Objective  This study aims to investigate the relationship between serum lactate dehydrogenase(LDH) levels and prognosis in the course of transarterial chemoembolization(TACE) of primary liver cancer(PLC).

  Methods  Clinical and laboratory data of 145 consecutive patients undergoing trans-arterial chemo-embolization of unresectable PLC from February 2005 to February 2009 were analyzed.LDH values were obtained from the patients a month before the procedure.

  Results  The patients were divided into two groups according to the concentration of the LDH serum registered before TACE(first: LDH < 450, U/L 86 patients; second: LDH > 450, U/L 59 patients).The patients were also classified according to the variation in the LDH serum levels before and after treatment(increased: 81 patients versus decreased: 64 patients).The median time to progression(TTP) was 14.2 months for patients with LDH values below 450 U/L, whereas median TTP was 9.1 months for patients with LDH values above the cut-off(P=0.000).The median overall survival(OS) was 19.3 months and 11.2 months(P=0.000).Median TTP was 11.3 months and median OS was 18.8 months for patients with decreased LDH values after treatment, whereas median TTP was 9.1 months and median OS was 9.8 months for patients with increased LDH levels(TTP: P=0.001;OS: P=0.004).

  Conclusions  LDH is able to predict the clinical outcome for HCC patients undergoing TACE.High LDH pretreatment levels may be suitable candidates for clinical exploration in a multimodality treatment approach with TACE and anti-VEGF inhibitors to improve TTP and OS.