Significance Of Serum Lactate Dehydrogenase Research Articles

Significance of Serum Lactate Dehydrogenase as a Prognostic Marker and Outcome Predictor in Patients With Breast Cancer.

Background Breast carcinoma has been the most prevalent cancer in women, with research-based evidence showing a significant rise in the incidence of cancer and related morbidity and mortality in the Indian subcontinent. The predictive value of plasmatic lactate dehydrogenase (LDH) levels has been studied in breast cancer. Numerous studies have connected high LDH values to a poor prognosis, increased risk of incidence, recurrence, and associated mortality in patients with breast carcinoma. This study aimed to assess the clinical profile of breast carcinoma and determine the correlation of serum lactate dehydrogenase levels with the stage of the disease and assessment of high-risk features using histopathology and immunohistochemistry. Methods A total of 75 patients with carcinoma breast were enrolled for this study and classified into two groups: upfront surgery and post-adjuvant therapy. Serum LDH levels were estimated a day before the surgery (baseline) and on postoperative days 1, 7, 14, and 30. The clinical tumor, node, metastasis (cTNM) staging was correlated with pathological tumor, node, metastasis TNM (pTNM) staging and immunohistochemistry findings. Results The clinical characteristics of breast cancer, serum LDH levels, and stage of the disease were collected and analyzed. A significant decreasing trend was noted in LDH values post-op days, and statistically significant higher LDH values were noted in the triple-negative group, positive lymph nodes, and positive lymphovascular invasion patients. Conclusion Regularly elevated levels or an unanticipated rise in serum LDH might indicate poor outcomes. Hence, this non-specific enzyme marker can be suggested to be used routinely to assess disease outcomes.

The prognostic significance of serum lactate dehydrogenase to albumin ratio in pancreatic ductal adenocarcinoma

Objective: This study was performed to investigate the prognostic role of lactate dehydrogenase/albumin ratio (LAR) and pancreatic ductal adenocarcinoma (PDAC) with initial curable resection treatment. Materials and Methods: This retrospective study was conducted with the data of patients with resectable PDAC. The (ROC) analysis showed that the optimal sill value for pretreatment LAR was 91.43 and this threshold value was used in other analyses. Univariate and multivariate analyses were performed to determine the prognostic factors for overall survival (OS). Results: Our study consisted of 70 patients with a mean age of 59.5±13.2 years and 37 (52,9%) women. OS was 50 months in LAR <91.43 (n = 32) patients and 27,7 months in LAR≥91.43 (n=38) patients, respectively. Kaplan–Meier curves showed that LAR≥91.43 was significantly associated with worse OS (p=0.029). Multivariate analyses proved that LAR was an independent predictor in resectable PDAC patients (p=0.017). Conclusion: Our results showed that a high pre-treatment LAR level was a unfavorable prognosticator in PDAC patients undergoing curative resection. LAR has the potential to be a prognostic biomarker in clinical practice.

Is the level of serum lactate dehydrogenase a potential biomarker for glucose monitoring with type 2 diabetes mellitus?

Type 2 diabetes mellitus (T2DM) is a metabolic disorder due to defects in insulin secretion or insulin resistance leading to the dysfunction and damage of various organs. To improve the clinical evaluation of short-term blood glycemic variability monitoring, it is critical to identify another blood cell status and nutritional status biomarker that is less susceptible to interference. This study identifies the significance of serum lactate dehydrogenase (LDH) level among T2DM patients treated in outpatient clinics and investigates the relationship of LDH level with other variables. This study comprised 72 outpatients with T2DM over 20 years of age. Blood samples were collected followed by a hematological analysis of serum glycated albumin (GA), LDH, fasting blood glucose, glycosylated hemoglobin, C-peptide, and insulin antibodies (insulin Ab). Serum LDH level was significantly correlated with GA (p < 0.001), C-peptide (p = 0.04), insulin Ab (p = 0.03), and thyroid-stimulating hormone (TSH) levels (p = 0.04). Hence, we performed a linear regression analysis of hematological markers. GA (p < 0.001, r2 = 0.45) and insulin Ab (p < 0.001, r2 = 0.40) were significantly associated with LDH level. Then, we classified patients into low (<200 U/L) and high (≥200 U/L) serum LDH level groups, respectively. GA (p < 0.001), C-peptide (p = 0.001), and TSH (p = 0.03) showed significant differences in patients with high LDH levels compared with those in patients with low LDH levels. In conclusion, we suggested that LDH level was independent of long-term but associated with short-term blood glucose monitoring. The results indicated that changes in serum GA induced cell damage and the abnormal elevation of the serum level of LDH may occur simultaneously with glycemic variability. It has been reported that many biomarkers are being used to observe glucose variability in T2DM. However, LDH could provide a more convenient and faster evaluation of glycemic variability in T2DM.

