Effect of Preoperative Serum Lactate Dehydrogenase-to-Albumin Ratio on the Survival of Oral Cancer: A Retrospective Study

Abstract

Background
Several studies have investigated the relationship between serum lactate dehydrogenase-to-albumin ratio (LAR) and the prognosis of cancers. However, no studies have explored the association between serum LAR and the survival of oral cancer (OC). This study was aimed to determine the association of serum LAR with the overall survival (OS) of OC.

Methods
One hundred and ninety patients with OC were included in this study between January 2018 and December 2019. Log rank test and Kaplan–Meier method were used to compare the survival rate of OC between the low LAR group and the high LAR group. The association between serum LAR and the survival of OC patients was determined via univariate and multivariate Cox regression analyses.

Results
Kaplan-Meier analysis and Log rank test indicated that the OS rate in low LAR group was significantly higher than that in high LAR group (P < 0.05). Univariate cox analysis showed that TNM III-IV stage, serum LDH > 162 U/L, and serum LAR > 3.79 were significantly associated with the OS of OC patients. Multivariate Cox analysis suggested that the TNM III-IV stage (HR, 2.317; 95% CI, 1.423–3.774, P = 0.001) and serum LAR > 3.79 (HR, 5.138; 95% CI, 2.245–11.756, P = 0.000) were independently related with poor OS of OC patients.

Conclusion
High serum LAR (>3.79) is an independent predictor of adverse prognosis in OC patients. LAR could be used as a promising marker for predicting the OS of OC patients.

Full text

ORIGINAL RESEARCH
Effect of Preoperative Serum Lactate
Dehydrogenase-to-Albumin Ratio on the Survival
of Oral Cancer: A Retrospective Study
Xuming Wang, Xiaoli Ji
Department of Stomatology, The Afliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, People’s Republic of China
Correspondence: Xiaoli Ji, Email jixiaoli214@163.com
Background: Several studies have investigated the relationship between serum lactate dehydrogenase-to-albumin ratio (LAR) and the
prognosis of cancers. However, no studies have explored the association between serum LAR and the survival of oral cancer (OC).
This study was aimed to determine the association of serum LAR with the overall survival (OS) of OC.
Methods: One hundred and ninety patients with OC were included in this study between January 2018 and December 2019. Log rank
test and Kaplan–Meier method were used to compare the survival rate of OC between the low LAR group and the high LAR group.
The association between serum LAR and the survival of OC patients was determined via univariate and multivariate Cox regression
analyses.
Results: Kaplan-Meier analysis and Log rank test indicated that the OS rate in low LAR group was signicantly higher than that in
high LAR group (P < 0.05). Univariate cox analysis showed that TNM III-IV stage, serum LDH > 162 U/L, and serum LAR > 3.79
were signicantly associated with the OS of OC patients. Multivariate Cox analysis suggested that the TNM III-IV stage (HR, 2.317;
95% CI, 1.423–3.774, P = 0.001) and serum LAR > 3.79 (HR, 5.138; 95% CI, 2.245–11.756, P = 0.000) were independently related
with poor OS of OC patients.
Conclusion: High serum LAR (>3.79) is an independent predictor of adverse prognosis in OC patients. LAR could be used as
a promising marker for predicting the OS of OC patients.
Keywords: oral cancer, lactate dehydrogenase to albumin ratio, prognosis, marker
Introduction
Oral cancer (OC) occurs commonly in middle-aged and elder people; however, it is also being reported in younger
individuals in recent years.
1,2
The OC ranks as the 6th most common malignancy in the world,
3
which is an issue of
global health burden. There are approximately 354,864 cases of oral cavity and lip cancer worldwide, with about 177,384
deaths every year.
4
Betel quid, diet and nutrition, mouthwash, alcohol, tobacco, occupational risks, and genetic factors
were associated with the risk of OC.
5
Despite advances in therapeutic methods,
6
the ve-year survival rate of OC is about
50%, which was not improved remarkably in recent years.
7
The poor prognosis of OC is mainly attributed to delayed
diagnosis and treatment. Therefore, early-stage diagnosis of OC is a crucial step in reducing its mortality rate.
8
It is
important to identify effective prognostic factors for OC patients to select suitable treatment regimens.
Lactate dehydrogenase (LDH), a key enzyme in the glycolytic pathway, could convert pyruvate to lactate. A meta-
analysis showed that high LDH was related to the adverse prognosis of many solid tumors.
9
Mafessoni et al found that
salivary LDH could help with the early diagnosis of OC in individuals with Fanconi anemia.
10
In addition, the serum
albumin (ALB) level could reect the individual’s the nutritional status. Previous studies indicated that low serum ALB
level was related with poor prognosis of different types of cancers,
11–13
including OC.
14,15
Thus, high LDH and low ALB
levels may be good predictors for the poor survival of OC patients. The serum LDH-to-ALB ratio (LAR), consisting of
LDH and ALB, may be more effective in predicting the survival of OC than each alone. Several studies showed that
Journal of Inammation Research 2024:17 5129–5138 5129
© 2024 Wang and Ji. 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).
Journal of Inflammation Research Dovepress
open access to scientific and medical research
Open Access Full Text Article
Received: 3 April 2024
Accepted: 16 July 2024
Published: 31 July 2024

