Affiliations: [a] Department of Medicine, NYU Lutheran Medical Center, Brooklyn, NY, USA | [b] Division of Pulmonary and Critical Care Medicine, NYU Lutheran Medical Center, Brooklyn, NY, USA
Correspondence:
[*]
Corresponding author: Panagiotis J. Vlachostergios, Department of Medicine, NYU Lutheran Medical Center, Brooklyn, NY, USA. Tel.: +1 718 630 6345; Fax: +1 718 210 5306; E-mail: pvlachostergios@lmcmc.com
Abstract:
BACKGROUND: Hyperlactatemia with or without type B lactic acidosis
is a rare complication of cancer, previously observed most often in
hematological malignancies. The aim of this study was to assess the
prognostic value of lactic acid (LA) in patients with metastatic lung
cancer. METHODS: Patients diagnosed with stage IV non-small cell
lung cancer (NSCLC) and extensive stage small cell lung cancer (SCLC), were
included in this single center retrospective study. Arterial and venous LA
level, anion gap (AG), serum LDH and presence of urine ketones were recorded
for each patient and their associations with demographic and clinical data
and overall survival (OS) were examined. RESULTS: Eighty-five patients (43
males, median age 74, range 45-96 years) were studied. The maximal levels of
arterial or venous LA were significantly associated with presence of ≥ 2 metastatic sites
(p= 0.001), ICU admission or transfer (p= 0.016),
intubation (p= 0.029), elevated serum anion gap (p< 0.001) and LDH levels
(p< 0.001). Hyperlactatemia (≥ 1.4 mmol/L) was associated with shorter OS
(log-rank p< 0.001). In a multivariate model including LA, ICU, intubation,
AG as well as other known prognostic factors of NSCLC and SCLC, including
age, sex, smoking status, number and location of metastases, histologic
type, performance status (PS), chemotherapy and LDH, LA retained its
prognostic value (OR: 1.3; 95%CI: 1.082-1.561; p= 0.005), along with PS
(p= 0.039) and chemotherapy (p= 0.039). CONCLUSIONS: The results of
the study suggest that a high lactic acid level (≥ 1.4 mmol/L) is
associated with significantly shorter overall survival in patients with
metastatic non-small cell lung cancer and extensive stage small cell lung
cancer. Hyperlactatemia is an independent predictor of poor survival in
metastatic lung cancer patients.
