Utilizing the Lactate Dehydrogenase-to-Albumin Ratio for Survival Prediction in Patients with Bladder Cancer After Radical Cystectomy

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Abstract

Purpose

Previous studies have suggested that the preoperative lactate dehydrogenase-to-albumin ratio (LAR) is correlated with survival in several cancers except bladder cancer (BCa). This study aimed to determine the prognostic value of the LAR in patients with urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC).

Patients and Methods

A total of 595 UCB patients with RC in West China Hospital from December 2010 to May 2020 were enrolled. A receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of the LAR. Kaplan–Meier curves and Cox regression analyses were applied to evaluate the association of the LAR with overall survival (OS) and recurrence-free survival. Independent factors in multivariate analyses were selected to construct nomograms. Calibration curves, ROC curves, concordance index (C-index) and decision curve analyses were used to evaluate the performance of the nomograms.

Results

The optimal cutoff value of the LAR was determined to be 3.8. Preoperative low LAR was associated with decreased OS (P < 0.001) and RFS (P < 0.001), especially in patients with ≥ pT2 disease. LAR was an independent factor for OS (hazard ratio [HR]: 1.719; P <0.001) and RFS (HR: 1.429; P = 0.012). The addition of the LAR into nomograms could result in better prediction performance. The areas under the curves of the nomograms were 0.821 and 0.801 for the prediction of 3-year OS and RFS, respectively. The C-indexes of the nomograms were 0.760 and 0.741 for the prediction of OS and RFS, respectively.

Conclusion

The preoperative LAR is a novel and reliable independent prognostic biomarker for survival in UCB after RC.

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Most cited references 38

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Cancer statistics, 2022

Rebecca Siegel, Kimberly D Miller, Hannah Fuchs … (2022)

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes. Incidence data (through 2018) were collected by the Surveillance, Epidemiology, and End Results program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2019) were collected by the National Center for Health Statistics. In 2022, 1,918,030 new cancer cases and 609,360 cancer deaths are projected to occur in the United States, including approximately 350 deaths per day from lung cancer, the leading cause of cancer death. Incidence during 2014 through 2018 continued a slow increase for female breast cancer (by 0.5% annually) and remained stable for prostate cancer, despite a 4% to 6% annual increase for advanced disease since 2011. Consequently, the proportion of prostate cancer diagnosed at a distant stage increased from 3.9% to 8.2% over the past decade. In contrast, lung cancer incidence continued to decline steeply for advanced disease while rates for localized-stage increased suddenly by 4.5% annually, contributing to gains both in the proportion of localized-stage diagnoses (from 17% in 2004 to 28% in 2018) and 3-year relative survival (from 21% to 31%). Mortality patterns reflect incidence trends, with declines accelerating for lung cancer, slowing for breast cancer, and stabilizing for prostate cancer. In summary, progress has stagnated for breast and prostate cancers but strengthened for lung cancer, coinciding with changes in medical practice related to cancer screening and/or treatment. More targeted cancer control interventions and investment in improved early detection and treatment would facilitate reductions in cancer mortality.

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Hallmarks of Cancer: New Dimensions

Douglas Hanahan (2022)

The hallmarks of cancer conceptualization is a heuristic tool for distilling the vast complexity of cancer phenotypes and genotypes into a provisional set of underlying principles. As knowledge of cancer mechanisms has progressed, other facets of the disease have emerged as potential refinements. Herein, the prospect is raised that phenotypic plasticity and disrupted differentiation is a discrete hallmark capability, and that nonmutational epigenetic reprogramming and polymorphic microbiomes both constitute distinctive enabling characteristics that facilitate the acquisition of hallmark capabilities. Additionally, senescent cells, of varying origins, may be added to the roster of functionally important cell types in the tumor microenvironment. SIGNIFICANCE: Cancer is daunting in the breadth and scope of its diversity, spanning genetics, cell and tissue biology, pathology, and response to therapy. Ever more powerful experimental and computational tools and technologies are providing an avalanche of "big data" about the myriad manifestations of the diseases that cancer encompasses. The integrative concept embodied in the hallmarks of cancer is helping to distill this complexity into an increasingly logical science, and the provisional new dimensions presented in this perspective may add value to that endeavor, to more fully understand mechanisms of cancer development and malignant progression, and apply that knowledge to cancer medicine.

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The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging.

