Department of Urology, Affiliated Hospital of Inner Mongolia University for Nationalities, China.
College of Physical and Electronic Information, Inner Mongolia University for Nationalities, China.
Int J Surg. 2020 Jul;79:66-73. doi: 10.1016/j.ijsu.2020.05.019. Epub 2020 May 14.
To date, there remain uncertainties over the prognostic role of serum lactate dehydrogenase (LDH) in patients with metastatic renal cell carcinoma (mRCC). A systematic review and meta-analysis was performed.
Eligible studies were retrieved from PubMed, Embase, Cochrane Library and Web of Science databases up to October 2019. The endpoints included overall survival (OS) and progression-free survival (PFS). Multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were used to evaluate each endpoint.
Thirty observational studies of low to moderate risk of bias embracing 6754 patients with mRCC were included. The results showed that patients with a high pretreatment serum LDH had an inferior OS (HR: 2.15, 95% CI: 1.85-2.51; P < 0.001) and PFS (HR: 1.76, 95% CI: 1.49-2.10; P < 0.001). Subgroup analyses according to year of publication, study design, patient population, geographic region, sample size and NOS score did not alter the direction of results. There was significant publication bias for OS, but not for PFS. Sensitivity analyses further confirmed the robustness of the results.
Our findings indicated that a high level of pretreatment serum LDH was associated with an inferior OS and DFS in patients with mRCC. Methodological limitations should be considered while interpreting these results.
迄今为止，血清乳酸脱氢酶（LDH）在转移性肾细胞癌（mRCC）患者中的预后作用仍存在不确定性。进行了系统评价和荟萃分析。
从 PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库中检索到符合条件的研究，截至 2019 年 10 月。终点包括总生存期（OS）和无进展生存期（PFS）。使用多变量调整后的风险比（HRs）和 95％置信区间（CIs）来评估每个终点。
纳入了 30 项低至中度偏倚风险的观察性研究，共纳入 6754 例 mRCC 患者。结果表明，预处理血清 LDH 水平高的患者 OS（HR：2.15，95％CI：1.85-2.51；P <0.001）和 PFS（HR：1.76，95％CI：1.49-2.10；P <0.001）更差。根据出版物年份、研究设计、患者人群、地理位置、样本量和 NOS 评分进行的亚组分析并未改变结果的方向。OS 存在显著的发表偏倚，但 PFS 则没有。敏感性分析进一步证实了结果的稳健性。
我们的研究结果表明，预处理血清 LDH 水平高与 mRCC 患者的 OS 和 DFS 较差相关。在解释这些结果时应考虑方法学局限性。