LDH and GGT/ALT Ratio as Novel Prognostic Biomarkers in Hepatocellular Carcinoma Patients after Liver Transplantation.

Background Liver inflammation indices reflect its inflammatory microenvironment, which may play a role in the proliferation, invasion, and migration of carcinoma. This study is aimed at exploring the prognostic significance of serum lactate dehydrogenase (LDH) levels and gamma-glutamyl transferase (GGT)/alanine aminotransferase (ALT) ratio in hepatocellular carcinoma after liver transplant (LT). Methods We retrospectively analyzed data from 155 patients with a pathologically confirmed diagnosis of hepatocellular carcinoma who received LT between January 2013 and September 2017. We used receiver operating characteristics (ROC) curves to determine the optimal LDH and GGT/ALT ratio cut-off values. The Kaplan–Meier method and the logarithmic rank test were used to compare the survival curves without recurrence (RFS) and overall survival (OS). Univariate and multivariate analyses were used to identify factors associated with survival. Results Serum LDH levels were significantly associated with the Child-Pugh score (P = 0.037), largest tumor size (<50 vs. ≥50 mm) (P = 0.017), tumor count (<3 vs. ≥3) (P = 0.009), microvascular invasion (P = 0.006), and the Milan criteria (P ≤ 0.001). The serum GGT/ALT ratio was significantly correlated with alpha-fetoprotein (AFP) levels (of <400 vs. ≥400 ng/ml) (P ≤ 0.001), largest tumor size (of <50 vs. ≥50 mm) (P ≤ 0.001), the Edmondson grade (I-II vs. III-IV) (P = 0.028), microvascular invasion (P ≤ 0.001), and the Milan (P = 0.002) and Hangzhou criteria (P = 0.018). The survival curves showed that the patients with high LDH and the GGT/ALT ratio were associated with poor RFS and OS (P < 0.05). Univariate and multivariate analyses showed that AFP levels of ≥400 ng/ml, largest tumor size of ≥50 mm, microvascular invasion, LDH levels of ≥213.5 U/l, and the GGT/ALT ratio of ≥3.1338 were factors independently associated with RFS. Conclusion Elevated LDH levels and the GGT/ALT ratio before LT were associated with poor OS and RFS in the present study. These factors could be used in the prognostication of patients with hepatocellular carcinoma undergoing LT.

Study of Clinical Profile of Carcinoma Breast and Prognostic Significance of Serum Lactate Dehydrogenase as Tumor Marker in Carcinoma Breast

Background: Breast cancer is the highly prevalent malignancy and is a major killer in women around world. In India, there is substantial statistically significant increase in breast cancer incidence patterns. Women from under developed areas(883000 cases) have a significantly higher no. of cases than those from developed areas (794,000) [1]. There are various risk factors associated with breast malignancy. A variety of bio-chemical markers have been tested to determine the malignancy, for the early detection of carcinoma of different origin. LDH is the easiest and cheapest to calculate of all of these indicators.&#x0D; Objectives:&#x0D; &#x0D; To study the clinical profile of patient with breast&#x0D; To study the prognostic significance of LDH as tumor marker in breast&#x0D; To compare post-operative LDH level in patient undergoing surgery for carcinoma breast v/s patient undergoing neoadjuvant chemotherapy.&#x0D; Compare variation in preoperative baselines LDH levels and post-operative LDH levels.&#x0D; &#x0D; Methodology: It is a prospective observational study done on patients with breast cancer. It will be conducted at Dept. of General Surgery , J.N.M.C and AVBRH, Sawangi (Meghe), Wardha. The study will be conducted on patients with Carcinoma Breast.&#x0D; Results: To be assessed after the study.&#x0D; Conclusion: Serum LDH is a good prognostic marker of breast cancer.

