From the Guidelines
Elevated Lactate Dehydrogenase (LDH) levels in malignancy are associated with a worse prognosis and indicate increased tumor burden, higher cell turnover, or tumor lysis. The significance of elevated LDH in malignancy can be understood by considering its role as a non-specific tumor marker. Elevated LDH levels in cancer patients typically indicate increased tumor burden, higher cell turnover, or tumor lysis, as rapidly dividing cancer cells release LDH when they die or are damaged 1.
Key Points to Consider
- LDH is particularly elevated in aggressive lymphomas, leukemias, melanoma, seminoma, neuroblastoma, and some solid tumors with extensive metastasis.
- The degree of LDH elevation often correlates with tumor burden and prognosis, with higher levels generally suggesting more advanced disease and poorer outcomes.
- When evaluating elevated LDH in a patient with suspected malignancy, it's essential to consider other causes such as hemolysis, myocardial infarction, liver disease, and muscle damage.
- Serial LDH measurements can be valuable for monitoring treatment response and detecting disease recurrence, with decreasing levels typically indicating effective therapy.
- LDH should always be interpreted alongside other clinical findings and specific tumor markers rather than in isolation, as stated in the study by 1 and 1.
Prognostic Factors
Some studies have identified LDH as a significant prognostic factor for patients with osteosarcoma, with elevated serum LDH levels associated with a worse prognosis 1. Similarly, in Ewing's sarcoma, elevated serum lactate dehydrogenase (LDH) is considered an adverse prognostic factor, along with metastatic disease, pelvic localization, tumor diameter >8–10 cm, age > 15, and poor histological response to preoperative chemotherapy 1.
Clinical Implications
In clinical practice, elevated LDH levels should prompt further investigation to determine the underlying cause, including imaging studies, biopsy, and other diagnostic tests. The management of patients with elevated LDH levels should be individualized, taking into account the specific type of cancer, tumor stage, and overall patient condition. As noted in the study by 1, LDH levels can be influenced by various factors, including tumor lysis, hepatocellular carcinoma, and other cancers, highlighting the importance of interpreting LDH results in the context of other clinical findings.
From the Research
Significance of Elevated Lactate Dehydrogenase (LDH) in Malignancy
- Elevated serum lactate dehydrogenase (LDH) levels are typically associated with a poor prognosis in many cancer types 2.
- High serum LDH levels are a well-known poor prognostic factor in patients with malignancies, and are often interpreted as a robust biomarker of poor prognosis by oncologists 3.
- The regulation of the five LDH isoforms, and their enzymatic and non-enzymatic functions, is closely related to key oncological processes, including the activation of several oncogenic signalling pathways, metabolic activity, invasiveness, and immunogenicity of many tumours 2.
Prognostic Value of LDH in Specific Cancers
- In primary duodenum adenocarcinoma patients, elevated baseline serum LDH indicates a poor prognosis, and is an independent prognostic factor associated with overall survival (OS) 4.
- In melanoma patients with elevated LDH, combined anti-PD-1 and anti-CTLA-4 blockade seems to be associated with prolonged OS compared with first-line targeted therapy 5.
- In non-small cell lung cancer (NSCLC) patients with brain metastases, high levels of serum LDH are associated with a significantly worse OS, and may provide useful prognostic information for patients and clinicians to choose more aggressive treatment strategies 6.
Clinical Implications of Elevated LDH
- Elevated LDH levels can predict a terminal stage in metastatic cancer patients, and OS is significantly prolonged in patients indicated for effective palliative treatment and LDH level decreased to normal at 2 months 3.
- The prognostic value of LDH can be used to identify patients who may benefit from more aggressive treatment strategies, such as combined anti-PD-1 and anti-CTLA-4 blockade in melanoma patients 5.
- LDH can be used as a biomarker to monitor treatment response and disease progression in cancer patients, and to adjust treatment strategies accordingly 2, 3, 4, 5, 6.