Received: 20 October 2016 Accepted: 14 January 2017 Published on: 8 March 2017
Pre-treatment serum lactate dehydrogenase as a biomarker in
small cell lung cancer
Amy Hsin-Chieh Hsieh
Department of Medical Oncology, Flinders
Medical Centre, Adelaide, South Australia,
Flinders Centre for Innovation in Cancer,
Flinders University, Adelaide, South Australia,
Centre for Population Health Research, School
of Health Sciences, University of South Aus-
tralia, North Terrace, Adelaide, South Australia,
Amy Hsin-Chieh Hsieh, Department of Medical
Oncology, Flinders Medical Centre, Bedford
Park, Adelaide, SA 5042, Australia.
Background: Small cell lung cancer is a rapidly progressive disease with high fatality. No sensitive
and specific biomarker to assist in managing this disease exists currently.
Aim: Role of pretreatment serum lactate dehydrogenase as a biomarker in small cell lung cancer.
Methods: A hospital-based cancer registry was used to identify eligible patients from 1999 to
2009. Demographic data, lactate dehydrogenase level and clinical outcome of patients were col-
lected for analysis.
Results: One hundred and sixty-eight patients were identified: 61% (n = 103) males and 39%
(n = 65) females. Majority had extensive stage (67%). High lactate dehydrogenase (≥230 U/L)
was present in 60.4% (n = 75); mean reading 260 U/L (range 148–898 U/L) in limited stage and
470 U/L (range 116–5462 U/L) in extensive stage. Extensive stage patients with high lactate
dehydrogenase had lower treatment response rate compared to those with normal lactate dehy-
drogenase (39% vs 79%, P = 0.002); no difference in treatment response was seen among patients
with limited stage. High lactate dehydrogenase conferred a worse survival; mean overall survivals
in limited and extensive stage were 8.0 and 5.2 months, respectively, in patients with elevated
lactate dehydrogenase. Those with normal lactate dehydrogenase had an overall survival of 16.5
and 8.2 months, respectively. The association remained significant after adjustment for age, sex
and treatment (HR 1.8, 95% CI 1.16–2.80, P = 0.009).
Conclusion: High pretreatment lactate dehydrogenase is a prognostic marker of survival in both
stages of small cell lung cancer. It is also a predictive marker of response to therapy in extensive
stage. Larger prospective studies to validate our findings would be beneficial.
lactate hydrogenase, lung cancer, prognostic marker, small cell, survival
Lung cancer is a major cause for cancer-related death globally.
Although small cell lung cancer (SCLC) accounts for only 15% of all lung
cancers, it is a rapidly progressive and often fatal form of lung cancer.
Traditionally, the Veterans Administration Lung Cancer Study Group
staging system was used to categorize SCLC into two stages; limited
stage (LS), defined as any tumor that can be encompassed within one
radiation field or is limited to a single hemithorax, while extensive
stage (ES) is defined as any disease extending beyond the extent of
Cure in SCLC is possible only in a small proportion of patients
with median survival in LS ranging from 16 to 24 months.
parison, patients with ES-SCLC, the survival rate is much poorer and
is in the order of 6–12 months with palliative chemotherapy (CT).
There has been little advancement in new therapies for this group of
Currently, there are no well-established biomarkers available in
SCLC that could be used as a surrogate marker to determine the
likelihood of survival outcome and treatment response to potential
life-extending therapies in SCLC. High serum lactate dehydrogenase
2017 John Wiley & Sons Australia, Ltd Asia-Pac J Clin Oncol. 2018;14:e64–e70.wileyonlinelibrary.com/journal/ajco