01.12.2017 | Research article | Ausgabe 1/2017 Open Access

Preoperative cholesterol level as a new independent predictive factor of survival in patients with metastatic renal cell carcinoma treated with cyto-reductive nephrectomy
- Zeitschrift:
- BMC Cancer > Ausgabe 1/2017
Background
Methods
Results
Entire patients (
n = 244)
|
High PCL group (
n = 72)
|
Low PCL group (
n = 172)
|
p value
|
|
---|---|---|---|---|
Median (IQR) or Number (percent)
|
||||
Age (y)
|
59.0 (52.0–68.0)
|
57.5 (52.0–67.0)
|
60.0 (51.3–68.8)
|
0.981
|
BMI (
kg/
m
2)
|
23.0 (21.0–24.8)
|
23.5 (21.8–42.8)
|
22.9 (20.8–24.9)
|
0.239
|
Sex (male)
|
185 (75.8%)
|
50 (69.4%)
|
135 (78.5%)
|
0.091
|
Serum Albumin (g/dL)
|
4.0 (3.5–4.3)
|
4.3 (3.9–4.4)
|
3.9 (3.4–4.2)
|
< 0.001
|
Hemoglobin (g/dL)
|
12.1 (10.6–13.6)
|
13.1 (11.7–14.7)
|
11.8 (10.3–13.1)
|
< 0.001
|
Platelet (k/dL)
|
274.5 (132.3–173.8)
|
271.5 (212.5–320.5)
|
299.8 (222.0–378.8)
|
0.038
|
PLC (mg/dL)
|
156.0 (132.3–173.8)
|
190 (178–205.8)
|
139.1 (126.3–157.8)
|
|
Corrected calcium (mg/dL)
|
9.2 (8.9–9.7)
|
9.4 (9.0–9.8)
|
9.5 (8.8–9.6)
|
|
ECOG score (≥2)
|
79 (32.4%)
|
22 (30.6%)
|
57 (33.1%)
|
0.765
|
Diabetes mellitus
|
60 (24.7%)
|
14 (19.7%)
|
46 (26.7%)
|
0.326
|
Hypertension
|
120 (49.6%)
|
33 (46.5%)
|
87 (50.9%)
|
0.574
|
Tumor size (cm)
|
8.0 (5.6–10.5)
|
6.5 (5.0–9.5)
|
8.7 (6.1–11.0)
|
0.407
|
Clinical stage (≥3)
|
138 (56.6%)
|
32 (44.4%)
|
106 (61.6%)
|
0.059
|
Metastatic sites
|
0.541
|
|||
Lung
|
78 (32.0%)
|
23 (31.9%)
|
55 (32.0%)
|
|
Liver
|
7 (2.7%)
|
1 (1.4%)
|
5 (2.9%)
|
|
Bone
|
24 (9.8%)
|
10 (13.9%)
|
14 (8.1%)
|
|
Non-regional LNI
|
2 (1.0%)
|
0 (0%)
|
2 (1.2%)
|
|
Adrenal gland
|
8 (3.3%)
|
4 (5.6%)
|
4 (2.3%)
|
|
Multiple metastasis
|
10 (4.1%)
|
3 (4.2%)
|
7 (4.1%)
|
|
Information missing
|
108 (44.3%)
|
33 (45.8%)
|
75 (43.6%)
|
|
Miscellaneous
|
2 (1.0%)
|
0 (0%)
|
2 (1.2%)
|
|
Pathologic stage
|
0.060
|
|||
pT1
|
60 (24.6%)
|
24 (33.3%)
|
36 (20.9%)
|
|
pT2
|
36 (14.8%)
|
11 (15.3%)
|
25 (14.5%)
|
|
pT3
|
117 (48.0%)
|
33 (45.8%)
|
84 (48.8%)
|
|
pT4
|
31 (12.7%)
|
4 (5.6%)
|
27 (15.7%)
|
|
Fuhrman grade
|
0.424
|
|||
≤ 2
|
34 (13.9%)
|
12 (16.7%)
|
22 (12.8%)
|
|
≥ 3
|
210 (86.1%)
|
60 (83.3%)
|
150 (87.2%)
|
|
Histologic subtype
|
