Elsevier

The Breast

Volume 32, April 2017, Pages 1-6
The Breast

Original article
The effect of preoperative serum triglycerides and high-density lipoprotein-cholesterol levels on the prognosis of breast cancer

https://doi.org/10.1016/j.breast.2016.11.024Get rights and content

Highlights

  • The cutoff value to stratify patients at high risk of death was established by receiver-operating curve analyses.

  • Preoperative serum different levels of lipids may be independent prognostic factor in breast cancer patients.

  • Surveillance and control the level of lipids may improve the prognosis of patients with breast cancer.

Abstract

Objectives

Although dyslipidemia has been documented to be associated with several types of cancer including breast cancer, it remains uncertainty the prognostic value of serum lipid in breast cancer. The purpose of this study is to evaluate the association between the preoperative plasma lipid profile and the prognostic of breast cancer patients.

Methods

The levels of preoperative serum lipid profile (including cholesterol [CHO], Triglycerides [TG], high-density lipoprotein-cholesterol [HDL-C], low-density lipoprotein-cholesterol [LDL-C], apolipoprotein A-I [ApoAI], and apolipoprotein B [ApoB]) and the clinical data were retrospectively collected and reviewed in 1044 breast cancer patients undergoing operation. Kaplan-Meier method and the Cox proportional hazards regression model were used in analyzing the overall survival [OS] and disease-free survival [DFS].

Results

Combining the receiver-operating characteristic and Kaplan-Meier analysis, we found that preoperative lower TG and HDL-C level were risk factors of breast cancer patients. In multivariate analyses, a decreased HDL-C level showed significant association with worse OS (HR: 0.528; 95% CI: 0.302–0.923; P = 0.025), whereas a decreased TG level showed significant association with worse DFS (HR: 0.569; 95% CI: 0.370–0.873; P = 0.010).

Conclusions

Preoperative serum levels of TG and HDL-C may be independent factor to predict outcome in breast cancer patient.

Introduction

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer-related death among women worldwide. According to the American Cancer Society, breast cancer alone is expected to account for 29% all new cancer diagnoses in women and lead to 40,890 deaths in the United States in 2016 [1]. Although death rates for female breast cancer are down 36% from peak rates as a result of early diagnosis and treatment [2], it is still a heavy burden on patients. Thus, it is important to search for minimally invasive methods and prognostic factors to identify breast cancer.

Abnormal lipid and lipoprotein metabolism, as a result of high-fat diet as well as physical inactivity, was considered to be related to several types of cancer [3], [4], [5]. Cholesterol plays an important role in cellular structure and function, especially the synthesis of steroid hormones, which may implicate in the etiology of breast cancer [6], [7]. A previous research revealed that oxysterol 27-hydroxycholesterol, the primary metabolite of cholesterol, can increase tumor growth and metastasis in mouse models of breast cancer [8], meanwhile abnormal cholesterol biosynthesis contribute to breast cancer development and progression [9]. Furthermore, prospective clinical studies data have provided that high level of total cholesterol [TC] may increase both breast cancer incidence [10], [11] and overall mortality [12]. However, the other authors showed that negative association between TC levels and breast cancer [13], [14], on the contrary, high level of TC even have a protective effect [15].

High and low density serum lipoproteins play a fundamental role in supplying of cholesterol to cancer cells and tumors, potentially via receptor mediated mechanisms [16]. However, researches about the effect of lipoproteins in breast cancer were also contradictory. Regarding high density serum lipoproteins, some prospective studies showed that low level can increase breast cancer risk [17], [18] and high level may be a protective effect in premenopausal patient [19]; while other studies revealed that a positive correlation between high level and breast cancer risk [20]. Regarding low density serum lipoproteins, it has been reported that high level at diagnosis was associated with poor disease free survival [21]. The aim of this study was to investigate the prognostic value of serum lipids and lipoproteins in patients of breast cancer.

Section snippets

Patient selection and clinical data collection

A total of 1044 patients diagnosed with breast cancer who were undergoing resection of primary tumor at Sun Yat-sen University Cancer Center between 2008 and 2011 were collected in the present study. All patients were eligible for inclusion in the study: (1) without cancer history; (2)without using hormone replacement therapy influencing in lipid metabolism; (3) without distant metastases (4)serum samples (including cholesterol, triglycerides, high-density lipoprotein-cholesterol [HDL-C],

Characteristics of all patients

A total of 1044 patients who were diagnosed with breast cancer and underwent radical surgical resection were enrolled in the analysis. The median age was 47 years (range: 22–85 years) and nearly one-tenth patients (9.6%) were under age 35years, and 602 (57.7%) patients were premenopausal. According to the pTNM classification for breast cancer, 211(20.2%), 494(47.3%) and 287 (27.5%) were staged in I, II, III respectively. Most of the patients (767, 73.5%) molecular type pathological were Luminal

Discussion

Breast cancer is the most commonly diagnosed cancer in women, it is important to identify the risk factors for tumor relapse and enhance the surveillance to reduce the rate of recurrence and improve the quality of life for patients. The diagnosis of breast cancer relies on using clinical and physical examinations, such as mammography imaging and ultrasound, and histopathology. However, the use of tumor marker tests have not yet played a major role in the prevention, screening, treatment, and

Conclusion

In conclusion, this study indicated that TG and HDL-C levels at diagnosis may be considered as independent prognostic factors for breast cancer, it may be beneficial to adjust these parameters to normal or higher levels with appropriate treatments in addition to routine cancer therapies. Meanwhile, further prospective and multiple center studies are still required.

Consent for publication

Written informed consent about the researchable use of the clinical data was obtained from each participant patient. All patient data were anonymous and de-identified prior to analysis.

Ethical approval and consent to participate

All procedures performed in this study involving human participants were approved by Ethics Committees of Sun Yat-Sen University Cancer Center and were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Acknowledgements

This study was supported by Medical Scientific Research Foundation of Guangdong Province, China (grand number B2014159) and The National Natural Science Foundation of China (grand number 81672598, 81472575, 81472469 and 81272514).

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