de Martino Michela, Leitner Carmen V, Seemann Christoph, Hofbauer Sebastian L, Lucca Ilaria, Haitel Andrea, Shariat Shahrokh F, Klatte Tobias
Department of Urology, Comprehensive Cancer Center of the Medical University of Vienna.
BJU Int. 2015 Mar;115(3):397-404. doi: 10.1111/bju.12767. Epub 2014 Jun 12.
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.
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.
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).
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.
评估术前血清胆固醇在肾细胞癌（RCC）患者中的预后作用，因为越来越多的证据表明脂质谱的改变与各种癌症的发生、发展和预后相关。
我们分析了2002年至2012年间因RCC接受根治性或部分肾切除术的867例患者。采用比色分析法（CHOD-PAP法）测定血清术前总胆固醇水平。用Cox模型评估与癌症特异性生存（CSS）的关联。用C指数量化鉴别能力。中位随访时间为52个月。
血清胆固醇中位数（四分位间距）为195（166 - 232）mg/dL。血清胆固醇降低与更晚期的T、N和M分期（P < 0.001）、更高分级（P = 0.001）以及肿瘤坏死的存在（P = 0.002）相关。连续编码的胆固醇在单变量分析（风险比[HR] 0.87，P < 0.001）和多变量分析（HR 0.93，P = 0.001）中均与CSS相关。纳入胆固醇后，多变量基础模型的鉴别能力从88.3%显著提高至89.2%（P = 0.006）。在临床局限性疾病（T1 - 3N0/+M0）患者中，胆固醇在多变量分析中仍与CSS相关（HR 0.90，P = 0.002），并将鉴别能力从74.6%提高至76.9%（P = 0.002）。
术前血清胆固醇是RCC患者的独立预后因素，水平较低与较差的生存率相关。其应用提高了既定预后因素的鉴别能力。由于胆固醇是一种广泛可用的常规标志物，其应用可能在临床实践中提供有意义的辅助。这种关联背后的生物学原理仍有待阐明。