serum LAR correlated with adverse survival in colorectal cancer (CRC),
16–19
bladder cancer,
20
breast cancer,
21
and non-
small cell lung cancer (NSCLC).
22
However, the relationship between serum LAR and the survival of OC has not been
investigated before. In this study, we determined to probe into the prognostic value of serum LAR in OC patients.
Patients and Methods
Patients and Data Collection
A total of 232 patients with OC were initially screened from January 2018 to December 2019. Finally, 190 cases were included
in this study. The inclusion criteria of OC cases were as follows: (1) diagnosis of OC was pathologically conrmed; (2) the
follow-up data and clinicopathologic characteristics were complete; (3) OC patients received surgical treatment. The
exclusion criteria were: (1) case had incomplete data; (2) cases refused to be included; (3) the pathological results were
contradictory to the clinical diagnosis of OC; (4) cases had other cancers. Figure 1 shows the ow chart of OC patient
selection. The study was approved by the Ethics Committee of the Afliated Huai’an No.1 People’s Hospital of Nanjing
Medical University, which was consistent with the Helsinki Declaration. All patients provided informed consent.
The demographic and clinical characteristics of OC patients were recorded. Age, sex, drinking, body mass index (BMI),
hypertension, smoking, tumor node metastasis (TNM) stage, diabetes mellitus, lymphatic and vascular invasion (LVI),
perineural invasion and anemia (PNI), serum ALB, and serum LDH were collected. The LAR was calculated as follows:
LAR = LDH (U/L) / ALB (g/L). All OC patients had their LAR calculated at the time of OC diagnosis in this study. All
relevant data were measured before treatments. All information was independently checked by two experienced clinicians.
Follow-Up
The follow-up of patients with OC was as follows: OC cases were recorded monthly in the rst half of the year after
treatment, and then twice a year thereafter. Different ways of follow-up (telephone, medical records, and outpatient/
inpatient) were used. The deadline time of follow-up was December 31, 2022. Overall survival (OS) was dened from
the time of diagnosis to the time of death due to any cause.
Figure 1 Flow chart of patient selection.
https://doi.org/10.2147/JIR.S472041
DovePress
Journal of Inammation Research 2024:17
5130
Wang and Ji Dovepress
Powered by TCPDF (www.tcpdf.org)

Statistical Analysis
Categorical data were shown as number (percentage), whereas continuous data were presented as median (range) or
means (± standard deviations). Chi-square test or Fisher’s exact test was used for analyzing categorical variables, while
the Student’s t-test or Mann–Whitney U-test was used for calculating continuous variables. The Kaplan–Meier method
and Log rank test were used to analyze survival rates among different groups. The risk factors associated with the
survival of OC patients were identied via univariate and multivariate Cox regression analyses. The variables with
P value <0.05 in univariate Cox analysis were selected into multivariate Cox analysis. Hazard ratios (HRs) and 95%
condence interval (CI) were calculated. P < 0.05 was considered statistically signicant. Statistical analyses were
performed using SPSS version 21.0, MedCalc 20, and GraphPad Prism version 8.0.
Results
Characteristics of OC Patients
Demographic and clinical characteristics of OC patients are presented in Table 1. Totally, 190 patients with OC were
included, among which 108 males (56.8%) and 82 females (43.2%) were analyzed. There were 122 (64.2%) cases aged
Table 1 Demographic and Clinical
Characteristics of Oral Cancer
Patients
Characteristics Overall (n=190)
Age (years)
>60 122(64.2%)
≤60 68(35.8%)
Sex
Male 108(56.8%)
Female 82(43.2%)
BMI (kg/m
2
)
>24.2 95(50.0%)
≤24.2 95(50.0%)
Smoking
Yes 14(7.4%)
No 176(92.6%)
Drinking
Yes 17(8.9%)
No 173(91.1%)
Hypertension
Yes 35(18.4%)
No 155(81.6%)
Diabetes mellitus
Yes 45(23.7%)
No 145(76.3%)
TNM stage
I-II 149(78.4%)
III-IV 41(21.6%)
LVI
Yes 68(35.8%)
No 122(64.2%)
PNI
Yes 21(11.1%)
No 169(88.9%)
(Continued)
Journal of Inammation Research 2024:17 https://doi.org/10.2147/JIR.S472041
DovePress
5131
Dovepress Wang and Ji
Powered by TCPDF (www.tcpdf.org)

