本帖最后由 独孤八戒 于 2017-12-1 10:09 编辑
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.
Discussion
An inverse relationship between LDH levels and length of survival has also been identified in many tumor types, including melanoma 15, breast cancer 16, myeloma 17, hepatocellular carcinoma 18, seminoma 19, nasopharyngeal cancer 20, lung cancer 21, colorectal cancer 10, renal cancer 22, oral cancer 23, and pancreatic cancer 24. For gynecologic malignancies, a strong association between the elevated expression of LDH and an aggressive phenotype has been noted in patients with ovarian and uterine carcinoma 25, 26. In consistent with these findings, our study demonstrated that LACC patients with elevated LDH levels were more likely to have positive SCCA, LVSI, lymph node metastasis, and parametrium invasion. Furthermore, compared with patients with baseline LDH less than 252.0 μ/L, patients with LDH ≥252.0 μ/L had a statistically significant 3.6‐fold risk of cancer recurrence and 3.1‐fold risk of cancer‐specific death, and this association was independent of other potential prognostic factor. The prognostic influence of elevated LDH levels was consistent across all the LACC patient subgroups. Additionally, we found pretreatment LDH levels <252.0 μ/L was an independent predictor of CR after NACT.
又是林仲秋教授的论文，看来林教授要火
418个样本量, 2A及2A之前的分期，新辅助化疗后，LDH取治疗前的基线值252：
LDH>252：淋巴受浸、淋巴转移、宫旁阳性等 概率大大增加
LDH<252: 浸润、受累、转移的概率明显减少
5年复发率统计：
LDH<252: 10.6% ； 1年复发率：0% 3年复发率：10.6 5年复发率：10.6%
LDH>252: 47.9% ; 1年复发率：12.5% 3年复发率：44.8% 5年复发率：47.9% |
显身卡
retreatment CYFRA 21–1 levels may be a useful prognostic indicator in patients with Non-SCC with reference to SCC-Ag.
