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. 2025 Mar 18;25(1):496.
doi: 10.1186/s12885-025-13889-4.

LDH and hemoglobin outperform systemic inflammatory indices as prognostic factors in patients with soft tissue sarcoma undergoing neoadjuvant treatment

Luc M Berclaz  1   2 , Dorit Di Gioia  3 , Vindi Jurinovic  3   4 , Michael Völkl  3 , Sinan E Güler  3 , Markus Albertsmeier  5 , Alexander Klein  6 , Hans Roland Dürr  6 , Sina Mansoorian  7 , Thomas Knösel  8 , Wolfgang G Kunz  9 , Michael von Bergwelt-Baildon  3   10 , Lars H Lindner  3 , Anton Burkhard-Meier  3
Affiliations

LDH and hemoglobin outperform systemic inflammatory indices as prognostic factors in patients with soft tissue sarcoma undergoing neoadjuvant treatment

Luc M Berclaz et al. BMC Cancer. .

Abstract

Background: The current understanding of the prognostic value of routine pre-treatment laboratory parameters in patients with high-risk soft tissue sarcoma (HR-STS) is limited. We sought to analyze several inflammatory biomarkers in a large cohort of HR-STS patients undergoing neoadjuvant therapy followed by curative surgical resection.

Methods: 123 patients with locally advanced high-risk undifferentiated pleomorphic sarcoma (UPS), liposarcoma (LPS), leiomyosarcoma (LMS), and synovial sarcoma (SS) who underwent preoperative chemotherapy and regional hyperthermia (RHT) between 2014 and 2022 were retrospectively evaluated. The association of several pre-treatment laboratory parameters with radiologic treatment response, event-free survival (EFS), and overall survival (OS), were analyzed.

Results: Low pre-treatment hemoglobin (HR 2.51, p = 0.018; HR 2.78, p = 0.030) and lactate dehydrogenase (LDH, HR 0.29, p = 0.0044; HR 0.23, p = 0.010) were significantly associated with EFS and OS in the multivariable analysis. Systemic inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR) did not have a significant impact on survival. Low C-reactive protein (CRP) and high albumin values were associated with poor radiologic response according to RECIST (p = 0.021 and p = 0.010, respectively).

Conclusion: Pre-treatment LDH and hemoglobin are strong independent predictors of survival in HR-STS patients. Systemic inflammatory indices based on circulating immune cells may not serve as reliable prognostic factors for HR-STS patients undergoing curative-intent treatment. Higher pre-treatment albumin levels and lower CRP values may reflect a reduced inflammatory status and could be associated with a poorer radiologic response to preoperative treatment.

Keywords: Chemotherapy; Hemoglobin; LDH; Regional hyperthermia; Soft tissue sarcoma; Systemic inflammatory index.

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Conflict of interest statement

Declarations. Ethics approval: The study was carried out in compliance with the Declaration of Helsinki. The Internal Review Board and the Ethical Review Committee at the Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany, approved the protocol of this research project (Protocol Nr. 24–0976). Consent to participate: The need for informed consent was waived for this study by the Internal Review Board and the Ethical Review Committee at the Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany, due to its retrospective design and irreversible anonymization of all data (Protocol Nr. 24–0976). Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests. Disclosures: All co-authors have no relevant disclosures regarding this publication.

Figures

Fig. 1
Fig. 1
Event-free survival (EFS) and overall survival (OS) according to hemoglobin (a) and lactate dehydrogenase (LDH; b) levels
See this image and copyright information in PMC

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References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2020. 10.3322/caac.21590. - PubMed
    1. Callegaro D, Miceli R, Bonvalot S, et al. Development and external validation of two nomograms to predict overall survival and occurrence of distant metastases in adults after surgical resection of localised soft-tissue sarcomas of the extremities: a retrospective analysis. Lancet Oncol. 2016;17(5):671–80. 10.1016/S1470-2045(16)00010-3. - PubMed
    1. Kane JM, Magliocco A, Zhang Q, et al. Correlation of High-Risk soft tissue sarcoma biomarker expression patterns with outcome following neoadjuvant chemoradiation. Sarcoma. 2018. 10.1155/2018/8310950. - PMC - PubMed
    1. Judson I, Verweij J, Gelderblom H, et al. Doxorubicin alone versus intensified doxorubicin plus Ifosfamide for first-line treatment of advanced or metastatic soft-tissue sarcoma: A randomised controlled phase 3 trial. Lancet Oncol. 2014. 10.1016/S1470-2045(14)70063-4. - PubMed
    1. Gronchi A, Miah AB, Dei Tos AP, et al. Soft tissue and visceral sarcomas: ESMO–EURACAN–GENTURIS clinical practice guidelines for diagnosis, treatment and follow-up☆. Ann Oncol. 2021. 10.1016/j.annonc.2021.07.006. - PubMed