A new use for an old index: preoperative high-density lipoprotein predicts recurrence in patients with hepatocellular carcinoma after curative resections

Abstract

BackgroundHepatocellular carcinoma has high incidence and mortality worldwide. Liver is the site of most metabolic biotransformation, which could reflect the status of cells. Most plasma apolipoproteins, endogenous lipids and lipoproteins are synthesized in the liver. Therefore, the effects of lipid metabolites on prognosis of HCC deserved to be explored.MethodsWe prospectively included 58 healthy donors (HD), 50 chronic hepatitis (CH) patients and a training cohort of 189 patients with HCC who underwent curative resections at Zhongshan Hospital from January 2012 to August 2012. We identified the optimal HDLPO cutoff value at 0.98 mmol/L and used it to stratify patients into low- or high-HDLPO groups for the entire cohort and four low-recurrent-risk subgroups. We also included an independent validation group of 182 HCC patients to validate this cutoff value. Prognostic values of HDLPO and other factors were determined by Kaplan–Meier curves and the Cox proportional hazards model.ResultsThe low-HDLPO group had a higher median tumor grade (P = 0.020) and a higher recurrence rate (P = 0.032). Results of multivariate analysis showed that preoperative γ-glutamyl transpeptidase (GGT) and HDLPO were independent predictors of recurrence. Moreover, the predictive value of HDLPO was retained in four low-recurrent-risk subgroups. As expected, clinicopathologic characteristics and predictive values were similar in the validation and training cohorts.ConclusionsHDLPO is an accessible predictor of HCC recurrence after liver resections that can help identify patients who need more careful monitoring and follow-up care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12944-017-0509-3) contains supplementary material, which is available to authorized users.

Low high-density lipoprotein cholesterol levels are associated with malignant intraductal papillary mucinous neoplasms: A multicenter study

“…The association between high density lipoprotein-cholesterol (HDL-c) and cancer risk is also reported, including breast cancer [ 12 , 17 ], prostate and ovarian cancer [ 12 ]. A similar correlation was also observed between HDL-c levels and risk of gastrointestinal cancer, such as liver cancer [ 18 , 19 ], biliary tract cancer [ 20 , 21 ] and pancreatic cancer [ 12 , 22 , 23 ]. However, to our knowledge, no study has investigated the association between HDL-c levels and IPMNs.…”

“…Compared with the control group, patients with pancreatic cancer showed at least 2-fold lower serum apolipoprotein A-II, transthyretin, and apolipoprotein A-I levels [ 31 ]. HDL-c levels were inversely associated with the risk of liver cancer [ 18 ], and preoperative HDL-c levels were associated with the risk of cancer recurrence [ 19 ]. Compared with the reference group, patients in the lowest quintile of HDL-c (< 30 mg/dL) had an 11.6-fold higher risk of gallbladder cancer and a 16.8-fold higher risk of bile duct cancer [ 21 ].…”

“…The medical history of pancreatitis and diabetes mellitus (DM) was also collected. A cut-off value of 0.7 mmol/L was chosen for HDL-c levels based on previous studies [ 19 , 22 ]. Fasting and 2-hour plasma glucose levels were determined within one week preoperatively.…”

Effect of serum triglyceride level on the prognosis of patients with hepatocellular carcinoma in the absence of cirrhosis

“…Previous studies suggested that dyslipidemia was a newly identified risk factor in the survival of several cancers such as colorectal, breast, and prostate cancers [ 15 , 16 , 18 ]. Although one study demonstrated that preoperative HDL level was a predictor of HCC recurrence after liver resections [ 22 ]; recently, there were few studies that addressed the association between lipid profiles and the outcome of liver cancer. In our study, we found that a decreased TG level in the baseline was an independent risk factor of OS in patients with HCC without cirrhosis.…”

“…Furthermore, the prognostic effect of lipid profiles on HCC remains unclear. Few studies indicated that low cholesterol and HDLc levels could predict the recurrence of HCC in patients after liver resections[ 22 ]. However, whether the alterations of lipid profiles are correlated with HCC prognosis is unclear.…”