>60 years, while 68 (35.8%) cases aged ≤60 years. The percentages of smokers and drinkers among the OC patients were
7.4% and 8.9%, respectively. The percentages of OC patients with hypertension and diabetes mellitus were 18.4% and
23.7%, respectively. The median values of ALB, LDH, and LAR were 42.6g/L, 162 U/L, and 3.79, which were used for
the grouping criteria. Other parameters regarding OC patients were shown in Table 1.
Relationship Between LAR and Clinicopathological Characteristics of OC
The median value of LAR was 3.79, which was used for dividing OC patients into two groups. The high LAR group was
>3.79, and low LAR group was ≤3.79. The associations between serum LAR and clinicopathological characteristics of
OC were shown in Table 2. This study indicated that the percentage of OC patients aged >60 years in the high LAR
group was signicantly higher than that in the low LAR group. The percentage of OC patients with higher serum LDH
levels (>162 U/L) in the high LAR group was remarkedly higher than that in the low LAR group. Regarding sex, BMI,
Table 1 (Continued).
Characteristics Overall (n=190)
Albumin (g/L)
>42.6 96(50.5%)
≤42.6 94(49.5%)
LDH (U/L)
>162 94(49.5%)
≤162 96(50.5%)
LAR
>3.79 95(50.0%)
≤3.79 95(50.0%)
Abbreviations: BMI, body mass index; TNM
stage, tumor node metastasis stage; PNI, peri-
neural invasion and anemia; LVI, lymphatic and
vascular invasion; LDH, lactate dehydrogenase;
LAR, LDH-to- albumin ratio.
Table 2 Correlation Between LAR and Clinicopathological Features
in Oral Cancer Patients
Variables LAR P-value
Low LAR (≤3.79) High LAR (>3.79)
Age (years) 0.002
>60 51(53.7%) 71(74.7%)
≤60 44(46.3%) 24(25.3%)
Sex 0.558
Male 56(58.9%) 52(54.7%)
Female 39(41.1%) 43(45.3%)
BMI (kg/m
2
) 0.059
>24.2 54(56.8%) 41(43.2%)
≤24.2 41(43.2%) 54(56.8%)
Smoking 0.267
Yes 9(9.5%) 5(5.3%)
No 86(90.5%) 90(94.7%)
Drinking 0.075
Yes 12(12.6%) 5(5.3%)
No 83(87.4%) 90(94.7%)
(Continued)
https://doi.org/10.2147/JIR.S472041
DovePress
Journal of Inammation Research 2024:17
5132
Wang and Ji Dovepress
Powered by TCPDF (www.tcpdf.org)

