title: Prognostic Role of Preoperative Serum Lipid Levels in Patients Undergoing Radical Prostatectomy for Clinically Localized Prostate Cancer.
abstract: The prognostic role of preoperative serum lipid levels in patients undergoing radical prostatectomy (RP) for clinically localized prostate cancer (PCa) is unclear. The aim of the present study was to investigate preoperative serum lipid levels in patients with clinically localized PCa undergoing RP and their association with clinicopathological features and oncological outcome.
  
  
  
  Preoperative lipid levels (total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides) and statin use from consecutive patients with clinically localized PCa undergoing RP in a tertiary referral center between 2008 and 2015 were recorded and patients were followed prospectively. Logistic regression analysis was used to test the association between lipid levels and clinicopathological parameters. Lipid values were analyzed both as continuous and dichotomized variables. Univariable and multivariable Cox regression analyses were performed to identify predictors for recurrence-free survival (RFS). Recurrence was defined as rising and verified PSA levels >0.1 ng/ml.
  
  
  
  Our cohort consisted of 371 men with a median age of 63 years (range 41-78 years) and a median preoperative PSA value of 6.79 ng/ml (0.43-81.4 ng/ml). Median follow-up was 28 months (1-64). No association was found between lipid levels and adverse pathological characteristics such as ≥pT3, Gleason score ≥8, positive nodal status and positive surgical margins. Recurrence occurred in 49 patients (15.4%) at a median time of 18 months (2-51 month). Compared to low LDL cholesterol, high LDL cholesterol was associated with longer RFS in univariable analysis (continuous: Hazard Ratio (HR): 0.67, 95%-Confidence Interval (CI): 0.47-0.96, P = 0.03; 3 mM cut-point: HR: 0.44, 95%-CI: 0.24-0.79, P = 0.006). Neither levels of other lipids, nor statin use were associated with RFS. Preoperative LDL cholesterol remained an independent predictor for PCa recurrence in a multivariable model adjusted for age, preoperative PSA, statin use, tumor stage, Gleason score, nodal status and surgical margin status (continuous: HR: 0.66, 95%-CI: 0.44-0.99, P = 0.04; 3 mM cut-point: HR: 0.41, 95%-CI: 0.21-0.78, P = 0.007).
  
  
  
  This is the first prospective study showing the potential adverse and independent prognostic role of low preoperative LDL cholesterol levels in patients with localized PCa undergoing RP. Prostate 77:549-556, 2017. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Marian S
authors.initials: MS
authors.lastname: Wettstein
authors.affiliation: Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Karim
authors.initials: K
authors.lastname: Saba
authors.affiliation: Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Martin H
authors.initials: MH
authors.lastname: Umbehr
authors.affiliation: Department of Urology, Tampere University Hospital, University of Tampere, Tampere, Finland.
authors.forename: Teemu J
authors.initials: TJ
authors.lastname: Murtola
authors.affiliation: Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Fankhauser
authors.affiliation: Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Adank
authors.affiliation: Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Hofmann
authors.affiliation: Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Tullio
authors.initials: T
authors.lastname: Sulser
authors.affiliation: Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hermanns
authors.affiliation: Department of Urology, Tampere University Hospital, University of Tampere, Tampere, Finland.
authors.forename: Holger
authors.initials: H
authors.lastname: Moch
authors.affiliation: Department of Pathology and Molecular Pathology, University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Wild
authors.affiliation: Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Cédric
authors.initials: C
authors.lastname: Poyet
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D015331:Cohort Studies; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*
chemical_list: D014408:Biomarkers, Tumor; D008078:Cholesterol, LDL; D008055:Lipids
keywords: biochemical recurrence; prostate cancer; radical prostatectomy; serum lipids