Lactate Dehydrogenase-Derived Indices and Prognosis in Patients with Resectable Gastric Cancer

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Introduction: Robust methodologies for risk stratification remain necessary for gastric cancer (GC). We investigated the prognostic significance of preoperative lactate dehydrogenase (LDH) and two LDH-based indices, the LDH-to-lymphocyte ratio (LLR) and LDH-to-albumin ratio (LAR), in patients undergoing curative resection for GC.

Methods: We retrospectively reviewed the medical records of 225 consecutive patients with GC who underwent R0 surgical resection. The prognostic value of preoperative LDH, LLR, and LAR was assessed using time-dependent receiver operating characteristic curves and Cox proportional hazards regression. Optimal cut-off values were determined with X-tile software.

Results: The median follow-up period was 61 months. The areas under the curves for predicting overall survival (OS) and relapse-free survival (RFS) were notably higher for LLR and LAR as compared to LDH alone. In univariate Cox analyses, both LLR and LAR were significantly associated with OS and RFS, whereas LDH was not. In multivariate analyses, LLR and LAR remained independent predictors of OS (high LLR: hazard ratio [HR] 2.66, 95% confidence interval [CI] 1.34-5.28, p = 0.005; high LAR: HR 2.61, 95% CI 1.45-4.71, p = 0.001). Similarly, both indices retained independent prognostic significance for RFS (high LLR: HR 2.22, 95% CI 1.14-4.31, p = 0.019; high LAR: HR 2.65, 95% CI 1.49-4.72, p < 0.001).

Conclusions: Preoperative LLR and LAR are independent prognostic indicators for OS and RFS in patients with resectable GC. These indices may facilitate early identification of high-risk patients and support individualized treatment strategies.