drinking, smoking, diabetes mellitus, hypertension, TNM stage, LVI, PNI, and serum ALB, no signicant association
was obtained between high LAR group and low LAR group.
Prognostic Signicance of Serum LAR on OC Patients
The OC cases were divided into a low LAR group and a high LAR group according to the median LAR value. The
Kaplan-Meier method and Log rank test showed that the high LAR group showed poorer OS compared with the low
LAR group (Figure 2, P < 0.0001). We also compared the OS rates between two groups, and found that the high LDH
group presented a shorter OS than the low LDH group (Supplementary Figure 1A). In addition, this study indicated that
the high ALB group did not show a higher OS than the low ALB group (Supplementary Figure 1B, P > 0.05).
Univariate and multivariate analyses were used to identify the risk factors of survival for OC patients. Univariate Cox
analysis indicated that TNM III-IV stage, serum LDH >162 U/L, and LAR > 3.79 were signicantly associated with poor
OS of OC patients (Table 3). Further multivariate Cox analysis suggested that the TNM III-IV stage (HR, 2.317; 95% CI,
1.423–3.774, P = 0.001) and serum LAR > 3.79 (HR, 5.138; 95% CI, 2.245–11.756, P = 0.000) were independent risk
factors for OS among OC patients (Table 3); however, serum LDH > 162 U/L was not associated with the OS of OC
patients.
Discussion
Herein, we introduced a novel biomarker, LAR, for predicting the survival of OC patients among a Chinese Han
population. We found that a high serum LAR (>3.79) was an independent predictor of OS for OC patients.
LDH is a glycolytic enzyme, which could convert pyruvate to lactate and lead to a hypoxic environment. Increased
serum levels of LDH were considered as a marker of poor prognosis for cancers, which was attributed to elevated cancer
Table 2 (Continued).
Variables LAR P-value
Low LAR (≤3.79) High LAR (>3.79)
Hypertension 0.575
Yes 16(16.8%) 19(20.0%)
No 79(83.2%) 76(80.0%)
Diabetes mellitus 0.232
Yes 26(27.4%) 19(20.0%)
No 69(82.6%) 76(80.0%)
TNM stage 0.860
I-II 74(77.9%) 75(78.9%)
III-IV 21(22.1%) 20(21.1%)
LVI 0.762
Yes 33(34.7%) 35(36.8%)
No 62(65.3%) 60(63.2%)
PNI 0.247
Yes 13(13.7%) 8(8.4%)
No 82(86.3%) 87(91.6%)
Albumin (g/L) 0.384
>42.6 45(47.4%) 51 (53.7%)
≤42.6 50(52.6%) 44 (46.3%)
LDH (U/L) 0.000
>162 11(11.6%) 83(87.4%)
≤162 84(88.4%) 12(12.6%)
Abbreviations: BMI, body mass index; TNM stage, tumor node metastasis stage; PNI,
perineural invasion and anemia; LVI, lymphatic and vascular invasion; LDH, lactate dehy-
drogenase; LAR, LDH-to- albumin ratio.
Journal of Inammation Research 2024:17 https://doi.org/10.2147/JIR.S472041
DovePress
5133
Dovepress Wang and Ji
Powered by TCPDF (www.tcpdf.org)

metabolism and tumor burden.
23–25
A host of studies found that elevated LDH level was associated with poor survival in
various cancers.
26–29
In this study, univariate Cox regression analysis showed that higher serum LDH was a risk factor
for the OS of OC patients; however, multivariate Cox regression analysis did not uncover that LDH was associated with
the prognosis of OC. Limited sample size, different treatment strategies, and clinical heterogeneity may contribute to
these inconsistent ndings. In addition, ALB is an important protein for cancers, which could reect the nutritional status
Table 3 Univariate and Multivariate COX Regression Analysis for Overall Survival in Oral
Cancer
Characteristics Univariate Analysis Multivariate Analysis
Hazard Ratio
(95% CI)
P-value Hazard Ratio
(95% CI)
P-value
Age (years)
>60 vs ≤60 1.703(0.982–2.953) 0.058
Sex
Male vs < Female 0.901(0.559–1.452) 0.667
BMI (kg/m
2
)
> 24.2 vs ≤ 24.2 1.114(0.692–1.795) 0.656
Smoking
Yes vs No 0.779(0.284–2.140) 0.628
Drinking
Yes vs No 0.625(0.227–1.716) 0.361
Hypertension
Yes vs No 1.087(0.593–1.990) 0.788
Diabetes mellitus
Yes vs No 0.790(0.439–1.424) 0.434
TNM stage
III-IV vs I-II 2.314(1.423–3.764) 0.001 2.317(1.423–3.774) 0.001
LVI
Yes vs No 1.364(0.841–2.211) 0.208
PNI
Yes vs No 1.025(0.468–2.247) 0.950
(Continued)
Figure 2 Comparison of overall survival rate between high LAR group and low LAR group among OC patients.
https://doi.org/10.2147/JIR.S472041
DovePress
Journal of Inammation Research 2024:17
5134
Wang and Ji Dovepress
Powered by TCPDF (www.tcpdf.org)

