10.6084/m9.figshare.4557664.v1 Fausto Petrelli Fausto Petrelli Mary Cabiddu Mary Cabiddu Andrea Coinu Andrea Coinu Karen Borgonovo Karen Borgonovo Mara Ghilardi Mara Ghilardi Veronica Lonati Veronica Lonati Sandro Barni Sandro Barni Prognostic role of lactate dehydrogenase in solid tumors: A systematic review and meta-analysis of 76 studies Taylor & Francis Group 2017 serum level 22 882 patients disease-free survival Seventy-six studies hematological malignancies lactate production OS cancer cells serum LDH random-effect modeling Pooled HRs prognostic value 73 studies Prognostic role Lactate dehydrogenase CSS cancer-specific survival prognostic effect tumor cell carcinomas lactate dehydrogenase form lactate CI DFS metastatic carcinomas outcome 76 studies Background serum LDH level LDH levels lung cancers prognostic biomarker energy source hazard ratio PFS 2017-01-17 09:36:34 Journal contribution https://tandf.figshare.com/articles/journal_contribution/Prognostic_role_of_lactate_dehydrogenase_in_solid_tumors_A_systematic_review_and_meta-analysis_of_76_studies/4557664 <p><b>Background.</b> In cancer cells, metabolism is shifted to aerobic glycolysis with lactate production coupled with a higher uptake of glucose as the main energy source. Lactate dehydrogenase (LDH) catalyzes the reduction of pyruvate to form lactate, and serum level is often raised in aggressive cancer and hematological malignancies. We have assessed the prognostic value of LDH in solid tumors.</p> <p><b>Material and methods.</b> A systematic review of electronic databases was conducted to identify publications exploring the association of LDH with clinical outcome in solid tumors. Overall survival (OS) was the primary outcome, and cancer-specific survival (CSS), progression-free survival (PFS), and disease-free survival (DFS) were secondary outcomes. Data from studies reporting a hazard ratio (HR) and 95% confidence interval (CI) were pooled in a meta-analysis. Pooled HRs were computed and weighted using generic inverse-variance and random-effect modeling. All statistical tests were two-sided.</p> <p><b>Results.</b> Seventy-six studies comprising 22 882 patients, mainly with advanced disease, were included in the analysis. Median cut-off of serum LDH was 245 U/L. Overall, higher LDH levels were associated with a HR for OS of 1.7 (95% CI 1.62–1.79; p < 0.00001) in 73 studies. The prognostic effect was highest in renal cell, melanoma, gastric, prostate, nasopharyngeal and lung cancers (all p < 0.00001). HRs for PFS was 1.75 (all p < 0.0001).</p> <p><b>Conclusions.</b> A high serum LDH level is associated with a poor survival in solid tumors, in particular melanoma, prostate and renal cell carcinomas, and can be used as a useful and inexpensive prognostic biomarker in metastatic carcinomas.</p>