Wettstein Marian S, Saba Karim, Umbehr Martin H, Murtola Teemu J, Fankhauser Christian D, Adank Jean-Pascal, Hofmann Marc, Sulser Tullio, Hermanns Thomas, Moch Holger, Wild Peter, Poyet Cédric
Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
Department of Urology, Tampere University Hospital, University of Tampere, Tampere, Finland.
Prostate. 2017 Apr;77(5):549-556. doi: 10.1002/pros.23296. Epub 2017 Jan 17.
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.
对于临床局限性前列腺癌（PCa）患者，术前血清脂质水平在根治性前列腺切除术（RP）中的预后作用尚不清楚。本研究的目的是调查接受RP的临床局限性PCa患者的术前血清脂质水平及其与临床病理特征和肿瘤学结局的关联。
记录2008年至2015年间在一家三级转诊中心接受RP的连续性临床局限性PCa患者的术前脂质水平（总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和甘油三酯）以及他汀类药物的使用情况，并对患者进行前瞻性随访。采用逻辑回归分析来检验脂质水平与临床病理参数之间的关联。脂质值既作为连续变量也作为二分变量进行分析。进行单变量和多变量Cox回归分析以确定无复发生存期（RFS）的预测因素。复发定义为前列腺特异性抗原（PSA）水平升高且经证实>0.1 ng/ml。
我们的队列由371名男性组成，中位年龄为63岁（范围41 - 78岁），术前PSA中位值为6.79 ng/ml（0.43 - 81.4 ng/ml）。中位随访时间为28个月（1 - 64个月）。未发现脂质水平与不良病理特征（如≥pT3、Gleason评分≥8、淋巴结阳性状态和手术切缘阳性）之间存在关联。49例患者（15.4%）出现复发，中位复发时间为18个月（2 - 51个月）。在单变量分析中，与低低密度脂蛋白胆固醇相比，高低密度脂蛋白胆固醇与更长的RFS相关（连续变量：风险比（HR）：0.67，95%置信区间（CI）：0.47 - 0.96，P = 0.03；3 mM切点：HR：0.44，95%CI：0.24 - 0.79，P = 0.006）。其他脂质水平和他汀类药物的使用均与RFS无关。在根据年龄、术前PSA、他汀类药物使用、肿瘤分期、Gleason评分、淋巴结状态和手术切缘状态进行调整的多变量模型中，术前低密度脂蛋白胆固醇仍然是PCa复发的独立预测因素（连续变量：HR：0.66，95%CI：0.44 - 0.99，P = 0.04；3 mM切点：HR：0.41，95%CI：0.21 - 0.78，P = 0.007）。
这是第一项前瞻性研究，表明术前低密度脂蛋白胆固醇水平低在接受RP的局限性PCa患者中具有潜在的不良和独立预后作用。《前列腺》77:549 - 556，2017。©2017威利期刊公司。