of cancer patients. Several studies have demonstrated that low serum ALB levels could predict poor prognosis of
cancers.
30–33
In this study, we did not nd that serum ALB was related to the survival of OC, which was partly consistent
with the ndings by Cui et al.
34
LAR, combing ALB and LDH, reected both tumor burden and nutritional status. Therefore, LAR may be more
effective in predicting the cancer survival than a single marker, such as LDH or ALB. LAR is cost-effective and easily
available, and it could be used for cancer patients at high risk of recurrence, progression, and death. A host of studies
have explored the relationship between the survival of cancers and LAR values. We summarized the ndings in
Table 3 (Continued).
Characteristics Univariate Analysis Multivariate Analysis
Hazard Ratio
(95% CI)
P-value Hazard Ratio
(95% CI)
P-value
Albumin (g/L)
>42.6 vs ≤42.6 0.915(0.569–1.473) 0.715
LDH (U/L)
>162 vs ≤162 4.346(2.476–7.628) 0.000 1.562(0.755–3.231) 0.229
LAR
High vs low 7.095(3.711–13.564) 0.000 5.138(2.245–11.756) 0.000
Abbreviations: BMI, body mass index; TNM stage, tumor node metastasis stage; PNI, perineural invasion and anemia;
LVI, lymphatic and vascular invasion; LDH, lactate dehydrogenase; LAR, LDH-to- albumin ratio.
Table 4 The Baseline Characteristics of the Studies Regarding the Association Between LAR and Cancer Survival
Author Year Country Types of Cancer Survival
Indicators
Association with the Survival
Gan et al
35
2018 China Hepatocellular carcinoma OS, RFS Yes (OS and RFS)
Gao et al
37
2018 China Unresectable pancreatic cancer OS Yes (OS)
Feng et al
36
2019 China Esophageal squamous cell
carcinoma
CSS Yes (CSS)
Aday et al
16
2020 Turkey Colorectal cancer OS Yes (OS)
Aday et al
39
2020 Turkey Gastric cancer OS No (OS)
Hu et al
17
2022 China Colorectal cancer OS, DFS Yes (OS and DFS)
Xie et al
38
2022 China Colon cancer OS, PFS Yes (OS and PFS)
Peng et al
40
2021 China Non-metastatic Nasopharyngeal
Carcinoma
OS, PFS Yes (OS and PFS)
Zhao et al
41
2022 China Advanced Nasopharyngeal
Carcinoma
OS Yes (OS)
He et al
21
2023 China Breast cancer PFS Yes (PFS)
Menekse et al
22
2023 Turkey Metastatic NSCLC OS, PFS Yes (OS and PFS)
Shu et al
18
2023 China Colorectal cancer OS, DFS Yes (OS and DFS)
Wu et al
19
2023 China Colorectal cancer OS Yes (OS)
Xu et al
20
2023 China Bladder cancer OS, RFS Yes (OS and RFS)
Abbreviations: NSCLC, non-small cell lung cancer; OS, overall survival; RFS, recurrence-free survival; DFS, disease-free survival; PFS, progression-free survival;
CSS, cancer-specic survival.
Journal of Inammation Research 2024:17 https://doi.org/10.2147/JIR.S472041
DovePress
5135
Dovepress Wang and Ji
Powered by TCPDF (www.tcpdf.org)

