title: Prognostic impact of LDH levels in patients with relapsed/refractory seminoma.
abstract: OBJECTIVE
  To evaluate the impact of age and LDH levels in patients with relapsed seminoma.
  
  
  METHODS
  Data on the 204 seminoma from the International Prognostic Factor Study Group (IPFSG) were analyzed. All patients experienced unequivocal relapse/progression after at least three cisplatin-based chemotherapy cycles. Age and LDH at relapse were assessed in addition to previously identified prognostic factors for all germ cell tumor patients from the database (J Clin Oncol 28:4906, 2010).
  
  
  RESULTS
  The impact of the IPFSG score remained highly significant in multivariate analysis. In addition, LDH ≥1.5 times the upper limit of normal (ULN) was significant in univariate (HR 1.96; CI 1.06-3.61) and multivariate analysis (HR 1.90; CI 1.00-3.62). Age, however, was not significant. Therefore, LDH was incorporated into a modified new IPFSG seminoma score by moving patients to the next unfavorable group for patients with LDH values ≥1.5 × ULN. Three prognostic groups were thus generated, which better subdivided seminoma patients than the original IPFSG score. Progression-free survival at 2 years: "very low risk" (n = 23) 85.7% (95% CI 62-95), "low risk" (n = 44) 62.7 % (95% CI 46-75) and "intermediate risk" (n = 36) 35.1% (95% CI 20-51). Overall survival at 3 years: "very low risk" 88.8% (95% CI 62-97), "low risk" 71.3% (95% CI 55-83) and "intermediate risk" 51.3% (95% CI 33-67).
  
  
  CONCLUSIONS
  The addition of LDH, but not age, improves the impact of the IPFSG prognostic score in seminoma patients relapsing or progressing after cisplatin-based chemotherapy.
authors: St. Bartholomew's Hospital, Charterhouse Square, London EC1A7BE, UK.
authors: Tom
authors: T
authors: Powles
authors: Caroline
authors: C
authors: Bascoul-Mollevi
authors: Andrew
authors: A
authors: Kramar
authors: Anja
authors: A
authors: Lorch
authors: Jörg
authors: J
authors: Beyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000032:analysis / Q000096:biosynthesis*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018239:Seminoma / Q000188:drug therapy / Q000201:enzymology* / Q000401:mortality; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000201:enzymology* / Q000401:mortality; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D007770:L-Lactate Dehydrogenase
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