Lactate Dehydrogenase as an Independent Prognostic Marker of Chemotherapy Response in Patients with Germ Cell Tumors: A Study from a Tertiary Care Hospital, Rawalpindi

Raishma; Mussavir Hussain  Bangash; Muhammad Nadeem; Sajid; Madiha  Sajad; Hafiz Muhammad Danyal

doi:10.51253/pafmj.v76i4.13036

Authors

Raishma Department of Medical Oncology, Combined Military Hospital Rawalpindi /National University of Medical Sciences (NUMS) Pakistan
Mussavir Hussain Bangash Department of Medical Oncology, Combined Military Hospital Rawalpindi /National University of Medical Sciences (NUMS) Pakistan
Muhammad Nadeem Department of Medical Oncology, Combined Military Hospital Rawalpindi /National University of Medical Sciences (NUMS) Pakistan
Sajid Department of Medical Oncology, Combined Military Hospital Rawalpindi /National University of Medical Sciences (NUMS) Pakistan
Madiha Sajad Department of Medical Oncology, Combined Military Hospital Rawalpindi /National University of Medical Sciences (NUMS) Pakistan
Hafiz Muhammad Danyal Department of Medical Oncology, Combined Military Hospital Rawalpindi /National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i4.13036

Keywords:

Chemotherapy; Germ cell; LDH; Response

Abstract

Objective: To determine the association of raised Lactate Dehydrogenase (LDH) levels with response to chemotherapy in germ cell tumor patients managed at a tertiary care oncology unit

Study Design: Prospective observational study

Place and Duration of Study: Medical Oncology Department, Combined Military Hospital Rawalpindi, Pakistan, from Sep to Dec 2024

Methodology: This study was conducted on patients of germ cell tumors managed with chemotherapy. Serum LDH levels and other relevant biochemical assessments were done along with physical examination at the time of diagnosis. Standard chemotherapy was provided to all the patients, and response was assessed at the end of the cycle in all the patients by the treating team. Association of raised LDH levels at the time of diagnosis and other factors was observed with response to treatment in all the study participants.

Results: Seventy patients of germ cell tumors were recruited in this study after application of inclusion/exclusion criteria. Mean age of the germ cell tumor patients included in the study was 39.07±10.55 years. All the patients were male in this study. At the end of the chemotherapy session, patients who had raised LDH at the time of diagnosis and those who were classed as poor risk did not have a good response to treatment (p-value<0.05).

Conclusion: Raised serum LDH levels at the time of diagnosis and being classified as poor risk at the time of diagnosis were the factors significantly associated with a poor response to chemotherapy in patients of germ cell tumors included in our study.

Downloads

Download data is not yet available.

References

1. Hao T, Li-Talley M, Buck A, Chen W. An emerging trend of rapid increase of leukemia but not all cancers in the aging population in the United States. Sci Rep 2019; 9(1): 12070. https://doi.org/10.1038/s41598-019-48445-1

2. Miranda-Filho A, Piñeros M, Ferlay J, Soerjomataram I, Monnereau A, Bray F. Epidemiological patterns of leukaemia in 184 countries: a population-based study. Lancet Haematol 2018; 5(1): e14-e24.

https://doi.org/10.1016/S2352-3026(17)30232-6

3. Yang J, Nittala MR, Velazquez AE, Buddala V, Vijayakumar S. An Overview of the Use of Precision Population Medicine in Cancer Care: First of a Series. Cureus 2023; 15(4): e37889. https://doi.org/ 10.7759/cureus.37889.

4. Tilsed CM, Fisher SA, Nowak AK, Lake RA, Lesterhuis WJ. Cancer chemotherapy: insights into cellular and tumor microenvironmental mechanisms of action. Front Oncol 2022; 12(3): 960317.

https://doi.org/10.3389/fonc.2022.960317.

5. Pathak S, Zajac KK, Annaji M, Govindarajulu M, Nadar RM, Bowen D, et al. Clinical outcomes of chemotherapy in cancer patients with different ethnicities. Cancer Rep 2023; 6(Suppl 1): e1830. https://doi.org/10.1002/cnr2.1830.

6. Janicic A, Petrovic M, Zekovic M, Vasilic N, Coric V, Milojevic B, et al. Prognostic Significance of Systemic Inflammation Markers in Testicular and Penile Cancer: A Narrative Review of Current Literature. Life 2023; 13(3): 600.

https://doi.org/10.3390/life13030600.