Table 4. Gan et al found that LAR was an independent prognostic predictor in cases with hepatocellular carcinoma
undergoing curative resection.
35
They showed that LAR was a signicant prognostic marker for both recurrence-free
survival and OS.
35
Feng et al suggested that LAR was an independent risk factor of cancer-specic survival in patients
with resectable esophageal squamous cell carcinoma.
36
Gao et al uncovered that high LAR was a prognostic factor for
pancreatic cancer.
37
For Gastrointestinal tumors, four Chinese studies
17–19,38
and two Turkish studies
16,39
have
addressed this issue before. Aday et al indicated that LAR was not a signicant predictor for patients with gastric
cancer.
39
In their further study, they found that LAR ≥ 52.7 was signicantly related to worse disease-free survival and
OS in CRC patients.
16
Hu et al
17
and Shu et al
18
demonstrated that high LAR was associated with poor OS and
disease-free survival among CRC patients. Xie et al suggested that high LAR was associated with progression-free
survival and OS in cases with colon cancer.
38
They did not include patients with rectal cancer.
38
Wu et al found that
LAR was a signicant predictor of OS among patients with CRC.
19
For nasopharyngeal carcinoma (NPC), two
Chinese studies showed a signicant association with the survival of NPC.
40,41
In addition, two studies indicated
that LAR was signicantly associated with the survival of breast cancer
21
and bladder cancer.
20
A Turkish study by
Menekse et al showed that LAR was an independent predictor of nivolumab in cases with NSCLC.
22
In line with
abovementioned studies, this study showed that high LAR was an independent prognostic marker of OS among OC
patients. To the best of our knowledge, this is the rst study to uncover an association between the LAR value and
survival of OC patients.
In addition, univariate and multivariate Cox regression analyses showed that TNM III-IV stage was a signicant
prognostic factor of OS among OC patients in this study, which was shown in other cancers.
18
It is of note that the
cutoff values of the LAR level differed among studies, which may exert effects on the nal results of LAR. Various
denitions of LAR may explain this discrepancy. The cutoff value of the LAR level in the study by Aday et al was
quite doubtful,
16
which was 52.7. Notably, the cutoff values of the LAR in most of abovementioned studies were lower
than 10.0.
Several limitations were shown in this study. First, this single-center study was retrospective. Multi-center prospective
studies are urgently needed in the future. Second, the sample size was not large enough. Third, the optimal threshold
value of LAR in this study was different from other studies. Fourth, confounding factors affecting the ndings were not
included in this study. Fifth, the dynamic monitoring of LAR value was not shown. Sixth, all studies investigating the
relationship between LAR and the survival of OC patients were from China and Turkey; studies from other countries are
needed. Last, other combined indexes including LDH or ALB may also be useful for evaluating the survival of OC
patients.
Conclusions
Totally, this study nds that serum LAR could be served as a marker for the survival of patients with OC. High serum
LAR is associated with poor OS of OC patients. LAR can help physicians make suitable treatment decisions and more
effective management for OC patients. However, these results should be interpreted as hypothesis generated rather than
practice changing due to multiple study limitations (small sample size, retrospective analysis, single-institution experi-
ence, heterogeneous patient population, etc).
Funding
There is no funding to report.
Disclosure
The authors report no conicts of interest in this work.
References
1. Sarode G, Maniyar N, Sarode SC, Jafer M, Patil S, Awan KH. Epidemiologic aspects of oral cancer. Dis Mon. 2020;66(12):100988. doi:10.1016/j.
disamonth.2020.100988
2. Wong T, Wiesenfeld D. Oral cancer. Aust Dent J. 2018;63(Suppl 1):S91–S99. doi:10.1111/adj.12594
https://doi.org/10.2147/JIR.S472041
DovePress
Journal of Inammation Research 2024:17
5136
Wang and Ji Dovepress
Powered by TCPDF (www.tcpdf.org)