Prognostic significance of serum lactate dehydrogenase in patients undergoing radical cystectomy for bladder cancer

BackgroundTo investigate the prognostic significance of preoperative serum lactate dehydrogenase (LDH) in patients undergoing radical cystectomy for bladder cancer (BCa). Patients and methodsA cohort of 263 patients undergoing open or laparoscopic radical cystectomy between 2011 and 2016 was studied. Baseline characteristics, hematological variables, follow-up data were collected. Kaplan-Meier curves and Cox proportional hazard regression model were applied to assess the relationship between LDH and overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). ResultsAfter a median 34.2 (22.9–45.8) months follow-up, all-cause death, cancer-specific death, and disease recurrence occurred in 66 patients, 50 patients, and 91 patients. The elevation of serum LDH was associated with several unfavorable parameters, including advanced age, continent cutaneous urinary diversion, increased neutrophil-to-lymphocyte ratio, decreased lymphocyte-to-monocyte ratio. Patients with a higher serum LDH (> 220 U/L) had a worse OS (P < 0.001), CSS (P < 0.001) and DFS (P < 0.001). Multivariate Cox analysis suggested that elevated LDH was an independent predictor for OS (hazard ratio [HR]: 3.113, 95% confidence interval [CI]: 1.524–6.358; P = 0.002), CSS (HR: 4.564, 95% CI: 2.008–10.373; P < 0.001), DFS (HR: 2.051, 95% CI: 1.125–3.739; P = 0.019). Medical history of diabetes, high pT stage, and positive lymph node also were adverse predictors for oncological outcomes of BCa patients in multivariate analysis. ConclusionsPreoperative serum LDH is an independent prognostic biomarker for OS, CSS, and DFS in patients undergoing radical cystectomy for BCa, which can be incorporated into prognostic models.

Prognostic significance of serum lactate dehydrogenase in patients with breast cancer: a meta-analysis.

Background: Multiple studies have assessed the prognostic significance of serum lactate dehydrogenase (LDH) in patients with breast cancer, but their results remain controversial. This study aimed to evaluate the prognostic value of LDH in breast cancer by meta-analysis.Methods: Electronic searches for relevant articles were conducted in PubMed, Embase and Web of Science databases. The HR and their 95% CI were used to assess the prognostic value of serum LDH. Stata Statistical Software 12.0 was applied for statistical analysis.Results: A total of 11 studies involving 6,102 patients were subjected to final analysis. Our results showed that higher serum LDH had significant effect on poor overall survival (HR, 1.88; 95% CI, 1.68–2.11) and progression-free survival (HR, 1.98; 95% CI, 1.46–2.68). Moreover, the results of subgroup analyses were consistent with that of overall outcomes. No significant heterogeneity and publication bias were found in this study.Conclusion: Serum LDH could act as a prognostic factor for patients with breast cancer. Future data are needed to validate and update our results.

Elevated pretreatment serum lactate dehydrogenase level predicts inferior overall survival and disease-free survival after resection of thymic carcinoma.

