The diagnostic value of pretreatment serum LDH in patients with limited disease small-cell lung carcinoma.
BACKGROUND
In patients with limited disease SCLC, the overall survival is still poor. Therefore, a retrospective study was performed involving 48 patients with limited disease SCLC to select a parameter which can identify prognostic subgroups at the time of diagnosis.


METHODS
Follow-up ranged from 3 to 96 months, during which period 38 patients died. Based on clinical outcome, patients were classified into 3 groups: complete remission (CR) (n = 16), local recurrence (LOC) (n = 7) and distant recurrence (DIS) (n = 25). Age, gender and pretreatment biochemical parameters were correlated with clinical outcome and survival. For survival 70 patients staged as having extensive disease (ED) served as a control group.


RESULTS
No differences in survival were found in patients with LOC (14% 2 year survival) and DIS (16% 2-year survival) (p = 0.67). Patients achieving a complete remission had a significantly better survival (75% two-year survival). LDH was found to be the only significant correlate of both tumor progression and survival. All patients with pretreatment LDH levels < 240 U/L (n = 13) had tumor recurrence. The survival rate of patients with LDH levels, 240 U/L (41% 2-year survival) was much better than that of patients with LDH levels > 240 U/L 8% 2-year survival) (p = 0.0001). No significant difference in survival (p = 0.33) was found between patients with LD and LDH > 240 U/L and patients with ED and LDH < 400 U/L. Patients with ED and LDH values > 400 U/L showed the poorest outcome.


CONCLUSIONS
LDH may be used for the identification of prognostic subgroups in SCLC. Patients showing pretreatment LDH levels > 240 U/L have an extremely high risk of tumor recurrence, while their survival is poor and comparable to that of patients staged as having extensive disease and LDH values < 400 U/L.
Stokkel
M P
MP
Department of Diagnostic Radiology and Nuclear Medicine, Leiden University Medical Center, The Netherlands.
Van Eck-Smit
B L
BL
Zwinderman
A H
AH
Willems
L N
LN
Pauwels
E K
EK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D018288:Carcinoma, Small Cell / Q000097:blood* / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D015993:Life Tables; D008175:Lung Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood*; D009364:Neoplasm Recurrence, Local / Q000097:blood; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D007770:L-Lactate Dehydrogenase