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Abstract
LDH may represent an indirect marker of neo-angiogenesis and worse prognosis in many tumour types. We assessed the correlation between LDH and clinical outcome for biliary tract cancer (BTC) patients treated with first-line chemotherapy. Overall, 114 advanced BTC patients treated with first-line gemcitabine and cisplatin were included. Patients were divided into two groups (low vs. high LDH), according to pre-treatment LDH values. Patients were also classified according to pre- and post-treatment variation in LDH serum levels (increased vs. decreased). Median progression free survival (PFS) was 5.0 and 2.6 months respectively in patients with low and high pre-treatment LDH levels (p = 0.0042, HR = 0.56, 95% CI: 0.37–0.87). Median overall survival (OS) was 7.7 and 5.6 months (low vs. high LDH) (p = 0.324, HR = 0.81, 95% CI: 0.54–1.24). DCR was 71% vs. 43% (low vs. high LDH) (p = 0.002). In 38 patients with decreased LDH values after treatment, PFS and OS were respectively 6.2 and 12.1 months, whereas in 76 patients with post-treatment increased LDH levels, PFS and OS were respectively 3.0 and 5.1 months (PFS: p = 0.0009; HR = 0.49; 95% IC: 0.33–0.74; OS: p < 0.0001; HR = 0.42; 95% IC: 0.27–0.63). Our data seem to suggest that LDH serum level may predict clinical outcome in BTC patients receiving first-line chemotherapy.
Highlights
Lactic dehydrogenase (LDH) may represent an indirect marker of neo-angiogenesis and worse prognosis in many tumour types
114 patients with advanced biliary tract cancer (BTC) receiving a first line chemotherapy were available for our analysis
The cut-off point with the highest sensitivity and specificity for estimating pre-treatment LDH serum levels as a function of treatment clinical activity was set at 0.89 times the upper normal range (UNR) after receiver operating characteristics curve (ROC) curve analysis (Fig. 1)
Summary
LDH may represent an indirect marker of neo-angiogenesis and worse prognosis in many tumour types. Patients were divided into two groups (low vs high LDH), according to pre-treatment LDH values. Patients were classified according to pre- and post-treatment variation in LDH serum levels (increased vs decreased). Median progression free survival (PFS) was 5.0 and 2.6 months respectively in patients with low and high pre-treatment LDH levels (p = 0.0042, HR = 0.56, 95% CI: 0.37–0.87). Median overall survival (OS) was 7.7 and 5.6 months (low vs high LDH) (p = 0.324, HR = 0.81, 95% CI: 0.54–1.24). The vascular endothelial growth factor (VEGF) is one of the principal pathways involved in cholangiocarcinogenesis, facilitating tumour growth and metastasis[7] In this view an increased microvessel density has been associated with a worse prognosis (lower 5-year survival rates, higher recurrence rates and increased nodal spread)[8]
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