Abstract
For locally advanced cervical cancer (LACC), hypoxia is a characteristic property. This study aimed to investigate whether baseline lactic dehydrogenase (LDH) level, which is a marker of hypoxia, had clinical value in determining neoadjuvant chemotherapy (NACT) response and prognosis for LACC patients. The study cohort included 418 patients with a median follow‐up of 37.5 months. Cox proportional hazards models were used to assess the prognostic value of baseline LDH levels. Multivariate logistic regression analysis was performed to identify independent predictors of complete response after NACT. Backward stepwise selection with the Akaike information criterion was used to identify factors that could be entered into the multivariate regression model. Compared with patients with LDH levels <252.0 μ/L, patients with LDH levels ≥252.0 μ/L were more likely to have an elevated level of squamous cell carcinoma antigen, lymphatic vascular space involvement, lymph node metastasis, and positive parametrium and achieved lower complete remission rates. Baseline LDH levels ≥252.0 μ/L was an independent prognosticator for recurrence‐free survival (adjusted hazard ratio [HR], 3.56; 95% confidence interval [CI] 2.22–5.69; P < 0.0001) and cancer‐specific survival (adjusted HR, 3.08; 95% CI, 1.89–5.01; P < 0.0001). The predictive value of baseline LDH value remained significant in the subgroup analysis. LDH level ≥252.0 μ/L was identified as an independent predictor of complete remission after NACT (adjusted odds ratio [OR], 0.29; 95% CI, 0.15–0.58; P < 0.0001). Baseline LDH ≥252.0 μ/L is an independent prognostic predictor for patients receiving neoadjuvant chemotherapy for LACC. It helps distinguish patients with different prognosis and select patients who are more likely to benefit from NACT.
Highlights
Cervical cancer is the leading cause of cancer-r elated deaths in women in developing countries [1]
The proportion of patients who achieved complete response (CR) after neoadjuvant chemotherapy (NACT) was significantly lower in the HL group in comparison with those in the NL group (11.5% vs. 32.3%, P < 0.0001, r = −0.196)
Other factors that were independently associated with decreased recurrence-free survival (RFS) included nonsquamous cell carcinoma, positive surgical margins ((adjusted hazard ratios (HRs), 4.00; 95% confidence intervals (CIs), 2.11–7.61; P < 0.0001), node metastasis, positive parametrium, and squamous cell carcinoma antigen (SCCA) levels ≥3.5 ng/mL
Summary
Cervical cancer is the leading cause of cancer-r elated deaths in women in developing countries [1]. Concurrent chemoradiotherapy (CCRT) has been the standard of care since 1999, optimal management of bulky IB2 and IIA2 disease remains controversial [3]. In this clinical setting, neoadjuvant chemotherapy (NACT). A published meta-analysis shows that NACT followed by surgery is superior to radiotherapy alone in terms of overall survival [5]. Because of these advantages, NACT is used in up to 25% of cervical cancer patients in many parts of the world, such as Asia, Italy, and South America [6].
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