Deichmann M, Kahle B, Moser K, Wacker J, Wüst K
Department of Dermatology, Heidelberg University Clinics, Vossstrasse 2, 69115 Heidelberg, Germany.
Br J Cancer. 2004 Aug 16;91(4):699-702. doi: 10.1038/sj.bjc.6602043.
Lactate dehydrogenase (LDH) in serum has recently been introduced into the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma because of its prognostic value. We hypothesised LDH to be of value in discriminating melanoma patients entering AJCC stage IV from patients staying in AJCC stages I, II or III. Lactate dehydrogenase was compared to the acute phase protein C-reactive protein (CRP), which we observed to reflect the course of melanoma metastasis in a previous report. In this prospective study, we measured LDH and CRP in the serum of 91 consecutive melanoma patients progressing into AJCC stage IV in comparison to 125 patients staying in AJCC stages I, II or III. Comparing distributions of the parameters by median values and quartiles by Mann-Whitney test, LDH was not significantly elevated in patients entering AJCC stage IV melanoma (P=0.785), whereas CRP was (P<0.001). Analysing the sensitivity and the specificity jointly by the areas under the receiver operating characteristics curves (ROC-AUC), LDH did not discriminate between the defined groups of patients (AUC=0.491; 95% confidence interval, 0.410, 0.581), whereas CRP did (AUC=0.933; 95% confidence interval, 0.900, 0.966; P<0.001). Upon logistic regression analysis to calculate the ROC-AUC values upon the predictive probabilities, LDH provided no additional information to CRP. Choosing a cutoff point of 3.0 mg l(-1), CRP yielded a sensitivity of 0.769 together with a specificity of 0.904 in diagnosing AJCC stage IV entry. Altogether, for first diagnosing AJCC stage IV melanoma, CRP is the superior serum marker when compared to the conventional LDH.
由于血清乳酸脱氢酶（LDH）具有预后价值，最近已被纳入美国癌症联合委员会（AJCC）皮肤黑色素瘤分期系统。我们假设LDH在区分进入AJCC IV期的黑色素瘤患者与处于AJCC I、II或III期的患者方面具有价值。将乳酸脱氢酶与急性期蛋白C反应蛋白（CRP）进行比较，我们在先前的报告中观察到CRP可反映黑色素瘤转移过程。在这项前瞻性研究中，我们测量了91例连续进展至AJCC IV期的黑色素瘤患者血清中的LDH和CRP，并与125例处于AJCC I、II或III期的患者进行比较。通过Mann-Whitney检验比较参数的中位数和四分位数分布，进入AJCC IV期黑色素瘤的患者中LDH没有显著升高（P = 0.785），而CRP有显著升高（P < 0.001）。通过受试者操作特征曲线下面积（ROC-AUC）联合分析敏感性和特异性，LDH无法区分特定的患者组（AUC = 0.491；95%置信区间，0.410，0.581），而CRP可以（AUC = 0.933；95%置信区间，0.900，0.966；P < 0.001）。在逻辑回归分析以根据预测概率计算ROC-AUC值时，LDH没有为CRP提供额外信息。选择3.0 mg l(-1)的截断点，CRP在诊断AJCC IV期时的敏感性为0.769，特异性为0.904。总体而言，对于首次诊断AJCC IV期黑色素瘤，与传统的LDH相比，CRP是更优的血清标志物。
