Preoperative cholesterol level as a new independent predictive factor of survival in patients with metastatic renal cell carcinoma treated with cyto-reductive nephrectomy

Abstract

BackgroundThe obesity and lipid metabolism were previously proposed to be related with the clinical outcomes of metastatic renal cell carcinoma (mRCC). We tried to investigate the relationship between preoperative cholesterol level (PCL) and survival outcomes in patients with mRCC.MethodsWe analysed the data of 244 patients initially treated with cyto-reductive nephrectomy after being diagnosed with mRCC. Patients were stratified into two groups according to the PCL cut-off level of 170 mg/dL. The postoperative survival rates were compared using Kaplan-Meier analysis and the possible predictors of patients’ cancer-specific survival (CSS) and overall survival (OS) were tested using multivariate Cox-proportional hazard models.ResultsThe low cholesterol group showed significantly worse postoperative CSS (p = 0.013) and OS (p = 0.009) than the high cholesterol group. On multivariate analysis, low PCL was revealed as an independent predictor of worse CSS (hazard ratio [HR], 2.162; 95% CI, 1.221–3.829; p = 0.008) and OS (HR, 2.013; 95% CI, 1.206–3.361; p = 0.007). Subsequent subgroup analysis showed that these results were maintained in the clear cell subgroup but not in the non-clear cell subgroup.ConclusionDecreased PCL was significantly correlated with worse survival outcomes in patients with mRCC treated with cytoreductive nephrectomy. The underlined mechanism is still uncharted and requires further investigation.

Preoperative serum total cholesterol is a predictor of prognosis in patients with renal cell carcinoma: a meta-analysis of observational studies

“…The basic clinical characteristics of the enrolled studies (12)(13)(14)(15)(21)(22)(23)(24)(25) are provided in Table 1. For the study design, the nine included studies were retrospective cohorts and published from 2014 to 2019.…”

“…Few studies included only locally or metastatic RCC patients (14,23), but most studies reported the inclusion of generalized RCC patients (12,13,15,21,22,24,25). Overall survival (OS) was reported in five studies (12)(13)(14)(15)23), cancer-specific survival (CSS) was assessed in six studies (14,(21)(22)(23)(24)(25), and progression-free survival (PFS) was evaluated in four studies (12,14,15,25). Finally, HRs and corresponding 95% CIs were sufficiently provided by all included studies.…”

“…Six retrospective cohort studies comprising 10.946 patients provided the CSS (14,(21)(22)(23)(24)(25). Low preoperative serum TC levels yielded a worse CSS (HR=0.98, 95% CI: 0.97-0.99; P=0.005) in patients with surgically treated RCC, and significant heterogeneity was observed (I 2 =74.2%).…”

“…Therefore, a random-effects model was applied for the analysis (Figure 3). In the subgroup analysis according to different countries, low preoperative serum TC levels were associated with poor CSS in studies conducted in Austria (21) and China (25), whereas no significant association was observed in studies conducted in Korea (14,22,23) and Japan (24). No sufficient data for extraction (1 studey).…”

“…Most of the enrolled studies generally suggested an increased risk of shortened OS, CSS and PFS in patients with surgically treated RCC, whereas two studies yielded conflicting results (15,23). Haddad AQ et al (15) performed a retrospective cohort study comprising 508 patients with surgically treated RCC in the United States.…”