Preoperative serum cholesterol is an independent prognostic factor for patients with renal cell carcinoma (RCC).
OBJECTIVE
To assess the prognostic role of preoperative serum cholesterol in patients with renal cell carcinoma (RCC), as increasing evidence suggests that alterations in the lipid profile are associated with the development, progression and prognosis of various cancers.


METHODS
We analysed 867 patients, who underwent radical or partial nephrectomy for RCC between 2002 and 2012. Preoperative total cholesterol levels were determined in serum using colorimetric analysis (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 (interquartile range) serum cholesterol was 195 (166-232) mg/dL. Decreasing serum cholesterol was associated with more advanced T, N and M stages (P < 0.001), higher grades (P = 0.001) and presence of tumour necrosis (P = 0.002). Continuously coded cholesterol was associated with CSS in both univariable (hazard ratio [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 localised 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.
Department of Urology, Comprehensive Cancer Center of the Medical University of Vienna.
Michela
M
de Martino
Carmen V
CV
Leitner
Christoph
C
Seemann
Sebastian L
SL
Hofbauer
Ilaria
I
Lucca
Andrea
A
Haitel
Shahrokh F
SF
Shariat
Tobias
T
Klatte
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D002784:Cholesterol / Q000097:blood*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies
D002784:Cholesterol
cholesterol; concordance; localised; prognosis; regression; survival