JMIR Publications

ABSTRACT

Background:

Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape of advanced esophageal squamous cell carcinoma (ESCC). However, treatment response varies.

Objective:

This study investigates the prognostic value of dynamic lactate dehydrogenase (LDH) changes during ICI therapy in predicting treatment outcomes.

Methods:

We retrospectively analyzed clinical data from 126 patients with advanced ESCC treated with first-line ICIs. Serum LDH levels were measured after every two cycles of combined immunotherapy and chemotherapy. Receiver Operating Characteristic curve analysis determined the optimal LDH reduction threshold. Kaplan-Meier survival curves and Cox regression models assessed progression-free survival (PFS) and overall survival (OS).

Results:

A reduction in LDH following first-line ICI therapy was associated with improved outcomes compared to LDH increases (median PFS: 9.5 vs. 5.4 months, p = 0.004). Patients exhibiting an LDH decrease of > 14.4% had a median PFS of 10.7 months, while those with reductions of 0-14.4% had 9.4 months and patients with LDH increases had 5.4 months. Significant PFS improvement was observed in patients with LDH reductions after two cycles of immunotherapy (p < 0.01). Multivariate analysis identified LDH reduction as an independent predictor of a 41% lower mortality risk (OR: 0.59, 95% CI: 0.36–0.96, p = 0.035).

Conclusions:

Dynamic LDH changes serve as a critical prognostic marker for PFS in advanced ESCC. LDH reductions >14.4% following ICI therapy correlate with significantly better outcomes. Patients with LDH reductions after two cycles of immunotherapy exhibited improved prognoses. All highlight LDH as a valuable biomarker for guiding personalizing treatment strategies in advanced ESCC.