Prognostic Significance Of Serum Alkaline Phosphatase And Lactate Dehydrogenase In Male Breast Cancer

Objective(s): At present,breast cancer is the world’s highest rates of cancer,has always been a hot spot in clinical research.Male breast cancer(MBC),as a special classification of breast cancer,has the characteristics of low incidence,late onset age and poor prognosis.With the development of clinical diagnosis and treatment technology,breast cancer prognostic indicators are more accurate and effective,but MBC still lacks more effective and scientific prognostic indicators.At present,many studies are aimed at finding some convenient,universal and scientific indicators as a reference for the prognosis of MBC.This study focused on the impact of serum alkaline phosphatase(ALP)and lactate dehydrogenase(LDH)levels on the prognosis of male breast cancer.Methods: Eighty-one male breast cancer patients who received treatment in Yunnan Province Hospital from December 2005 to August 2021 were enrolled retrospectively and continuously,and serum ALP and LDH levels were routinely measured.We used Maximally Selected Test Statistics analysis to find the best cut-off values of serum ALP and LDH levels,and established a "joint score" based on ALP and LDH levels.Patients were divided into three groups according to the value of "joint score",which were(good,0 factor;Moderate,1 factor;Poor,2 factors),univariate and multivariate Cox proportional hazards regression models were used for analysis,and Kaplan-Meier curves were plotted.The primary endpoint was overall survival(OS),and the secondary endpoints were disease-free survival(DFS)and progression-free survival(PFS).Results: Among the 81 MBC patients enrolled,the mean age was 63.25 years(±11.26 years),the mean OS was 60.46 months(±34.24 months),and the median OS was 54 months;The mean DFS was 51.33 months(±27.36 months)and the median DFS was 50 months.The optimal cut-off values for ALP and LDH were determined to be 114U/L and 207U/L,respectively,with OS as the study endpoint.When patients were grouped by “joint score”,53 patients had a “joint score” of 0,16 patients had a“joint score” of 1,and 12 patients had a “joint score” of 2.The median OS for patients with a "joint score" of 0 was 120 months;The median OS for patients with a "joint score" of 1 was 56 months;The median OS for patients with a "joint score" of 2 was35 months.Hazard Ratios(HRs)were 75.91 and 13.36 times higher in patients with a“joint score” of 2 and 1,respectively,than in patients with a “joint score” of 0.High“joint score”,nodal grade 3,and molecular classification as Luminal B were associated with shorter DFS.The elevation of LDH after the second chemotherapy was a protective factor for DFS(P=0.017).The changes of ALP and LDH after the first chemotherapy,the changes of ALP after the second chemotherapy and the changes of ALP and LDH after the last chemotherapy were not significantly correlated with OS and DFS.Conclusion(s): We concluded that the increase of serum ALP and LDH levels before treatment can predict the recurrence,metastasis and poor prognosis of MBC to a certain extent,and can provide new prognostic information for MBC in the future,as a supplement to guide the diagnosis and treatment of MBC patients.