Pelizzari Giacomo, Basile Debora, Zago Silvia, Lisanti Camilla, Bartoletti Michele, Bortot Lucia, Vitale Maria Grazia, Fanotto Valentina, Barban Serena, Cinausero Marika, Bonotto Marta, Gerratana Lorenzo, Mansutti Mauro, Curcio Francesco, Fasola Gianpiero, Minisini Alessandro Marco, Puglisi Fabio
Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano (PN), Italy.
Department of Medicine (DAME), University of Udine, 33100 Udine, Italy.
Cancers (Basel). 2019 Aug 24;11(9):1243. doi: 10.3390/cancers11091243.
Elevated plasmatic lactate dehydrogenase (LDH) levels are associated with worse prognosis in various malignancies, including metastatic breast cancer (MBC). Nevertheless, no data are available on the prognostic role of LDH as a dynamic biomarker during first-line treatment in unselected MBC. We reviewed data of 392 women with MBC to evaluate the association between LDH variation after 12 weeks of first-line treatment and survival. The prognostic impact was tested by multivariate Cox regression analysis. Results: Plasmatic LDH was confirmed as an independent prognostic factor in MBC. Patients who maintained elevated LDH levels after 12 weeks of first-line treatment experienced worse progression-free survival (PFS, HR 2.88, 95% CI: 1.40-5.89, = 0.0038) and overall survival (OS, HR 2.61, 95% CI 1.16-5.86, = 0.02) compared to patients with stable normal LDH levels, even after adjustment for other prognostic factors. Notably, LDH low-to-high variation emerged as an unfavorable prognostic factor for PFS (HR 3.96, 95% CI 2.00-7.82, = 0.0001). Plasmatic LDH and its variation during first-line treatment predict PFS and OS in MBC, providing independent prognostic information. It would be worthwhile to prospectively evaluate the association between LDH variation and therapeutic benefit in MBC, and explore how it may affect treatment strategies.
血浆乳酸脱氢酶（LDH）水平升高与包括转移性乳腺癌（MBC）在内的多种恶性肿瘤的预后较差相关。然而，关于LDH作为未选择的MBC一线治疗期间动态生物标志物的预后作用，尚无可用数据。我们回顾了392例MBC女性的数据，以评估一线治疗12周后LDH变化与生存之间的关联。通过多变量Cox回归分析测试预后影响。结果：血浆LDH被确认为MBC的独立预后因素。与LDH水平稳定正常的患者相比，一线治疗12周后LDH水平持续升高的患者无进展生存期（PFS，HR 2.88，95%CI：1.40 - 5.89， = 0.0038）和总生存期（OS，HR 2.61，95%CI 1.16 - 5.86， = 0.02）更差，即使在调整其他预后因素后也是如此。值得注意的是，LDH从低到高的变化成为PFS的不良预后因素（HR 3.96，95%CI 2.00 - 7.82， = 0.0001）。血浆LDH及其在一线治疗期间的变化可预测MBC的PFS和OS，提供独立的预后信息。前瞻性评估MBC中LDH变化与治疗获益之间的关联，并探索其如何影响治疗策略将是值得的。
