Abstract
The present study aimed to evaluate the prognostic significance of preoperative serum lactate dehydrogenase (SLDH) levels for resected gastric cancer and construct prognostic nomograms for risk prediction. The study cohort consisted of 619 patients with D2-resected gastric cancer. The relationship of SLDH levels with clinicopathological features and clinical outcomes was evaluated. Prognostic nomograms were created using identified prognosticators to predict 3-year overall survival (OS) and 3-year disease-free survival (DFS), and bootstrap validation was performed. High SLDH levels were correlated with old age but not depth of invasion or lymph node metastasis. When assessed as a continuous variable, high SLDH levels were independently associated with poor OS and DFS. Internal validation of the developed nomograms revealed good predictive accuracy (bootstrap-corrected concordance indices: 0.77 and 0.75, respectively for prediction of OS and DFS). The preoperative SLDH levels, an identified unfavorable prognosticator, were incorporated into nomograms along with other clinicopathological features to refine the prediction of clinical outcomes for patients with D2-resected gastric cancer.
Highlights
Despite the decrease in its incidence and improvements in prognosis, gastric cancer remains the fifth most common malignancy and ranks third in terms of fatality among cancers worldwide, [1] with an especially high incidence in Eastern Asia. [2] Surgical resection is the only possible curative method for gastric cancer, especially for patients with early-stage disease, [3] but because of the high rate of postsurgical recurrence, patients with locally advanced tumors have a rather poor prognosis. [4].Traditionally, gastric cancer outcomes are predicted on the basis of the TNM staging system, which involves tumor invasion depth, lymph node metastasis, and distant metastasis
We observed that a high preoperative serum lactate dehydrogenase (SLDH) level was independently associated with low overall survival (OS) and disease-free survival (DFS) for patients who had undergone D2 lymphadenectomy, especially male patients
[28] Previous studies have shown that high SLDH levels are significantly associated with unfavorable prognosis in several gastrointestinal malignancies. [14,15,16,17,18,19,20,21] it is noteworthy that these studies were almost exclusively conducted on metastatic/non-resectable gastrointestinal tumor
Summary
[2] Surgical resection is the only possible curative method for gastric cancer, especially for patients with early-stage disease, [3] but because of the high rate of postsurgical recurrence, patients with locally advanced tumors have a rather poor prognosis. Gastric cancer outcomes are predicted on the basis of the TNM staging system, which involves tumor invasion depth, lymph node metastasis, and distant metastasis. [9] in the process of converting glucose to lactate, which is regulated by www.impactjournals.com/oncotarget the lactate dehydrogenase (LDH), cancer cells may protect themselves better from oxidative stress, avoid mitochondria pathway apoptosis, [10] and maintain a higher proliferation rate. Only two of these studies are aimed at gastric cancer, and both include patients with advanced gastric cancer. [15, 21, 27] studies regarding the prognostic value of SLDH in patients with resectable gastric cancer remain scarce, and preoperative SLDH might be identified as an inexpensive and accessible prognosticator for these patients
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