Chinese General Practice ›› 2022, Vol. 25 ›› Issue (26): 3263-3269.DOI: 10.12114/j.issn.1007-9572.2022.0293

• Original Research • Previous Articles     Next Articles

Prognostic Value of Lactate Dehydrogenase in Advanced Esophageal Squamous Cell Carcinoma Patients with Immunotherapy

  

  1. 1. Department of Oncological Radiotherapy, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China
    2. Case Room, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China
    3. Department of Radiation Oncology, Anyang Cancer Hospital, Anyang 455000, China
  • Received:2022-02-14 Revised:2022-06-19 Published:2022-09-15 Online:2022-07-06
  • Contact: Ling YUAN
  • About author:
    LI Y, WANG K L, YANG H, et al. Prognostic value of lactate dehydrogenase in advanced esophageal squamous cell carcinoma patients with immunotherapy[J]. Chinese General Practice, 2022, 25 (26) : 3263-3269.

乳酸脱氢酶对晚期食管鳞状细胞癌免疫治疗的预后价值研究

  

  1. 1.450008 河南省郑州市,郑州大学附属肿瘤医院(河南省肿瘤医院)放疗科
    2.450008 河南省郑州市,郑州大学附属肿瘤医院(河南省肿瘤医院)病案室
    3.455000 河南省安阳市肿瘤医院放疗科
  • 通讯作者: 袁翎
  • 作者简介:
    作者贡献:李艳、杨晖、袁翎负责研究设计,并对研究的可行性及数据进行了分析;李艳收集数据、绘制图表,并撰写论文及校正;王昆仑、杨晖、赵二江负责文章的质量控制及审校;李炳旭、李胜磊、董小滔对文章进行结果的分析与解释;袁翎对文章整体负责,监督管理。所有作者均已审阅并认可论文。 李艳,王昆仑,杨晖,等.乳酸脱氢酶对晚期食管鳞状细胞癌免疫治疗的预后价值研究[J].中国全科医学,2022,25(26):3263-3269.[www.chinagp.net]
  • 基金资助:
    河南省医学科技攻关计划省部共建项目(SB201901113); 河南省科技厅科技攻关项目(192102310048)

Abstract:

Background

The overall efficacy of immunotherapy is unsatisfactory in patients with advanced esophageal squamous cell carcinoma (ESCC) , since only a few cases could obtain benefits from the therapy. Therefore, it is of great importance to select effective prognostic indicators.

Objective

To investigate the prognostic value of lactate dehydrogenase (LDH) in advanced ESCC patients with immunotherapy.

Methods

This study enrolled patients diagnosed with advanced ESCC by pathological and imaging examinations in Henan Cancer Hospital from October 2016 to October 2019. Data were collected, including baseline data obtained from the electronic medical record system, LDH level at the 8th week of immunotherapy, and results〔containing death, disease remission, progression-free survival (PFS) and overall survival (OS) 〕 of a follow-up until August 31, 2021. Log-rank test was used to compare Kaplan-Meier curves of PFS and OS by baseline LDH. Multivariate Cox regression analysis was used to analyze the potential factors associated with PFS and OS.

Results

Of the 44 cases enrolled, a higher objective response rate was found in those with lower baseline LDH (n=28, baseline LDH<200 U/L) instead of those with higher baseline LDH (n=16, baseline LDH≥200 U/L) (χ2=8.522, P=0.013) . Eight patients with disease progression (PD) had higher ?LDH than 36 patients without PD (t=2.394, P=0.021) . At the end of follow-up, 9 patients (20.5%) survived, with a median PFS of 6 (2, 11) months, and a median OS of 11 (7, 18) months. PFS was significantly different in those with higher and lower baseline LDH levels (χ2=6.790, P=0.009) . OS was also significantly different in those with higher and lower baseline LDH levels (χ2=12.327, P<0.001) . The baseline LDH〔HR=2.686, 95%CI (1.274, 5.664) , P=0.009〕was associated with the PFS after immuotherapy. And the multivariate analyses showed that baseline LDH〔HR=17.440, 95%CI (2.254, 134.962) , P=0.001〕, hemoglobin〔HR=0.005, 95%CI (<0.001, 0.120) , P=0.001〕, monocyte count〔HR=0.066, 95%CI (0.008, 0.525) , P=0.010〕were associated with the OS after immunotherapy (P<0.05) .

Conclusion

Baseline LDH may be used as a prognostic marker after immunotherapy in patients with advanced ESCC, and a lower baseline LDH may be associated with longer PFS and OS.

Key words: Esophageal neoplasms, Esophageal squamous cell carcinoma, Immunotherapy, Programmed death -1, Lactate dehydrogenases, Clinical reaction, Prognosis, Progress-free survival, Overall survival

摘要:

背景

仅有少量晚期食管鳞状细胞癌(ESCC)患者可从免疫治疗中获益,总体疗效不令人满意。因此,选择有效的预后观察指标十分重要。

目的

探讨乳酸脱氢酶(LDH)预测晚期ESCC患者免疫治疗的预后价值。

方法

选取2016年10月至2019年10月在河南省肿瘤医院经病理及影像学检查确诊为晚期ESCC患者为研究对象。从医院电子病历系统中回顾性收集患者基线资料,并收集患者免疫治疗第8周LDH水平。随访截至2021-08-31,记录随访结果。观察死亡情况、患者疾病缓解情况,并记录无进展生存期(PFS)和总生存期(OS)。采用Kaplan-Meier法绘制不同基线LDH水平患者PFS、OS生存曲线以进行生存分析,生存曲线的比较采用Log-rank检验;采用多因素Cox比例风险回归分析探究晚期ESCC患者免疫治疗PFS、OS的影响因素。

结果

44例患者中基线LDH低水平(基线LDH<200 U/L)者28例,基线LDH高水平(基线LDH≥200 U/L)者16例。基线LDH低水平的患者客观缓解率(ORR)高于基线LDH高水平患者(χ2=8.522,P=0.013)。44例患者中病情进展(PD)8例,无PD患者36例。PD患者?LDH(治疗过程中LDH的变化)高于无PD患者(t=2.394,P=0.021)。截至2021-08-31,9例(20.5%)患者存活;中位PFS为6(2,11)个月;中位OS为11(7,18)个月。基线LDH低水平与基线LDH高水平患者PFS、OS比较,差异均有统计学意义(χ2值分别为6.790、12.327,P值分别为0.009、<0.001)。多因素Cox比例风险回归分析结果显示,基线LDH水平是晚期ESCC患者免疫治疗后PFS的影响因素〔HR=2.686,95%CI(1.274,5.664),P=0.009〕;基线LDH水平〔HR=17.440,95%CI(2.254,134.962),P=0.001〕、血红蛋白〔HR=0.005,95%CI(<0.001,0.120),P=0.001〕、单核细胞计数〔HR=0.066,95%CI(0.008,0.525),P=0.010〕是晚期ESCC患者免疫治疗后OS的影响因素。

结论

基线LDH可作为晚期ESCC患者免疫治疗预后的预测指标,且基线LDH低水平者有更好的PFS及OS。

关键词: 食管肿瘤, 食管鳞状细胞癌, 免疫治疗, 程序性细胞死亡蛋白1, 乳酸脱氢酶类, 临床反应, 预后, 无进展生存期, 总生存期