Is preoperative serum lactate dehydrogenase useful in predicting the outcomes of patients with upper tract urothelial carcinoma?

Abstract

Background: Lactate dehydrogenase (LDH) has been proved to be associated with clinical outcomes in various carcinomas; however, limited evidence was available in upper urinary tract urothelial carcinoma (UTUC). Thus, the aim of this study was to evaluate the prognostic impact of LDH in UTUC. Patients and methods: A cohort of 668 patients WERE retrospectively included between 2003 and 2016. Kaplan-Meier method and Cox proportional hazards regression models were used to evaluate the association of LDH with overall survival (OS), cancer-specific survival (CSS), disease recurrence-free survival (RFS), and metastasis-free survival (MFS). The cutoff level of LDH was set at 220 U/L for the upper limit of normal. Results: Kaplan-Meier plots showed the group with elevated LDH had significant poor OS (P = 0.003), CSS (P = 0.005), and RFS (P = 0.005), but not MFS (P = 0.099). However, multivariate Cox analysis suggested that LDH was not an independent predictor for CSS (HR 1.50, 95%CI: 0.87-2.59), OS (HR 1.56, 95%CI: 0.94-2.58), RFS (HR 1.33, 95%CI: 0.83-2.12), or MFS (HR 1.16, 95%CI: 0.79-1.71). Albumin, globulin, and HBDH were also not related to survival outcomes of UTUC patients in multivariate analysis, while higher alkaline phosphatase was associated with worse CSS and OS, and higher white blood cells contributed to poor CSS and RFS. In subgroup analysis, results found higher LDH was associated with poor OS in patients with localized disease (pT ≤ 2) (HR 4.03, 95%CI: 1.37-11.88). Conclusion: The preoperative LDH was not an independent prognostic factor for patients with UTUC, while elevated LDH was proved to be correlated with worse OS in patients with localized disease.