients, there was no difference in the response rate between those who initially had a normal NSE and those who presented with high NSE. In 56 ED patients no significant correlation was found between initial serum NSE level and response to therapy (Carney et al, 1982 albeit such a relationship later was proven in two large series from Copenhagen (0sterlind et al, 1987) and Toronto (Sagman et al, 1991), respectively. NSE was not included in these studies, but a close correlation between LDH and NSE has been shown (J0rgensen et al, 1988).…”