Preoperative lactate dehydrogenase (LDH) serum level has impact on survival of melanoma patients after therapeutic lymph node dissection (TLND) but not on patients after completion lymph node dissection (CLND)

Abstract

8568 Background: The aim of the study was to evaluate the additional prognostic value of preoperative LDH serum level on overall survival (OS) of AJCC stage III cutaneous melanoma patients. Methods: The preoperative LDH serum level was available in 402 consecutive melanoma patients, who underwent radical LND (196 CLND after positive sentinel node biopsy and 206 TLND for clinically/cytologically detected regional lymph node metastases) between 1994 and 2004. Median follow-up time was 36 months (range: 6–110 months). Results: LDH serum level was increased before LND in 92 patients (22.9%) in the entire group of stage III melanoma patients [56 patients (27%) in TLND group and in 36 patients (18.4%) in CLND group (p=0.03)]. There were significant differences for OS (calculated from the date of LND) between patients with normal and high preoperative LDH level in the entire group of patients: median OS time was 51.2 months (95% CI: 34.8–91.9) and 27.9 months (95% CI: 18.2-); 5-year OS rate was 45.2% and 37.5%, respectively (p=0.0079 in univariate analysis and p=0.02 in multivariate analysis). However, to these differences mainly contributed the patients from TLND group: for patients with normal and high preoperative LDH level median OS time was 36.6 months (95% CI: 24.9–57.6) and 15.1 months (95% CI: 12.4- 27.9); 5-year OS rate was 40.0% and 20.3%, respectively (p=0.0013 in univariate analysis and p=0.01 in multivariate analysis). We did not observe any differences between patients with normal and high preoperative LDH level in CLND group: median OS time was 60.0 months (95% CI: 39.8-) and 65 months (95% CI: 45.6-); 5-year OS rate was 51% and 58%, respectively (p=0.703 in univariate analysis). Conclusions: Pre-LND increased LDH serum level has additional negative impact on OS of melanoma patients with palpable nodal metastases after TLND. [Table: see text]