Pre-Op Cholesterol Level Predicts RCC Patients Survival

Renal cell carcinoma (RCC) is the most frequently diagnosed renal malignancy. The constant advances of modern imaging technologies and the percentage of incidentally detected renal tumors has constantly increased during the last couple of decades, and a good percentage of patients are still diagnosed with metastatic renal cell carcinoma (mRCC).

Lipid metabolism is one of the important tumor metabolic mechanisms that are essential to tumor survival and progression. Since cholesterol is an essential cellular component that plays a crucial role in lipid metabolism, preoperative serum cholesterol level (PCL) may have significant correlation with prognosis in RCC patients.

A large team of scientists led by those at the Seoul National University Bundang Hospital, (Seongnam, South Korea) retrospectively analyzed the data of 244 patients diagnosed with mRCC and initially treated with nephrectomy at multiple centers of South Korea. Every patient was initially evaluated using chest computed tomography (CT) (or simple radiography), abdominal CT, and bone scan. The PCL was included in the routine chemistry panels, which were performed as a part of preoperative anesthetic risk evaluation within 4 weeks preceding the surgery. Patients were stratified into two groups according to the PCL cut-off level of 170 mg/dL.

There were 88 patients in the high PCL group and 156 patients in the low PCL group. The low PCL group showed significantly lower hemoglobin level and higher platelet level than the high PCL group, but no significant differences were noted in the other clinical characteristics or pathological outcomes between the two groups. The median age was 59.0 years; median tumor diameter was 8.0 cm, median PCL was 156.0 mg/dL (interquartile range (IQR), 132.3–173.8 mg/dL), and median follow-up time was 13.0 months. The low cholesterol group showed significantly worse postoperative cancer-specific survival (CSS) and overall survival (OS).

The authors concluded that decreased preoperative serum cholesterol level was significantly correlated with worse survival outcomes in patients with metastatic renal cell carcinoma treated with cytoreductive nephrectomy. The underlined mechanism is still uncharted and requires further investigation. The study was published on May 25, 2017, in the journal BMC Cancer.

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Seoul National University Bundang Hospital