title: Correlation between LDH levels and response to sorafenib in HCC patients: an analysis of the ITA.LI.CA database.
abstract: BACKGROUND
  Lactate dehydrogenase (LDH) is a predictor of clinical outcome in hepatocellular carcinoma (HCC) patients. However, its predictive role in the clinical outcomes of sorafenib treatment has been poorly documented. The correlation between LDH levels and clinical outcomes in HCC patients treated with sorafenib and included in the nationwide Italian database ITA.LI.CA was investigated here.
  
  
  METHODS
  The ITA.LI.CA database contains data for 5,136 HCC patients. All patients treated with sorafenib treatment and with available LDH values were considered. Overall survival (OS) and time to progression (TTP) were compared in patients with LDH levels above and below a defined threshold, determined through an ROC analysis. An explorative analysis investigated the relationship between the variation of LDH levels during treatment and response to sorafenib.
  
  
  RESULTS
  Baseline LDH levels were available for 97 patients. The most accurate cutoff value for LDH concentration was 297 U/L. Patients with LDH values above (n=45) and below (n=52) this threshold showed equal OS (12.0 months) and TTP (4.0 months) values. Data on LDH levels during sorafenib treatment were reported for 10 patients. LDH values decreased in 3 patients (mean difference = -219 U/L) who also reported a prolonged OS and TTP versus those with unmodified/increased LDH (OS: NE (not evaluated) vs. 8.0 months, p=0.0083; TTP: 19.0 vs. 3.0 months, p=0.008).
  
  
  CONCLUSIONS
  The clinical benefits of sorafenib do not seem to be influenced by baseline LDH. According to the results of an explorative analysis, however, a decreased LDH concentration during sorafenib might be associated with improved clinical outcomes.
authors.affiliation: Gastroenterology Unit, Cisanello Hospital, Pisa - Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sacco
authors.forename: Valeria
authors.initials: V
authors.lastname: Mismas
authors.forename: Alessandro
authors.initials: A
authors.lastname: Granito
authors.forename: Gianna
authors.initials: G
authors.lastname: Musettini
authors.forename: Gianluca
authors.initials: G
authors.lastname: Masi
authors.forename: Chiara
authors.initials: C
authors.lastname: Caparello
authors.forename: Caterina
authors.initials: C
authors.lastname: Vivaldi
authors.forename: Martina
authors.initials: M
authors.lastname: Felder
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bresci
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fornaro
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008113:Liver Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D012372:ROC Curve; D012189:Retrospective Studies; D000077157:Sorafenib; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib; D007770:L-Lactate Dehydrogenase