The prognostic significance of serum lactate dehydrogenase (LDH) level in thymic carcinoma (TC) remains unclear. Therefore, we evaluated the role of pretreatment serum LDH level in the prognosis for TC in this study. Sixty consecutive surgical patients were analyzed in this study with pathologic confirmed TC in Sun Yat-sen University Cancer Center from June 1996 to June 2014. The cut-off value of LDH was 210.50 IU/L. In both univariate analysis and multivariable analysis, only pretreatment serum LDH level (P=0.027) and pathological Masaoka stage (P=0.041) were associated with overall survival (OS). In univariate analysis, pretreatment serum LDH level, tumor size, postoperative radiotherapy (PORT) and pathological Masaoka stage were associated with disease-free survival (DFS) (all P<0.050). Multivariable analysis showed that LDH level (P=0.001), PORT (P=0.001) and pathological Masaoka stage (P=0.038) were independently prognostic factors of DFS. This study also revealed that male patients and larger tumor size had a significantly higher rate of elevated pretreatment serum LDH level than in the other groups. In conclusion, pretreatment serum LDH level was an independent prognosis factor of OS and DFS for patients with TC.

Elevation of serum lactate dehydrogenase in AL amyloidosis reflects tissue damage and is an adverse prognostic marker in patients not eligible for stem cell transplantation.

The significance of serum lactate dehydrogenase (LDH) in light chain (AL) amyloidosis has not been previously explored. We studied 1019 newly diagnosed patients and correlated the elevation of LDH above the upper limit of normal (ULN) with disease characteristics and outcome. Four hundred and nine patients had an LDH above ULN, representing 40% of the study population. Patients with an elevated LDH were older, were less likely to be male and had more extensive organ involvement compared to patients with a normal LDH. Patients with high LDH had greater cardiac and renal dysfunction. Elevated LDH was an independent prognostic marker for overall survival and for death within 6months of diagnosis, but this was restricted to patients not eligible for stem cell transplant. Serum LDH may act as a marker for organ damage and should be explored as a potential marker for tissue healing and organ recovery.

Significance of Serum Lactate Dehydrogenase in Childhood Acute Lymphoblastic Leukaemia

Introduction: Acute Lymphoblastic Leukaemia (ALL) is the most common childhood malignancy accounting for approximately 30% of childhood malignancies. The incidence rate of leukaemia in various parts of India varies from 0.3-1.2%. Lactate Dehydrogenase (LDH) is a pyridine-linked enzyme which is involved in metabolism of glucose in normal tissue. In leukaemic cells, there is loss of coordination of glycolytic sequence and tricarboxylic acid cycle, which leads to increased utilization of glucose. As there is high cell turnover, this leads to increased cell burden and high levels of serum LDH in ALL and the increase is much more than other haematological malignancies barring Burkitts lymphoma. Aim: To study the level of LDH in ALL cases at the time of diagnosis in comparison with Non ALL cases. Materials and Methods: Fifty five cases of ALL and 23 cases of Non ALL haematological malignancies as control were evaluated based on clinical manifestations, haematological parameters, peripheral blood picture and bone marrow findings. Serum LDH was estimated at the time of presentation by Cobas 6000, a photometrically automated system. Statistical analysis was done using SPSS version 20. Results: In our study, high serum LDH levels were seen in 89.1% (49) cases and normal levels in 10.9% (6) cases. High blast percentage i.e., >20% on peripheral smear (65.5%) was associated with high serum LDH level. On correlation of serum LDH with peripheral smear blast percentage, a p-value of <0.05 was obtained which shows a significant correlation Conclusion: Serum LDH level can be considered as a simple cost-effective tool in the presumptive evaluation of childhood Acute Lymphoblastic Leukaemia. LDH in combination with Uric acid helps in detecting tumourlysis syndrome at an early stage thereby aiding in early management.

