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. 2012 Apr;31(4):197-206.
doi: 10.5732/cjc.011.10283. Epub 2012 Jan 9.

Increased pretreatment levels of serum LDH and ALP as poor prognostic factors for nasopharyngeal carcinoma

Guo Li  1 , Jin Gao, Ya-Lan Tao, Bing-Qing Xu, Zi-Wei Tu, Zhi-Gang Liu, Mu-Sheng Zeng, Yun-Fei Xia
Affiliations

Increased pretreatment levels of serum LDH and ALP as poor prognostic factors for nasopharyngeal carcinoma

Guo Li et al. Chin J Cancer. 2012 Apr.

Abstract

Serum enzymes that play potential roles in tumor growth have recently been reported to have prognostic relevance in a diverse array of tumors. However, prognosis-related serum enzymes are rarely reported for nasopharyngeal carcinoma(NPC). To clarify whether the level of serum enzymes is linked to the prognosis of NPC, we reviewed the pretreatment data of lactate dehydrogenase(LDH), alkaline phosphatase (ALP), and glutamyl transferase (GGT) in 533 newly diagnosed NPC patients who underwent radical radiotherapy between May 2002 and October 2003 at Sun Yat-sen University Cancer Center. Patients were grouped according to the upper limit of normal values of LDH, ALP, and GGT. The Kaplan-Meier method and log-rank test were used for selecting prognostic factors from clinical characteristics and serum enzymes, and the chi-square test was applied to analyze the relationships of clinical characteristics and serum enzymes. Finally, a Cox proportional hazards model was used to identify the independent prognostic factors. We found that increased levels of LDH had poor effects on both overall survival and distant metastasis-free survival (P = 0.009 and 0.035, respectively), and increased pretreatment level of serum ALP had poor effects on both overall survival and local recurrence-free survival (P = 0.037 and 0.039, respectively). In multivariate analysis, increased LDH level was identified as an independent prognostic factor for overall survival. Therefore, we conclude that increased pretreatment serum LDH and ALP levels are poor prognostic factors for NPC.

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Figures

Figure 1.
Figure 1.. Overall survival (OS), distant metastasis-free survival (DMFS), and local recurrence-free survival (LRFS) curves of 533 nasopharyngeal carcinoma (NPC) patients with different pretreatment levels of lactate dehydrogenase (LDH).
A, the 5-year OS rates were 57% in the increased LDH level group and 75% in the normal LDH level group (χ2 = 6.908, P = 0.009). B, the 5-year DMFS rates were 76% in the increased LDH level group and 86% in the normal LDH level group (χ2 = 4.450, P = 0.035). C, the 5-year LRFS rates were 84% in the increased LDH level group and 90% in the normal LDH level group (χ2 = 1.558, P = 0.212).
Figure 2.
Figure 2.. OS, LRFS, and DMFS curves of 533 NPC patients with different pretreatment levels of alkaline phosphatase (ALP).
A, the 5-year OS rates were 65% in the increased ALP level group and 74% in the normal ALP level group (χ2 = 4.329, P = 0.037). B, the 5-year LRFS rates were 79% in the increased ALP level group and 90% in the normal ALP level group (χ2 = 4.274, P = 0.039). C, the 5-year DMFS rates were 89% in the increased ALP level group and 85% in the normal ALP level group (χ2 = 0.382, P = 0.537).
Figure 3.
Figure 3.. OS, LRFS, and DMFS curves of 533 NPC patients with different pretreatment levels of glutamyl transferase (GGT).
A, the 5-year OS rates were 71% in the increased GGT level group and 73% in the normal GGT level group (χ2 = 0.555, P = 0.456). B, the 5-year LRFS rates were 90% in the increased GGT level group and 89% in the normal GGT level group (χ2 = 0.103, P = 0.748). C, the 5-year DMFS rates were 86% in the increased GGT level group and 85% in the normal GGT level group (χ2 = 0.024, P = 0.877).
Figure 4.
Figure 4.. The relationships between the incidence of higher level of LDH and AJCC N category and between the incidence of higher level of ALP and AJCC T category.
A, the incidence of higher LDH levels (> 240 U/L) was increased in patients with N stage pregression (P = 0.036); B, the incidence of higher ALP levels (> 110 U/L) was increased in patients with T stage pregression(P < 0.001).
Figure 5.
Figure 5.. OS and DMFS curves of N0–1 NPC patients with different pretreatment levels of LDH.
A, 5-year OS rates were 43% in the increased LDH level group and 78% in the normal LDH level group (χ2 = 21.615, P < 0.001). B, 5-year DMFS rates were 68% in the increased LDH level group and 88% in the normal LDH level group (χ2 = 11.023, P = 0.001).
Figure 6.
Figure 6.. OS and LRFS curves of T3–4 NPC patients with different pretreatment levels of ALP.
A, 5-year OS rates were 69% in the increased ALP level group and 87% in the normal ALP level group (χ2 = 3.003, P = 0.083). B, 5-year LRFS rates were 55% in the increased ALP level group and 68% in the normal ALP level group (χ2 = 5.261, P = 0.022).
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