Huang Luo, Sim Adelene Y L, Wu Yongzhong, Liang Zhongguo, Li Kaiguo, Du Youqin, Ong Enya H W, Tan Hong Qi, Wee Joseph T S, Xie Yue, Shu Xiaolei, Wang Ying, Chua Melvin L K, Zhu Xiaodong
Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China.
Division of Medical Sciences, National Cancer Centre Singapore, Singapore.
Ther Adv Med Oncol. 2020 Nov 13;12:1758835920970050. doi: 10.1177/1758835920970050. eCollection 2020.
Lactate dehydrogenase (LDH) is a known prognostic biomarker for the endemic variant of nasopharyngeal carcinoma (NPC). Here, we investigate whether serial changes in LDH level between chemotherapy (CT) cycles are associated with tumour response to CT.
Patients with biopsy-proven, recurrent or treatment-naïve metastatic NPC (mNPC) were recruited. All patients had received at least two cycles of platinum-based doublet or triplet CT, with serial assessment of LDH prior to every cycle of chemotherapy (CT1-6). Patients harbouring conditions that affect LDH levels (IU/L) were excluded. Tumour response was assessed after every two cycles of CT by RECIST v1.1.
A total of 158 patients were analysed, including 77 with recurrent and 81 with treatment-naïve mNPC. High pre-CT LDH was associated with an inferior overall survival [hazard ratio 1.93 for ⩾240 <240 (1.34-2.77), < 0.001], which is consistent with published literature. We found that both absolute LDH levels and LDH ratios (LDH: LDH) were associated with tumour response [partial response progressive disease: median value across CT1-6 = 168-190 222-398 (absolute); 0.738-0.988 1.039-1.406 (ratio)], albeit LDH ratio had a tighter variance between patients. Finally, we showed that an LDH ratio cut-off of 1.0 at CT1, CT3 and CT5 was predictive of progressive disease at CT2, CT4, CT6 [area under the curve of 0.73 (0.65-0.80)].
Herein, we characterised the longitudinal variation of LDH in response to CT in mNPC. Our findings suggest the potential utility of interval LDH ratio to predict subsequent tumour response to CT.
乳酸脱氢酶（LDH）是已知的鼻咽癌（NPC）地方病变体的预后生物标志物。在此，我们研究化疗（CT）周期之间LDH水平的系列变化是否与肿瘤对CT的反应相关。
招募经活检证实的复发或初治转移性NPC（mNPC）患者。所有患者均接受了至少两个周期的铂类双联或三联CT治疗，在每个化疗周期（CT1 - 6）之前对LDH进行系列评估。排除患有影响LDH水平（IU/L）疾病的患者。每两个周期的CT治疗后，根据RECIST v1.1评估肿瘤反应。
共分析了158例患者，其中77例为复发性mNPC，81例为初治mNPC。CT前LDH水平高与总生存期较差相关[≥240 <240时的风险比为1.93（1.34 - 2.77），<0.001]，这与已发表的文献一致。我们发现LDH的绝对水平和LDH比值（LDH:LDH）均与肿瘤反应相关[部分缓解 疾病进展：CT1 - 6期间的中位数=168 - 190 222 - 398（绝对）；0.738 - 0.988 1.039 - 1.406（比值）]，尽管患者之间LDH比值的差异较小。最后，我们表明在CT1、CT3和CT5时LDH比值截止值为1.0可预测CT2、CT4、CT6时的疾病进展[曲线下面积为0.73（0.65 - 0.80）]。
在此，我们描述了mNPC中LDH对CT反应的纵向变化。我们的研究结果表明，间隔LDH比值在预测后续肿瘤对CT的反应方面具有潜在效用。