Prognostic Significance of Serum Lactate Dehydrogenase in Saudi Patients with Mycosis Fungoides: A Retrospective Study of 47 Patients

Background: Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma and its advanced-stage (MF; stage IIB to IV)) has aggressive behavior. Lactate dehydrogenase (LDH) has been demonstrated to correlate with progression of malignancy specially lymphoma and leukemia. The LDH level is expected to be useful clinical tool for evaluating the progression of MF. Objective: This study aimed to evaluate the pretreatment LDH as a prognostic factor in Saudi patients with Mycosis fungoides. Methods: We designed a retrospective study using biopsy-based data collected from 1997 to 2015 at King Khalid University Hospital. The correlation of LDH levels with clinical stages of Mycosis fungoides was studied. Results: Of the 47 MF patients, there were 25 male and 22 female patients for a male: female ratio of 1.4:1. The mean patient age was 39 years; 87.2% (n=31) had limited stage of MF and 12.8 (n=6) had an advanced stage >IIA. There were 13 patients with a raised LDH at the time of diagnosis. All stage IA patients had normal LDH levels while stage IB, IIA and advanced stage had 20%, 50% and 100% elevated LDH, respectively. Conclusions: Our results suggest that high LDH level may be used as an independent prognostic factor to measure the progression of Mycosis fungoides.

Clinical significance of serum myocardial enzymes and CSF LDH detection in adults with intracranial infection

Objective To investigate the changes and clinical significance of serum lactate dehydrogenase (LDH), creatine kinase (CK), glutamate pyruvate transaminase (AST), and cerebrospinal fluid lactate dehydrogenase (CSF LDH) in adult patients with acute central nervous system infection. Methods The levels of myocardial enzymes (AST, LDH, and CK ) in serum of 96 adult patients with acute intracranial infection in 7days and 39 healthy people were measured by Beckman automatic biochemical analyzer and enzyme rate assay, and CSF LDH level in 96 patients were measured simultaneously. Results ⑴The serum myocardial enzymes (LDH, CK, and AST ) of intracranial infection group (47 cases with viral encephalitis, 30 cases with tuberculous meningitis, and 19 cases with purulent encephalitis) were significantly higher than those of normal control group (P 0.05). Conclusions ⑴There is significant change in the levels of serum LDH, CK, AST, and CSF LDH of adult patients with acute intracranial infection, especially in infected patients with cerebral functional disorder, and the change of LDH is the most obvious. ⑵The levels of serum myocardial enzymes and CSF LDH are helpful to the differential diagnosis of intracranial infection in early stage, and judging the severity of the illness. Key words: Tuberculosis, meningeal/ME; Meningitis, viral/ME; Meningitis, bacterial/ME; Lactate dehydrogenases/ME; Creatine kinase/ME; Aspartate aminotransferases/ME

Brisk Elevation of Serum Lactate Dehydrogenase During G-CSF Priming is a Significant Predictor for the Ensuing Successful Autologous Peripheral Blood Stem Cell Collection

Autologous stem cell transplantation plays a critical role in the management of patients with hematologic malignancies such as multiple myeloma and malignant lymphoma. The minimum number of CD34 positive cells required for transplantation is believed to be 2.0×106 cells/kg. Up to 20% of the patients, however, fail to reach the number after a single collection attempt and require multiple aphereses to obtain a sufficient number of stem cells. To predict the outcome of mobilization, several pre-mobilization factors have been investigated, including peripheral blood CD34+ cell count at the time of harvest, but little is as yet known about the significance of serum lactate dehydrogenase (LDH). We, therefore, sought to evaluate the predictive potential of serum LDH for the autologous stem cell yield. Peripheral blood stem cell mobilization attempts were made from April 2002 to March 2012 for 55 consecutive patients of hematologic disorders. Primary diagnosis of our patients and their mobilization chemotherapy regimens are shown in Table 1. All patient received G-CSF (filgrastim 400μg/sq/day or lenograstim 10μg/kg/day subcutaneously). None was mobilized with G-CSF alone. Aphereses were repeated until the total stem cell yield exceeded 2×106cells/kg, for maximum 3 consecutive days. Forty-four patients successfully produced the sufficient number of stem cells, while 11 patients failed (poor mobilizer). Between the two groups, there were no significant differences in pre-mobilization WBC counts and serum LDH levels. However, the ratio of the LDH level immediately before apheresis to the lowest one (“LDH-ratio”) were significantly lower in poor mobilizers than good mobilizers. Our ROC analysis showed that the cut-off value of “LDH-ratio” was 1.75. An elevation of serum LDH levels to reach “LDH-ratio”>1.75 were found to be a useful predictive factor for successful CD34+ stem cell collection. The delay in reaching “LDH-ratio”>1.75 may suggest that we should modify the mobilization regimen by, for instance, adding prelixafor.Table 1Pts’ characteristicsNo. of Patients55Median age (range)56(35-69)Gender, male (%)31(56)Primary Disease MM19 NHL26 HL4 Others6Median WBC counts ×103/μL (range)2.1(1.5-3.2)Median LDH Level IU/L (range)196(145-445)PBSC mobilization regimen ESHAP27 HD-CY22 G-CSF alone0 Others6MM indicates: multiple myeloma, NHL: non-hodgkin lymphoma, HL: hodgkin lymphoma, HD-CY: high dose cyclophosphamide Open table in a new tab MM indicates: multiple myeloma, NHL: non-hodgkin lymphoma, HL: hodgkin lymphoma, HD-CY: high dose cyclophosphamide

