The prognostic value of lactate dehydrogenase/albumin ratio in extranodal natural killer/T cell lymphoma

Objective Extranodal natural killer/T-cell lymphoma (ENKTL) is recognized for its aggressive nature and variable clinical presentation, often leading to a poor prognosis. While the combined assessment of baseline serum lactate dehydrogenase (LDH) and albumin (ALB) levels has demonstrated prognostic value across various malignancies, its specific application and evidence in ENKTL are unstudied. Purpose This study aimed to investigate the impact of the lactate dehydrogenase/albumin ratio (LAR) in ENKTL, offering nutritional and immunological insights to enhance risk stratification. Results We conducted a retrospective analysis of 484 ENKTL patients treated with asparaginase-based regimens. The optimal thresholds for serum LDH and ALB levels were identified as 230 u/L and 40 g/L, respectively, and 5.4 for LAR. With a median follow-up of 70 months, the 5-year overall survival (OS) and progression-free survival (PFS) rates were determined to be 58.7% and 52.0%, respectively. Patients with higher LAR values exhibited more unfavorable clinical features and poorer 5-year OS and PFS rates compared to those with lower LAR values. Utilizing the LAR-associated prognostic score, patients were categorized into distinct risk groups, revealing significant differences in 5-year OS and PFS among these groups. By integrating the LAR and LAR-associated prognostic score into the prognostic index for natural killer lymphoma (PINK) and PINK with Epstein-Barr virus (PINK-E) models, we found that these measures provided additional prognostic information. Conclusion Elevated LDH and decreased ALB levels at the time of initial diagnosis are indicative of a poor prognosis in ENKTL patients. The LAR and LAR-associated prognostic score may serve as independent prognostic indicators for ENKTL, potentially aiding in risk stratification and informing clinical decision-making.