3. Warnakulasuriya S. Living with oral cancer: epidemiology with particular reference to prevalence and life-style changes that inuence survival.
Oral Oncol. 2010;46(6):407–410. doi:10.1016/j.oraloncology.2010.02.015
4. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality
worldwide for 36 cancers in 185 countries. Cancer J Clin. 2018;68(6):394–424. doi:10.3322/caac.21492
5. Kumar M, Nanavati R, Modi TG, Dobariya C. Oral cancer: etiology and risk factors: a review. J Cancer Res Ther. 2016;12(2):458–463.
doi:10.4103/0973-1482.186696
6. Baskar G, Palaniyandi T, Viswanathan S, et al. Recent and advanced therapy for oral cancer. Biotechnol Bioeng. 2023;120(11):3105–3115.
doi:10.1002/bit.28452
7. Slieker FJB, de Bree R, Van Cann EM. Oral squamous cell carcinoma involving the maxillae: factors affecting local recurrence and the value of
salvage treatment for overall survival. Head Neck. 2020;42(8):1821–1828. doi:10.1002/hed.26108
8. Kaur J, Srivastava R, Borse V. Recent advances in point-of-care diagnostics for oral cancer. Biosens Bioelectron. 2021;178:112995. doi:10.1016/j.
bios.2021.112995
9. Zhang J, Yao YH, Li BG, Yang Q, Zhang PY, Wang HT. Prognostic value of pretreatment serum lactate dehydrogenase level in patients with solid
tumors: a systematic review and meta-analysis. Sci Rep. 2015;5(1):9800. doi:10.1038/srep09800
10. Mafessoni TP, Mazur CE, Amenabar JM. Salivary lactate dehydrogenase (LDH) as a tool for early diagnosis of oral cancer in individuals with
Fanconi anemia. Med Hypotheses. 2018;119:29–31. doi:10.1016/j.mehy.2018.07.021
11. Duzkopru Y, Kocanoglu A, Dogan O, Sahinli H, Cilbir E, Altinbas M. Hemoglobin, albumin, lymphocyte, and platelet score as a predictor of
prognosis in metastatic gastric cancer. World J Gastrointest Oncol. 2023;15(9):1626–1635. doi:10.4251/wjgo.v15.i9.1626
12. Li Q, Kong F, Ma J, et al. Nomograms based on brinogen, albumin, neutrophil-lymphocyte ratio, and carbohydrate antigen 125 for predicting
endometrial cancer prognosis. Cancers. 2022;14(22):5632. doi:10.3390/cancers14225632
13. Wang X, Xu J, Zhang H, Qu P. The effect of albumin and hemoglobin levels on the prognosis of early-stage cervical cancer: a prospective,
single-center-based cohort study. BMC Women's Health. 2023;23(1):553. doi:10.1186/s12905-023-02713-5
14. Bao X, Liu F, Lin J, et al. Nutritional assessment and prognosis of oral cancer patients: a large-scale prospective study. BMC Cancer. 2020;20
(1):146. doi:10.1186/s12885-020-6604-2
15. Hiraoka SI, Shimada Y, Kawasaki Y, Akutagawa M, Tanaka S. Preoperative nutritional evaluation, surgical site infection, and prognosis in patients
with oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022;134(2):168–175. doi:10.1016/j.oooo.2022.01.009
16. Aday U, Boyuk A, Akkoc H. The prognostic signicance of serum lactate dehydrogenase-to-albumin ratio in colorectal cancer. Ann Surg Treat Res.
2020;99(3):161–170. doi:10.4174/astr.2020.99.3.161
17. Hu Y, Zhou Y, Cao Y, et al. Nomograms based on lactate dehydrogenase to albumin ratio for predicting survival in colorectal cancer. Int J Med Sci.
2022;19(6):1003–1012. doi:10.7150/ijms.71971
18. Shu XP, Xiang YC, Liu F, Cheng Y, Zhang W, Peng D. Effect of serum lactate dehydrogenase-to-albumin ratio (LAR) on the short-term outcomes
and long-term prognosis of colorectal cancer after radical surgery. BMC Cancer. 2023;23(1):915. doi:10.1186/s12885-023-11446-5
19. Wu J, Wu A, Wang S, et al. The value of lactate dehydrogenase to albumin ratio and immune inammation biomarkers in colorectal cancer. Front
Surg. 2023;10:1118403. doi:10.3389/fsurg.2023.1118403
20. Xu H, Lin T, Ai J, et al. Utilizing the lactate dehydrogenase-to-albumin ratio for survival prediction in patients with bladder cancer after radical
cystectomy. J Inamm Res. 2023;16:1733–1744. doi:10.2147/JIR.S384338
21. He J, Tong L, Wu P, Wu Y, Shi W, Chen L. Prognostic signicance of preoperative lactate dehydrogenase to albumin ratio in breast cancer:
a retrospective study. Int J Gen Med. 2023;16:507–514. doi:10.2147/IJGM.S396871
22. Menekse S, Kut E, Almuradova E. Elevated serum lactate dehydrogenase to albumin ratio is a useful poor prognostic predictor of nivolumab in
patients with non-small cell lung cancer. Eur Rev Med Pharmacol Sci. 2023;27(5 Suppl):86–94. doi:10.26355/eurrev_202310_34076
23. Claps G, Faouzi S, Quidville V, et al. The multiple roles of LDH in cancer. Nat Rev Clin Oncol. 2022;19(12):749–762. doi:10.1038/s41571-022-
00686-2
24. Miholjcic TBS, Halse H, Bonvalet M, et al. Rationale for LDH-targeted cancer immunotherapy. Eur J Cancer. 2023;181:166–178. doi:10.1016/j.
ejca.2022.11.032
25. Sharma D, Singh M, Rani R. Role of LDH in tumor glycolysis: regulation of LDHA by small molecules for cancer therapeutics. Semin Cancer
Biol. 2022;87:184–195. doi:10.1016/j.semcancer.2022.11.007
26. Anami S, Doi H, Nakamatsu K, et al. Serum lactate dehydrogenase predicts survival in small-cell lung cancer patients with brain metastases that
were treated with whole-brain radiotherapy. J Radiat Res. 2019;60(2):257–263. doi:10.1093/jrr/rry107
27. Liu J, Wu D, Shen B, et al. Serum lactate dehydrogenase predicts brain metastasis and survival in limited-stage small cell lung cancer patients
treated with thoracic radiotherapy and prophylactic cranial irradiation. Strahlenther Onkol. 2022;198(12):1094–1104. doi:10.1007/s00066-022-
01977-4
28. Ma L, Qiu J, Zhang Y, et al. Prognostic factors for operable biliary tract cancer: serum levels of lactate dehydrogenase, a strong association with
survival. Onco Targets Ther. 2018;11:2533–2543. doi:10.2147/OTT.S150502
29. Pelizzari G, Basile D, Zago S, et al. Lactate dehydrogenase (LDH) response to rst-line treatment predicts survival in metastatic breast cancer: rst
clues for a cost-effective and dynamic biomarker. Cancers. 2019;11(9):1243. doi:10.3390/cancers11091243
30. Chen CC, Tang WH, Wu CC, et al. Pretreatment circulating albumin, platelet, and rdw-sd associated with worse disease-free survival in patients
with breast cancer. Breast Cancer. 2024;16:23–39. doi:10.2147/BCTT.S443292
31. Dai D, Balega J, Sundar S, et al. Serum albumin as a predictor of survival after interval debulking surgery for advanced ovarian cancer (aoc):
a retrospective study. J Invest Surg. 2022;35(2):426–431. doi:10.1080/08941939.2020.1827314
32. Liu C, Li X. Stage-dependent changes in albumin, nlr, plr, and afr are correlated with shorter survival in patients with gastric cancer. Clin Lab.
2019;65(9). doi:10.7754/Clin.Lab.2019.190132
33. Tang Q, Li X, Sun CR. Predictive value of serum albumin levels on cancer survival: a prospective cohort study. Front Oncol. 2024;14:1323192.
doi:10.3389/fonc.2024.1323192
34. Cui L, Yu H, Sun Q, Miao Y, Jiang K, Fang X. Effects of body mass index and serum albumin on overall survival in patients with cancer
undergoing pancreaticoduodenectomy: a single-center retrospective cohort study. World J Surg Oncol. 2022;20(1):221. doi:10.1186/s12957-022-
02678-z
Journal of Inammation Research 2024:17 https://doi.org/10.2147/JIR.S472041
DovePress
5137
Dovepress Wang and Ji
Powered by TCPDF (www.tcpdf.org)