Significance of Serum Lactate Dehydrogenase and its Isoenzymes During Post-Burn Follow-Up

Significance of Serum Lactate Dehydrogenase and its Isoenzymes During Post-Burn Follow-UpThe present study aims to evaluate the role of lactate dehydrogenase (LDH) isoenzymes in thermal burns. A total of 18 patients of both genders with 20 to 50% total burn surface area (TBSA), admitted to the Burn Ward of JN Medical College and Hospital was assessed. These patients were subjected to general and systemic examinations. The sera collected at day 1, 2, 5 and 10 during follow-up of burn patients were used for LDH quantitation. PAGE profiles showed significant differences in the levels of LDH isoenzymes in all the burn subjects (P=0.05). Software analysis of gel-scans showed the presence of five isoenzyme bands of which LDH-1 and -2 are the least contributors. During follow-up, it was observed that the ranking of LDH isoenzymes approaches control values at day 2 in 20% TBSA patients, while in the remaining cases it occurs at day 5. 3D-densitograms indicated high activity of LDH in 50% of TBSA patients even at day 10; however, the relative ranking of these isoenzymes was similar to control values (LDH-4&gt;- 5&gt;-3&gt;-1&gt;-2). We were of the opinion that the high activity of LDH enzyme is due to the enzyme-immunoglobulin-G (LDH-IgG) complex, but surprisingly we did not observe this complex in 50% of burn patients at any of the durations. Therefore, it is suggested that LDH isoenzymes play a role in the pathophysiology of the disease and can be an asset to ascertain the invisible tissue damage. Moreover, the high activity of LDH in 50% of burns is due to some unknown mechanism and not due to the binding of LDH with IgG.

Prognostic Significance of Serum Lactate Dehydrogenase in Osteosarcoma of the Extremity: Experience at Rizzoli on 1421 Patients Treated over the Last 30 Years

The study evaluated the correlation between pretreatment serum lactate dehydrogenase (LDH) levels with the stage of disease and its clinical prognostic value. Pretreatment serum LDH of 1421 patients with osteosarcoma of the extremity were assessed to investigate whether the enzyme correlates with the stage of the tumor. In 860 assessable patients with localized disease, treated according to 10 different protocols of adjuvant (four) and neoadjuvant chemotherapy (six), we also evaluated the correlation between the serum levels of LDH and outcome. According to the stage of disease, the rate of high serum level of LDH was significantly higher in 199 patients with metastatic disease at presentation than in 1222 patients with localized disease (36.6% vs 18.8%; P < 0.0001). In these patients, the 5-year disease-free survival was 39.5% for patients with high LDH levels and 60% for those with normal values. The 5-year disease-free survival correlated with serum level of LDH at univariate and multivariate analysis, although it lost its significance when histologic response to chemotherapy was also considered in the multivarite analysis. Serum LDH has a prognostic value and it should be considered in evaluating the results of therapeutic trials of chemotherapy, as well as defining a category of patients at high-risk of relapse to be treated with a more aggressive regimen.

