title: Elevated LDH predicts poor outcome of recurrent germ cell tumours treated with dose dense chemotherapy.
abstract: OBJECTIVE
  Prognostic factors for recurrent germ cell tumours (GCTs) treated with dose dense salvage chemotherapy have not been identified. This study determines whether lactate dehydrogenase (LDH) or established prognostic models can predict the outcome of recurrent GCTs treated with dose dense cisplatin-based chemotherapy.
  
  
  METHODS
  Retrospective analysis of 117 consecutive male patients with a first recurrence of a GCT treated with dose dense chemotherapy at a single cancer centre. Characteristics associated with progression-free survival (PFS) and overall survival (OS) were identified by univariate and multivariate analyses. Prognostic criteria published by the Medical Research Council (MRC) and the Memorial Sloan Kettering Cancer Centre (MSK) were also applied in an attempt to validate them and to compare their performance to that of LDH.
  
  
  RESULTS
  Raised LDH was significantly associated with poor PFS (hazard ratio (HR)=3.7; p<0.001) and OS (HR=3.4; p=0.001). Further factors associated with poor PFS and OS, respectively, were failure to achieve a complete response or marker negative partial response for at least 6 months (HR=2.1; p=0.033) and seminoma histology (HR=3.4; p=0.003). The MRC prognostic model, but not the MSK model, identified groups of patients with statistically significant differences in PFS and OS but raised LDH predicted OS and PFS with a higher HR.
  
  
  CONCLUSIONS
  Raised LDH is associated with a poor prognosis in recurrent GCTs and outperforms established prognostic models in this setting. LDH as a prognostic factor should be validated prospectively and should also be assessed in patients receiving conventional dose chemotherapy regimens.
authors: Department of Medical Oncology, St Bartholomew's Hospital, Barts and the London School of Medicine and Dentistry, West Smithfield, London EC1A 7BE, UK. marco.gerlinger@bartsandthelondon.nhs.uk
authors: Marco
authors: M
authors: Gerlinger
authors: Peter
authors: P
authors: Wilson
authors: Thomas
authors: T
authors: Powles
authors: Jonathan
authors: J
authors: Shamash
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D005834:Genital Neoplasms, Male / Q000188:drug therapy / Q000201:enzymology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000201:enzymology*; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000201:enzymology*; D016879:Salvage Therapy; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D007770:L-Lactate Dehydrogenase