Follow-up Serum Lactic Dehydrogenase as a Predictor of Distant Metastasis and Survival for Patients With Nasopharyngeal Carcinoma

Abstract

Purpose/Objective(s)Pretreatment serum lactic dehydrogenase (LDH) was predictive of survival or distant metastasis among patients with nonmetastatic nasopharyngeal carcinoma (NPC). However, the predictive value of serum LDH after treatment was unknown. Hence, the purpose of this study was to examine the relationships between follow-up serum LDH and locoregional control, distant metastasis-free survival (DMFS), and overall survival among patients with nonmetastatic NPC after intensity modulated radiation therapy (IMRT).Materials/MethodsThe charts of 739 nonmetastatic NPC patients admitted to 1 institution between January 2007 and May 2012 were reviewed. The patients were with normal renal, cardiac, and liver function. The median follow-up time is 34 Months. The relationships between follow-up serum LDH and locoregional control, distant metastasis-free survival (DMFS), and overall survival were identified.ResultsFor all patients, the cumulative survive rate of 1, 3, and 5 years was 97%, 92%, and 81%, respectively. The local and regional relapse-free survival rate of 1, 3, and 5 years was 99%, 93%, and 92%, respectively. The distant metastasis-free survival rate of 1, 3, and 5 years was 97%, 88%, and 82%, respectively. Distant metastasis rate was 32.8% (20/61) for patients with high LDH level during follow-up, 8% (54/678) for those with normal LDH level (OR 5.67, 95% CI 3.09-10.30, P<.001). The median DMFS was 46 months in patients with higher LDH level during follow-up versus 66 months among those with normal LDH level (HR 4.07, 95% CI 2.43-6.80, P<.001). The median DFS was 46 months among patients with higher LDH level during follow-up, 63 months among those with normal LDH level (HR 2.78, 95% CI 1.70-4.53, P<.001). The median OS was 54 months among patients with higher LDH level during follow-up, compared with 66 months among those with normal LDH level (HR 2.93, 95% CI 1.65-5.23, P<.001). COX regression showed that age (HR 1.05 95% CI 1.02-1.07, P<.001), radiation time (HR 1.05 95% CI 1.01-1.10, P=.012), and LDH level during follow-up (HR 2.91 95% CI 1.57-5.41) were independent prognostic factors of worst outcome for nonmetastatic NPC patients.ConclusionOur findings indicated that high serum LDH during follow-up provides easily available prognostic value for distant metastasis and survival for nonmetastatic NPC patients. Purpose/Objective(s)Pretreatment serum lactic dehydrogenase (LDH) was predictive of survival or distant metastasis among patients with nonmetastatic nasopharyngeal carcinoma (NPC). However, the predictive value of serum LDH after treatment was unknown. Hence, the purpose of this study was to examine the relationships between follow-up serum LDH and locoregional control, distant metastasis-free survival (DMFS), and overall survival among patients with nonmetastatic NPC after intensity modulated radiation therapy (IMRT). Pretreatment serum lactic dehydrogenase (LDH) was predictive of survival or distant metastasis among patients with nonmetastatic nasopharyngeal carcinoma (NPC). However, the predictive value of serum LDH after treatment was unknown. Hence, the purpose of this study was to examine the relationships between follow-up serum LDH and locoregional control, distant metastasis-free survival (DMFS), and overall survival among patients with nonmetastatic NPC after intensity modulated radiation therapy (IMRT). Materials/MethodsThe charts of 739 nonmetastatic NPC patients admitted to 1 institution between January 2007 and May 2012 were reviewed. The patients were with normal renal, cardiac, and liver function. The median follow-up time is 34 Months. The relationships between follow-up serum LDH and locoregional control, distant metastasis-free survival (DMFS), and overall survival were identified. The charts of 739 nonmetastatic NPC patients admitted to 1 institution between January 2007 and May 2012 were reviewed. The patients were with normal renal, cardiac, and liver function. The median follow-up time is 34 Months. The relationships between follow-up serum LDH and locoregional control, distant metastasis-free survival (DMFS), and overall survival were identified. ResultsFor all patients, the cumulative survive rate of 1, 3, and 5 years was 97%, 92%, and 81%, respectively. The local and regional relapse-free survival rate of 1, 3, and 5 years was 99%, 93%, and 92%, respectively. The distant metastasis-free survival rate of 1, 3, and 5 years was 97%, 88%, and 82%, respectively. Distant metastasis rate was 32.8% (20/61) for patients with high LDH level during follow-up, 8% (54/678) for those with normal LDH level (OR 5.67, 95% CI 3.09-10.30, P<.001). The median DMFS was 46 months in patients with higher LDH level during follow-up versus 66 months among those with normal LDH level (HR 4.07, 95% CI 2.43-6.80, P<.001). The median DFS was 46 months among patients with higher LDH level during follow-up, 63 months among those with normal LDH level (HR 2.78, 95% CI 1.70-4.53, P<.001). The median OS was 54 months among patients with higher LDH level during follow-up, compared with 66 months among those with normal LDH level (HR 2.93, 95% CI 1.65-5.23, P<.001). COX regression showed that age (HR 1.05 95% CI 1.02-1.07, P<.001), radiation time (HR 1.05 95% CI 1.01-1.10, P=.012), and LDH level during follow-up (HR 2.91 95% CI 1.57-5.41) were independent prognostic factors of worst outcome for nonmetastatic NPC patients. For all patients, the cumulative survive rate of 1, 3, and 5 years was 97%, 92%, and 81%, respectively. The local and regional relapse-free survival rate of 1, 3, and 5 years was 99%, 93%, and 92%, respectively. The distant metastasis-free survival rate of 1, 3, and 5 years was 97%, 88%, and 82%, respectively. Distant metastasis rate was 32.8% (20/61) for patients with high LDH level during follow-up, 8% (54/678) for those with normal LDH level (OR 5.67, 95% CI 3.09-10.30, P<.001). The median DMFS was 46 months in patients with higher LDH level during follow-up versus 66 months among those with normal LDH level (HR 4.07, 95% CI 2.43-6.80, P<.001). The median DFS was 46 months among patients with higher LDH level during follow-up, 63 months among those with normal LDH level (HR 2.78, 95% CI 1.70-4.53, P<.001). The median OS was 54 months among patients with higher LDH level during follow-up, compared with 66 months among those with normal LDH level (HR 2.93, 95% CI 1.65-5.23, P<.001). COX regression showed that age (HR 1.05 95% CI 1.02-1.07, P<.001), radiation time (HR 1.05 95% CI 1.01-1.10, P=.012), and LDH level during follow-up (HR 2.91 95% CI 1.57-5.41) were independent prognostic factors of worst outcome for nonmetastatic NPC patients. ConclusionOur findings indicated that high serum LDH during follow-up provides easily available prognostic value for distant metastasis and survival for nonmetastatic NPC patients. Our findings indicated that high serum LDH during follow-up provides easily available prognostic value for distant metastasis and survival for nonmetastatic NPC patients.