Mahul B Amin, Frederick Greene, Stephen Edge … (2017)

The American Joint Committee on Cancer (AJCC) staging manual has become the benchmark for classifying patients with cancer, defining prognosis, and determining the best treatment approaches. Many view the primary role of the tumor, lymph node, metastasis (TNM) system as that of a standardized classification system for evaluating cancer at a population level in terms of the extent of disease, both at initial presentation and after surgical treatment, and the overall impact of improvements in cancer treatment. The rapid evolution of knowledge in cancer biology and the discovery and validation of biologic factors that predict cancer outcome and response to treatment with better accuracy have led some cancer experts to question the utility of a TNM-based approach in clinical care at an individualized patient level. In the Eighth Edition of the AJCC Cancer Staging Manual, the goal of including relevant, nonanatomic (including molecular) factors has been foremost, although changes are made only when there is strong evidence for inclusion. The editorial board viewed this iteration as a proactive effort to continue to build the important bridge from a "population-based" to a more "personalized" approach to patient classification, one that forms the conceptual framework and foundation of cancer staging in the era of precision molecular oncology. The AJCC promulgates best staging practices through each new edition in an effort to provide cancer care providers with a powerful, knowledge-based resource for the battle against cancer. In this commentary, the authors highlight the overall organizational and structural changes as well as "what's new" in the Eighth Edition. It is hoped that this information will provide the reader with a better understanding of the rationale behind the aggregate proposed changes and the exciting developments in the upcoming edition. CA Cancer J Clin 2017;67:93-99. © 2017 American Cancer Society.

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Author and article information

Journal

Journal ID (nlm-ta): J Inflamm Res

Journal ID (iso-abbrev): J Inflamm Res

Journal ID (publisher-id): jir

Title: Journal of Inflammation Research

Publisher: Dove

ISSN (Electronic): 1178-7031

Publication date (Electronic): 18 April 2023

Publication date Collection: 2023

Volume: 16

Pages: 1733-1744

Affiliations

[1 ]Department of Urology, West China Hospital, Sichuan University , Sichuan, People’s Republic of China

[2 ]Institute of Urology, West China Hospital, Sichuan University , Sichuan, People’s Republic of China

Author notes

Correspondence: Ping Tan; Lu Yang, Department of Urology, West China Hospital, Sichuan University , Sichuan, People’s Republic of China, Tel +86 18980606829; +86 15208212056, Email uro_tanping@163.com; wycleflue@scu.edu.cn

[*]

These authors contributed equally to this work

Author information

Tianhai Lin http://orcid.org/0000-0003-0954-3282

Jianzhong Ai http://orcid.org/0000-0003-0617-9286

Qiang Wei http://orcid.org/0000-0003-3750-3042

Article

Publisher ID: 384338

DOI: 10.2147/JIR.S384338

PMC ID: 10122464

PubMed ID: 37096127

SO-VID: b697d402-9f1c-4001-8305-e6fde2021495

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 06 August 2022

Date accepted : 18 January 2023

Page count

Figures: 3, Tables: 4, References: 38, Pages: 12

Funding

Funded by: the National Natural Science Foundation of China;

Funded by: Science & Technology Department of Sichuan Province, China;

Funded by: Science and Technology Department of Sichuan Province, open-funder-registry 10.13039/501100004829;

Funded by: Young Investigator Award of Sichuan University 2017;

Funded by: Sichuan University--Panzhihua science and technology cooperation special fund;

Funded by: China Postdoctoral Science Foundation, open-funder-registry 10.13039/501100002858;

Funded by: PostDoctor Research Project of West China Hospital of Sichuan University;

This work was supported by grants from the National Natural Science Foundation of China (82070784, 81702536) to J. A., a grant from Science & Technology Department of Sichuan Province, China (2022JDRC0040) to J. A., grants from The National Natural Science Foundation of China (Grant Nos. 81974099, 82170785) to L.Y., a grant from Science and Technology Department of Sichuan Province (Grant Nos. 2021YFH0172) to L.Y., a grant from Young Investigator Award of Sichuan University 2017 (Grant No. 2017SCU04A17) to L.Y., a grant from Sichuan University--Panzhihua science and technology cooperation special fund (2020CDPZH-4) to L.Y., grants from The National Natural Science Foundation of China (Grant Nos. 81974099, 82170785) to Q.W. China Postdoctoral Science Foundation (2021M692306; 2022T150455) and PostDoctor Research Project of West China Hospital of Sichuan University (2021HXBH025) to X.Z.

Utilizing the Lactate Dehydrogenase-to-Albumin Ratio for Survival Prediction in Patients with Bladder Cancer After Radical Cystectomy

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Abstract

Purpose

Patients and Methods

Results

Conclusion

Related collections

Cancer Immunotherapy

Most cited references 38

Cancer statistics, 2022

Hallmarks of Cancer: New Dimensions

The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging.

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