35. Gan W, Zhang MX, Wang JX, et al. Prognostic impact of lactic dehydrogenase to albumin ratio in hepatocellular carcinoma patients with
child-Pugh I who underwent curative resection: a prognostic nomogram study. Cancer Manag Res. 2018;10:5383–5394. doi:10.2147/CMAR.
S176317
36. Feng JF, Wang L, Yang X, Jiang YH. Prognostic value of lactate dehydrogenase to albumin ratio (LAR) in patients with resectable esophageal
squamous cell carcinoma. Cancer Manag Res. 2019;11:7243–7251. doi:10.2147/CMAR.S208320
37. Gao S, Wu M, Chen Y, et al. Lactic dehydrogenase to albumin ratio in prediction of unresectable pancreatic cancer with intervention chemotherapy.
Future Oncol. 2018;14(14):1377–1386. doi:10.2217/fon-2017-0556
38. Xie Z, Zhou H, Wang L, Wu Y. The signicance of the preoperative lactate dehydrogenase/albumin ratio in the prognosis of colon cancer:
a retrospective study. PeerJ. 2022;10:e13091. doi:10.7717/peerj.13091
39. Aday U, Tatli F, Akpulat FV, et al. Prognostic signicance of pretreatment serum lactate dehydrogenase-to-albumin ratio in gastric cancer. Contemp
Oncol. 2020;24(3):145–149. doi:10.5114/wo.2020.100219
40. Peng RR, Liang ZG, Chen KH, Li L, Qu S, Zhu XD. Nomogram based on lactate dehydrogenase-to-albumin ratio (LAR) and platelet-to-
lymphocyte ratio (plr) for predicting survival in nasopharyngeal carcinoma. J Inamm Res. 2021;14:4019–4033. doi:10.2147/JIR.S322475
41. Zhao R, Liang Z, Chen K, Zhu X. Nomogram based on inammatory biomarkers and nutritional indicators for predicting overall survival in
locoregionally advanced nasopharyngeal carcinoma. J Inamm Res. 2022;15:2971–2981. doi:10.2147/JIR.S366299
Journal of Inflammation Research Dovepress
Publish your work in this journal
The Journal of Inammation Research is an international, peer-reviewed open-access journal that welcomes laboratory and clinical ndings on
the molecular basis, cell biology and pharmacology of inammation including original research, reviews, symposium reports, hypothesis
formation and commentaries on: acute/chronic inammation; mediators of inammation; cellular processes; molecular mechanisms; pharmacology
and novel anti-inammatory drugs; clinical conditions involving inammation. The manuscript management system is completely online and
includes a very quick and fair peer-review system. Visit http://www.dovepress.com/testimonials.php to read real quotes from published authors.
Submit your manuscript here: https://www.dovepress.com/journal-of-inammation-research-journal
DovePress Journal of Inammation Research 2024:17
5138
Wang and Ji Dovepress
Powered by TCPDF (www.tcpdf.org)