7. Sung M, Jang WS, Kim HR, Park JA, Lim SM, Kim HR, et al. Prognostic value of baseline and early treatment response of neutrophil-lymphocyte ratio, C-reactive protein, and lactate dehydrogenase in non-small cell lung cancer patients undergoing immunotherapy. Transl Lung Cancer Res 2023; 12(7): 1506-1516.

https://doi.org/ 10.21037/tlcr-23-7.

8. Liu R, Cao J, Gao X, Zhang J, Wang L, Guo L et al. Overall survival of cancer patients with serum lactate dehydrogenase greater than 1000 IU/L. Tumor Biol 2016; 37(3): 14083–14088. https://doi.org/10.1007/s13277-016-5228-2

9. Dieckmann KP, Simonsen-Richter H, Kulejewski M, Anheuser P, Zecha H, Isbarn H, et al. Serum Tumour Markers in Testicular Germ Cell Tumours: Frequencies of Elevated Levels and Extents of Marker Elevation Are Significantly Associated with Clinical Parameters and with Response to Treatment. Biomed Res Int 2019; 2019(3): 5030349.

https://doi.org/10.1155/2019/5030349.

10. Saeed K, Sadaf T, Siddiqui N, Syed AA, Jamshed A. Malignant ovarian germ cell tumors-Survival outcomes from a single institution in Pakistan. J Cancer Allied Spec 2015; 1(2): 4-8.

https://doi.org/10.37029/jcas.v1i2.32

11. Ozaki Y, Narita T, Hatakeyama S, Tanaka T, Togashi K, Hamaya T, et al. Trends of incidence and age in adults with testicular germ cell tumors: a two-decade multicenter retrospective study. Transl Androl Urol 2023; 12(2): 161-167.

https://doi.org/10.21037/tau-22-521.

12. Lobo J, Leão R. Editorial: Diagnostic and predictive biomarkers in testicular germ cell tumors. Front Oncol 2022; 12(3): 1027363. https://doi.org/10.3389/fonc.2022.1027363.

13. Adra N, Althouse SK, Liu H, Brames MJ, Hanna NH, Einhorn LH, et al. Prognostic factors in patients with poor-risk germ-cell tumors: a retrospective analysis of the Indiana University experience from 1990 to 2014. Ann Oncol 2016; 27(5): 875-879.

https://doi.org/10.1093/annonc/mdw045.

14. King JM, Althouse S, Cary C, Masterson T, Foster RS, Ashkar R, et al. Surveillance after Complete Response to First-Line Chemotherapy in Patients with Metastatic Nonseminomatous Germ Cell Tumor. J Urol 2022; 208(3): 641-649.

https://doi.org/10.1097/JU.0000000000002751.

15. Patel P, Sharma V, Raval G, Rawal RM, Patel MM, Balar DB et al. Serum lactate dehydrogenase levels in malignant germ cell tumors of ovary. Int J Gynecol Cancer 1996; 6(3): 328-332.

https://doi.org/10.1046/J.1525-1438.1996.06040328.X

16. Seidel C, Daugaard G, Nestler T, Tryakin A, Fedyanin M, Fankhauser CD, et al. The prognostic significance of lactate dehydrogenase levels in seminoma patients with advanced disease: an analysis by the Global Germ Cell Tumor Collaborative Group (G3). World J Urol 2021; 39(9): 3407-3414.

https://doi.org/10.1007/s00345-021-03635-3.

17. Nair LM, Krishna KMJ, Kumar A, Mathews S, Joseph J, James FV. Prognostic factors and outcomes of nonseminomatous germ cell tumours of testis-experience from a tertiary cancer centre in India. Ecancermedicalscience 2020; 14(3): 1145.

https://doi.org/doi: 10.3332/ecancer.2020.1145.

18. Lakshmi KH, James FV, Kumar A, Joseph J, Km JK. Tumor Marker Decline in Predicting Treatment Outcome among Poor-Risk Testicular Germ Cell Tumors-A Tertiary Cancer Center Data. South Asian J Cancer 2022; 11(3): 218-222.

https://doi.org/doi: 10.1055/s-0042-1743423.

19. Malhotra G, Gattani RG, Shinde RK, Gianchandani SG, Nayak K, Salwan A. Significance of Serum Lactate Dehydrogenase as a Prognostic Marker and Outcome Predictor in Patients With Breast Cancer. Cureus 2024; 16(3): e55932.

https://doi.org/doi: 10.7759/cureus.55932.

20. Vasanth A, Patel SM, Arora R, Parekh CD, Dave P, Patel BM, et al. Study of neoadjuvant chemotherapy in advanced malignant ovarian germ cell tumors at a tertiary center in western India. J Gynecol Oncol 2024; 35(2): e19.

https://doi.org/doi: 10.3802/jgo.2024.35.e19.