OBJECTIVE: Increasing evidence suggests that alterations in the lipid profile are associated with the development, progression and prognosis of various cancers.
The purpose of this study was to assess the prognostic role of preoperative serum cholesterol in patients with renal cell carcinoma (RCC).
PATIENTS AND METHODS: We analyzed 867 patients, who underwent radical or partial nephrectomy for RCC between 2002 and 2012. Total cholesterol levels were determined in preoperative serum using the CHOD-PAP method. The association with cancer-specific survival (CSS) was assessed with Cox models. Discrimination was quantified with the C-index. The median follow-up was 52 months.
RESULTS: The median serum cholesterol was 195 mg/dl (IQR 166-232). Decreasing serum cholesterol was associated with more advanced T, N and M stages (P< 0.001), higher grades (P=0.001) and presence of tumor necrosis (P=0.002). Continuously coded cholesterol was associated with CSS in both univariable (HR 0.87, P< 0.001) and multivariable analyses (HR 0.93, P=0.001). The discrimination of a multivariable base model increased significantly from 88.3% to 89.2% following inclusion of cholesterol (P=0.006). In patients with clinically localized disease (T1-3N0/+M0), cholesterol remained associated with CSS in multivariable analysis (HR 0.90, P=0.002) and increased the discrimination from 74.6% to 76.9% (P=0.002).
CONCLUSIONS: Preoperative serum cholesterol is an independent prognostic factor for patients with RCC, with lower levels being associated with worse survival. Its use increases the discrimination of established prognostic factors. As cholesterol is a broadly available routine marker, its use may provide a meaningful adjunct in clinical practice. The biological rationale underlying this association remains to be clarified.
Written by:
de Martino M, Leitner CV, Seemann C, Hofbauer SL, Lucca I, Haitel A, Shariat SF, Klatte T. Are you the author?
Department of Urology, Comprehensive Cancer Center of the Medical University of Vienna and General Hospital Vienna, Medical University of Vienna - General Hospital, Vienna, Austria.
Reference: BJU Int. 2014 Apr 4. Epub ahead of print.
doi: 10.1111/bju.12767
PubMed Abstract
PMID: 24698164
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