Prognostic Value of Lactate Dehydrogenase in Metastatic Prostate Cancer: A Systematic Review and Meta-analysis |
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| Affiliation: | 1. Department of Urology, Medical University of Vienna, Vienna, Austria;2. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan;3. Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Teheran, Iran;4. Department of Urology, Medical University of Hamburg, Hamburg, Germany;5. Research Center for Evidence-based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran;6. Department of Urology, Weill Cornell Medical College, New York, NY;7. Department of Urology, University of Texas Southwestern, Dallas, TX;8. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria;9. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic;10. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;1. Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel;2. Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel;1. Bladder Section, Urology Department, Hospital Ramón y Cajal, Madrid, Spain;2. Bristol Urological Institute, Southmead Hospital, Bristol, UK;3. Functional, Female and Urodynamic Section, Urology Department, Hospital Rey Juan Carlos, Madrid, Spain;4. Videourodynamics Unit, Neuro-Urology Department, Moinhos de Vento Hospital, Porto Alegre, Brazil;5. Urology Department, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain;6. Department of Surgery, Universidad de La Laguna, Tenerife, Spain;7. Medical School, Sorbonne Université, Academic Hospital Pitié-Salpêtrière, Paris, France;8. Hospital São João and Faculty of Medicine of Porto, Porto, Portugal;9. Vanderbilt University Medical Center, Nashville, TN, USA;10. Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy;11. Research Center for Evidence Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran;12. Department of Urology, Radboudumc, Nijmegen, The Netherlands;13. Urology Department, Moscow State University of Medicine and Dentistry, Spasokukotsky Moscow City Hospital, Moscow, Russia;14. Department of Urology, Marmara University School of Medicine and Department of Urology, Koç University School of Medicine, Istanbul, Turkey;15. Department of Urology, University of Rennes, Rennes, France;p. Department of Urology, Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá, Colombia;q. Urology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium;r. Functional and Reconstructive Urology Section, Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain;1. Gynecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, France;2. Methodology and Biostatistics Unit, EA2694, UDSL2, University Lille Nord de France, University Hospital of Lille, France;1. Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;2. Kingston Health Sciences Centre, Department of Oncology, Queen’s University, Kingston, Ontario, Canada;1. Department of Gynecology, Amersfoort, The Netherlands;2. Department of Science, Amersfoort, The Netherlands;3. Twente University, Faculty of Electrical Engineering, Mathematics and Computer Science, Institute of Technical Medicine, Enschede, The Netherlands;4. Department of Gynecologic Oncology, University Medical Center Utrecht, Utrecht, The Netherlands |
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| Abstract: | The purpose of this study was to assess the prognostic value of lactate dehydrogenase (LDH) in patients with metastatic prostate cancer (PC). A systematic review and meta-analysis was performed in March 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared patients with PC with high versus low LDH to determine the predictive value of LDH for overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). We performed a formal meta-analysis for both OS and PFS. A total of 59 articles with 14,851 patients were included in the systematic review and 45 studies with 12,224 patients for the qualitative assessment. High LDH was associated with both worse OS (pooled hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.75-2.44) and PFS (pooled HR, 1.08; 95% CI, 1.01-1.16). In subgroup analyses of both patients with castration-resistant prostate cancer (CRPC) and those with hormone-sensitive prostate cancer (HSPC), LDH was associated with OS (pooled HR, 2.02; 95% CI, 1.69-2.42 and pooled HR, 2.25; 95% CI, 1.78-2.84, respectively). In patients with CRPC, LDH was associated with OS in those treated with docetaxel systemic chemotherapy and androgen receptor–axis-targeting agents (pooled HR, 2.03; 95% CI, 1.37-3.00 and pooled HR, 1.79; 95% CI, 1.25-2.57, respectively). Elevated serum levels of LDH were associated with an increased risk of mortality and progression in patients with metastatic PC. LDH was independently associated with OS in both patients with CRPC and HSPC. LDH could be integrated into prognostic tools that help guide treatment strategy, thereby facilitating the shared decision-making process. |
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| Keywords: | Castration-resistant prostate cancer (CRPC) Hormone-sensitive prostate cancer (HSPC) Lactate dehydrogenase (LDH) Meta-analysis Metastatic prostate cancer |
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