Abstract
Serum lactate dehydrogenase (LDH) level is predictive of prognosis in various malignancies. Nevertheless, the association between the prognosis of patients with advanced triple-negative breast cancer (TNBC) and LDH is not well understood. This explorative and retrospective study was conducted to clarify the issue. We found that abnormal baseline LDH levels (> 250 IU/L) were significantly associated with age (> 40 y vs. ≤ 40 y, OR: 0.383, P = 0.031) and number of metastatic sites (2 vs. 1, OR: 4.619, P = 0.006; ≥ 3 vs. 1, OR: 4.727, P = 0.002). The progression-free survival (PFS) of patients with post-treatment LDH higher than baseline (Group 1) was significantly shorter than that in patients with LDH decreased to normal (Group 3) and those with normal baseline and post-treatment LDH (Group 4) (Group 3 vs. Group 1, HR: 0.517, P = 0.038; Group 4 vs. Group 1, HR: 0.346, P < 0.001). Overall survival (OS) in patients with abnormal baseline LDH was significantly shorter than in patients with normal baseline LDH (abnormal vs. normal, HR: 2.073, P < 0.001). Patients whose post-treatment LDH decreased to normal had the most objective response (complete and partial responses) rate after first-line chemotherapy (Group 3 vs. Group 1, OR: 0.074, P < 0.001). In this exploratory analysis, baseline LDH levels associated with OS, while LDH changes after first-line chemotherapy associated with PFS and the chemotherapeutic response. These results show that LDH may have important prognostic value for the survival and chemotherapeutic response in patients with advanced TNBC.
Highlights
Breast cancer is the second leading cause of cancerrelated deaths in women and is the most common cancer in females, accounting for 23% of all cancer cases [1, 2]
progression-free survival (PFS) and Overall survival (OS) of different groups are shown in Figures 1 and 2
Using the Cox regression model, we found that the independent prognostic factors of PFS for advanced triple-negative breast cancer (TNBC) patients were disease-free interval (DFI) (≤ 12 mon vs. > 12 mon, HR: 1.976, 95% CI: 1.300–3.003, P = 0.001), chemotherapeutic response, and lactate dehydrogenase (LDH) changes (Group 3 vs. Group 1, HR: 0.517, 95% CI: 0.278–0.963, P = 0.038; Group 4 vs. Group1, HR: 0.346, 95% CI: 0.204–0.587, P < 0.001)
Summary
Breast cancer is the second leading cause of cancerrelated deaths in women and is the most common cancer in females, accounting for 23% of all cancer cases [1, 2]. Triple-negative breast cancer (TNBC) is a subtype characterized by the lack of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) expression, as confirmed by immunohistochemistry or fluorescent in situ hybridization. TNBC is associated with a poor prognosis due to its more aggressive behavior, higher recurrence, generation of more metastases, and fewer treatment options compared with other breast cancer subtypes [3]. Cytotoxic chemotherapy remains the mainstay of treatment for TNBC, and metastatic organ sites and disease-free interval (DFI) are thought to be prognostic factors of advanced disease [4]. Abnormally high serum levels of LDH are predictive of prognosis in various malignancies [8] and are associated with breast cancer patient survival [4, 9,10]. The association between advanced TNBC and serum LDH is not well understood; we conducted an explorative study to determine the potential relationship
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