Deciphering the potential of the lactate dehydrogenase-to-albumin ratio as a prognostic biomarker in malignancy: a systematic review and meta-analysis.

Background: Recent studies have indicated that the pretreatment lactate dehydrogenase (LDH)-to-albumin ratio (LAR) serves as a comprehensive prognostic biomarker. However, no comprehensive meta-analysis that assesses its prognostic role in various malignancies has been conducted. This study aimed to summarize the current evidence on the prognostic value of the LAR in patients with malignancies.

Method: A systematic literature search was conducted before 1 October 2024 in six databases. Quantitative analysis with random-effect meta-analysis was employed for generating the pooled estimates of survival outcomes (overall, progression-free, disease-free, and relapse-free survivals [OS, PFS, DFS, and RFS, respectively]).

Results: A meta-analysis of 19 retrospective studies encompassing 11,088 patients with cancer demonstrated the significant association between a high LAR and poorer OS (hazard ratio [HR] = 1.67 [1.37-2.05], I² = 84%). Patients with solid tumors exhibited a significantly higher risk of poorer OS and PFS (HR = 1.73 [1.44-2.06], I² = 84%; HR = 1.43 [1.11-1.84], I² = 75%). Subgroup analysis revealed that digestive system tumors were associated with an increased risk of poor OS (HR = 2.15), including oral cancer (HR = 5.14), esophageal carcinoma (HR = 1.85), hepatocellular carcinoma (HR = 1.90), and colorectal cancer (HR = 2.12). Furthermore, nasopharyngeal carcinoma was associated with poorer OS and PFS (HR = 1.62 [1.36-1.92]; HR = 1.60 [1.20-2.14], I² < 50%).

Conclusion: This study demonstrated the significant association between an elevated pretreatment LAR and poorer survival outcomes in malignancies, particularly in solid and digestive system tumors. These findings support the LAR as a potential prognostic biomarker, warranting further validation in diverse populations with standardized cutoff values.