Prognostic significance of serum lactate dehydrogenase in patients with osteosarcoma of the extremities.

Six hundred and fifty-six patients with osteosarcoma of the extremities (107 metastatic and 549 with localized disease) were followed from 2.5 to 20 years (average: 10 years) to evaluate whether their pretreatment serum lactate dehydrogenase (LDH) enzyme levels had a clinical value in predicting the course of the disease. The percentage of patients who had an elevated serum LDH at the time of diagnosis was significantly higher in those patients with metastatic disease than those who had localized disease (64% versus 33%, p < 0.0001). For those who presented with localized disease and had an increased serum LDH level, far more ultimately developed a relapse of disease (60% versus 38%, p < 0.0001) than those patients with a normal pre-treatment value. The prognostic significance of the serum LDH was more pronounced for the 247 patients treated with adjuvant chemotherapy (relapse rate of 72% versus 48%; p < 0.0002) than the 271 patients treated with neoadjuvant chemotherapy (relapse rate: 46% versus 28%, p < 0.005). Following treatment, serum LDH levels almost uniformly returned to normal and no correlation between postoperative levels and relapse of disease could be identified. We have demonstrated that in patients with osteosarcoma of the extremities, pretreatment serum LDH levels have a definite prognostic value which should be considered when comparing the results achieved with different therapeutic protocols and in planning new randomized clinical trials.

Serum lactate dehydrogenase and human choriogonadotrophin in seminoma.

The clinical significance of serum lactate dehydrogenase (LDH) and serum human choriogonadotrophin (HCG) as tumour markers was assessed in 105 patients with pure seminoma from whom 981 blood samples were analysed. The specificity of elevated HCG and LDH was 100 and 93% respectively. The comparable sensitivity was 32 and 47%. Serum LDH could not discriminate between patients with clinical stage I seminoma, prior to orchiectomy, and those with benign testicular lesions. In patients with advanced metastatic seminoma subjected to orchiectomy, serum LDH was increased in 82%, but elevated HCG was found in only 40%. After cisplatin-based chemotherapy, falsely elevated LDH was observed in 7 of 37 tumour-free patients, but HCG was normal in all patients with no evidence of disease. Six patients with residual tumour after chemotherapy had normal LDH and 4 of them had elevated HCG; 70% of the relapses in seminoma patients were associated with increased LDH (64%) and/or HCG (48%). In seminoma patients with comparable disease extension, elevated HCG seemed to be correlated with a high risk of relapse. Patients with normal pre-treatment LDH had a lower relapse-free survival rate than patients with elevated LDH. HCG is a highly specific tumour marker in seminoma with a rather low sensitivity. HCG is particularly useful for the primary diagnosis in patients with testicular lesions and during monitoring of chemotherapy in seminoma patients. LDH is less specific than HCG. Both markers should be analysed during follow-up of seminoma patients, since 70% of relapses are associated with an increase in one or both markers. Elevated pre-treatment HCG, but not elevated LDH, seems to indicate an increased risk of relapse in patients with seminoma.

Prognostic significance of serum lactate dehydrogenase in malignant lymphoma.

The pretreatment serum lactate dehydrogenase level (LDH) was the single most important prognostic variable in 30 patients with diffuse histiocytic lymphoma treated between January 1973 and January 1977 with a poly-drug chemotherapy program called the cyclophosphamide L2 protocol at the Memorial Sloan-Kettering Cancer Center. A highly significant difference was found between the survival patterns of patients with LDH levels of 500 U or less and those with LDH levels greater than 500 U. (Two-year survival rates were 67% and 13%, respectively.) A similar trend was observed for 25 patients with diffuse, poorly differentiated lymphocytic lymphoma treated with the same protocol, although this difference was not statistically significant. (Corresponding two-year survival rates were 74% and 33%, respectively.) The association of LDH level with survival was evident even after adjustment for other factors of potential prognostic significance. Pretreatment serum LDH determinations may provide a useful means of stratifying patient populations when comparing treatment programs for advanced stage non-Hodgkin's lymphoma.