Predictive value of a reduction in the level of high-density lipoprotein-cholesterol in patients with non-small-cell lung cancer undergoing radical resection and adjuvant chemotherapy: a retrospective observational study

Abstract

Background Cancer patients often exhibit chemotherapy-associated changes in serum lipid profiles, however, their prognostic value before and after adjuvant chemotherapy on survival among non-small-cell lung cancer (NSCLC) patients is unknown. Methods NSCLC patients undergoing radical resection and subsequent adjuvant chemotherapy from 2013 to 2017 at Sun Yat-sen University Cancer Center were retrospectively reviewed. Fasted serum lipid levels were measured before and after chemotherapy. The optimal lipid cut-off values at baseline and fluctuation were determined using X-tile™. The fluctuations in serum lipid levels and disease-free survival (DFS) were assessed. Results Serum cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglyceride, apolipoprotein (Apo) A-I, and ApoB all significantly increased after adjuvant chemotherapy. X-tile determined 1.52 mmol/L of HDL-C and 0.74 g/L of ApoB as the optimal cut-off values before chemotherapy. Patients with HDL-C ≥ 1.52 mmol/L (median DFS: not reached vs. 26.30 months, P = 0.0005) and a decreased HDL-C level after adjuvant chemotherapy (median DFS: 80.43 vs. 26.12 months, P = 0.0204) had a longer DFS. An HDL-C level that increased by ≥ 0.32 mmol/L after chemotherapy indicated a worse DFS. A high baseline ApoB level were associated with a superior DFS. In the univariate analysis and the multivariate Cox analyses, a high baseline HDL-C level and a HDL-C reduction after adjuvant chemotherapy were independent indicators for superior DFS. High baseline HDL-C was related to N0-1 stage (χ2 = 6.413, P = 0.011), and HDL-C fluctuation was significantly correlated with specific chemotherapy regimens (χ2 = 5.002, P = 0.025). Conclusions Adjuvant chemotherapy increased various lipid levels in resected NSCLC patients. A higher HDL-C level before chemotherapy and a reduced HDL-C level after adjuvant chemotherapy were independent predictors of longer DFS in patients with curable NSCLC.

Preoperative Serum Triglyceride to High-Density Lipoprotein Cholesterol Ratio Can Predict Prognosis in Non-Small Cell Lung Cancer: A Multicenter Retrospective Cohort Study

“…A retrospective study of Ma et al [ 25 ] proved the association of the preoperative upregulated TG and downregulated HDL-C with an unfavorable prognosis in patients who died from NSCLC. Furthermore, Luo et al [ 26 ] reported that relatively high HDL-C before adjuvant chemotherapy were independent prognostic factors with longer disease-free survival for NSCLC patients. Meanwhile, Lv et al [ 30 ] revealed that the decrease in HDL-C level could indicate liver dysfunction caused by adjuvant chemotherapy in NSCLC, which partly supported the predictive significance of TG/HDL-C for patient prognosis.…”

“…Additionally, the correlation of TG and HDL-C levels with cancer prognosis is not well characterized, especially in the context of NSCLC. In only limited studies, serum TG or HDL-C was linked to the prognosis of NSCLC patients [ 25 , 26 , 27 ].…”

Cancer therapy's impact on lipid metabolism: Mechanisms and future avenues

“…Histologic review of sacrificed rats showed evidence of myofibrillar loss and vessel wall thickening in those treated with cisplatin but not oxaliplatin, but these results have not been replicated in human studies. In clinical studies in humans, an adjuvant combination regimen primarily composed of cisplatin, carboplatin, and nedaplatin was found to be associated with increased levels of TC, LDL, HDL, and TG at the end of the treatment period ( 76 ). However, in two other studies in human subjects, no changes in plasma cholesterol were seen shortly after cisplatin therapy ( 77 ) nor after >5 year follow up ( 74 ).…”

Statin Use in Cancer Patients with Acute Myocardial Infarction and Its Impact on Long-Term Mortality

“…Importantly, patients with active neoplastic disease are most often excluded from randomized controlled trials [ 3 ]. The ESC expert document on cancer treatments and cardiovascular toxicity also does not address the issue of optimal lipid-lowering treatment in patients with active cancer and MI [ 5 ], despite surprisingly reported lower levels of low-density lipoprotein (LDL) cholesterol in patients with MI and cancer than non-cancer ones (risk ratio 0.87, 95% confidence interval (CI) 0.85–0.89) [ 6 ] and the fact that neoplastic treatment changes the lipid profile to pro-atherogenic [ 7 , 8 , 9 ]. This problem is especially urgent since statins, due to their pleiotropic effects, constitute another potentially useful anticancer pharmacotherapy [ 10 ].…”