PRETREATMENT SERUM LACTATE-DEHYDROGENASE AS ADDITIONAL STAGING PARAMETER IN PATIENTS WITH SMALL-CELL LUNG-CARCINOMA

At present the standard staging procedure in patients with small-cell lung cancer (SCLC) is extensive, expensive and time-consuming. Further more, the predictive and prognostic value of the current staging syste m is poor. To determine the value of pretreatment clinical and biochem ical parameters to predict tumour stage and to assess prognosis, a ret rospective study was performed of 121 consecutive patients with newly diagnosed SCLC. Methods: On the basis of routine diagnostic procedures , 51 patients were staged as having limited disease and 70 patients as having extensive disease. During follow-up, data on tumour progressio n and survival were gathered. These data and the tumour stage were cor related with lactate dehydrogenase (LDH), alkaline phosphatase, liver enzymes, leucocyte count, protein, albumin, calcium, age and gender. R esults: Follow-up ranged from 1 week to 96 months, during which 110 pa tients died. In all patients with LDH levels above 400 U/l n = 31), me tastases were found at the initial stage, whereas all patients initial ly staged as having limited disease and LDH levels above 240 U/l showe d tumour progression. Bone and liver were found to be the most commonl y involved sites, whereas the incidence of brain metastases increased during followup. In patients initially staged as having limited diseas e, no differences in survival were found between those showing local r ecurrence and those developing metastases during follow-up (P = 0.67), Compared to the patients initially staged as having extensive disease , the survival of both groups was significantly better (P < 0.001). Si gnificant independent variables of survival were LDH, albumin, initial stage and gender, but LDH was the best overall predictor (P < 0.001). Conclusion: These results suggest that pretreatment LDH may be used a s an additional staging parameter in SCLC, which can identify prognost ic subgroups before treatment.