Lenz Heinz-Josef, Lunacsek Orsolya, Ostojic Helene, Pan Xiaoyun, Dochy Emmanuelle, Vassilev Zdravko, Khan Nasreen
Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States.
Bayer HealthCare Pharmaceuticals, Whippany, NJ 07981, United States.
Oncologist. 2025 Jul 4;30(7). doi: 10.1093/oncolo/oyaf192.
Serum lactate dehydrogenase (LDH) is a potential prognostic biomarker of outcomes in patients with metastatic colorectal cancer (mCRC). This retrospective, observational study assessed real-world LDH testing patterns and LDH as a prognostic factor for overall survival (OS) in US patients receiving chemotherapy for mCRC.
Patients with mCRC who initiated first-line chemotherapy between January 1, 2016, and November 30, 2022, were selected from a nationwide de-identified Electronic Health Record-derived database. LDH value was categorized based on laboratory reference ranges. The prognostic relationship between pretreatment LDH value and OS was assessed using Kaplan-Meier and multivariate Cox proportional-hazards models.
Of 15 329 adult patients (median age 64 years), 3379 (22%) had LDH testing at or postindex; 21% had abnormal baseline values, while 40% had normal values. Patients with abnormal LDH levels were more likely to be female (47% abnormal LDH vs 41% normal LDH), ≥ 65 years of age (52% vs 49%), Black or African American (12% vs 7%), or reside in the Northeast (30% vs 21%). The median OS (95% CI) in patients with normal baseline LDH was 29.9 (28.3-31.7) vs 16.8 (14.8-18.2) months for those with abnormal LDH. In a multivariate Cox proportional-hazards model, patients with abnormal baseline LDH had higher risk of death (HR 1.91, P < .0001) after adjustment for demographic/clinical characteristics.
Abnormal baseline LDH levels were associated with shorter OS; however, only one-fifth of patients receiving chemotherapy underwent LDH testing. Efforts to increase LDH testing could be valuable in helping guide treatment decisions.
血清乳酸脱氢酶（LDH）是转移性结直肠癌（mCRC）患者预后的潜在生物标志物。这项回顾性观察性研究评估了美国接受mCRC化疗患者的实际LDH检测模式以及LDH作为总生存期（OS）的预后因素。
从全国范围的匿名电子健康记录衍生数据库中选取2016年1月1日至2022年11月30日期间开始一线化疗的mCRC患者。根据实验室参考范围对LDH值进行分类。使用Kaplan-Meier法和多变量Cox比例风险模型评估治疗前LDH值与OS之间的预后关系。
在15329例成年患者（中位年龄64岁）中，3379例（22%）在索引时或索引后进行了LDH检测；21%的患者基线值异常，40%的患者基线值正常。LDH水平异常的患者更可能为女性（LDH异常者占47%，LDH正常者占41%）、年龄≥65岁（分别为52%和49%）、黑人或非裔美国人（分别为12%和7%）或居住在东北部（分别为30%和21%）。基线LDH正常的患者中位OS（95%CI）为29.9（28.3 - 31.7）个月，而LDH异常的患者为16.8（14.8 - 18.2）个月。在多变量Cox比例风险模型中，调整人口统计学/临床特征后，基线LDH异常的患者死亡风险更高（HR 1.91，P <.0001）。
基线LDH水平异常与较短的OS相关；然而，接受化疗的患者中只有五分之一进行了LDH检测。增加LDH检测的努力可能有助于指导治疗决策。