0.214
|
|||
Clear cell
|
213 (87.3%)
|
67 (93.1%)
|
146 (84.9%)
|
|
Papillary
|
13 (5.3%)
|
2 (2.8%)
|
11 (6.4%)
|
|
Chromophobe
|
4 (1.6%)
|
0 (0%)
|
4 (2.3%)
|
|
Collecting duct
|
5 (2.0%)
|
1 (1.4%)
|
4 (2.3%)
|
|
Unclassified
|
9 (3.7%)
|
2 (2.8%)
|
7 (4.1%)
|
Cancer-specific survival
|
Overall survival
|
|||||
---|---|---|---|---|---|---|
HR
|
95% CI of HR
|
p value
|
HR
|
95% CI of HR
|
p value
|
|
Age
|
1.004
|
0.986–1.023
|
0.679
|
1.005
|
0.989–1.023
|
0.530
|
BMI (
kg/
m
2)
|
Reference (< 20)
|
Reference (< 20)
|
||||
20–25
|
0.778
|
0.456–1.327
|
0.356
|
0.783
|
0.478–1.283
|
0.332
|
≥ 25
|
0.373
|
0.182–0.762
|
0.007
|
0.387
|
0.202–0.743
|
0.004
|
Albumin (g/dL)
|
Reference (< 3.5)
|
Reference (< 3.5)
|
||||
3.5–4.3
|
0.610
|
0.375–0.991
|
0.046
|
0.577
|
0.371–0.899
|
0.015
|
≥ 4.3
|
0.515
|
0.290–0.916
|
0.024
|
0.485
|
0.286–0.822
|
0.007
|
Heng’s criteria
|
Reference (Low risk)
|
Reference (Low risk)
|
||||
Intermediate risk
|
1.265
|
0.729–2.198
|
0.403
|
1.188
|
0.720–1.961
|
0.499
|
High risk
|
1.842
|
0.957–3.546
|
0.067
|
1.806
|
0.999–3.266
|
0.050
|
Cholesterol level (cat.)
|
2.251
|
1.285–3.941
|
0.005
|
2.100
|
1.272–3.466
|
0.004
|
Cancer-specific survival
|
Overall survival
|
|||||
---|---|---|---|---|---|---|
HR
|
95% CI of HR
|
p value
|
HR
|
95% CI of HR
|
p value
|
|
Age
|
1.002
|
0.983–1.021
|
0.865
|
1.003
|
0.986–1.021
|
0.713
|
BMI (
kg/
m
2)
|
Reference (< 20)
|
Reference (< 20)
|
||||
20–25
|
0.792
|
0.459–1.369
|
0.404
|
0.805
|
0.485–1.336
|
0.402
|
≥ 25
|
0.443
|
0.202–0.924
|
0.030
|
0.466
|
0.232–0.936
|
0.032
|
Albumin (g/dL)
|
Reference (< 3.5)
|
Reference (< 3.5)
|
||||
3.5–4.3
|
0.776
|
0.440–1.370
|
0.382
|
0.716
|
0.426–1.204
|
0.208
|
≥ 4.3
|
0.784
|
0.399–1.544
|
0.482
|
0.713
|
0.383–1.328
|
0.287
|
Heng’s criteria
|
Reference (Low risk)
|
Reference (Low risk)
|
||||
Intermediate risk
|
1.095
|
0.623–1.926
|
0.752
|
1.033
|
0.619–1.725
|
0.902
|
High risk
|
1.185
|
0.550–2.553
|
0.664
|
1.132
|
0.565–2.270
|
0.727
|
Cholesterol level (cat.)
|
2.162
|
1.221–3.829
|
0.008
|
2.013
|
1.206–3.361
|
0.007
|
Age
|
1.002
|
0.983–1.021
|
0.830
|
1.003
|
0.986–1.021
|
0.701
|
BMI (
kg/
m
2)
|
Reference (< 20)
|
Reference (< 20)
|
||||
20–25
|
0.827
|
0.479–1.430
|
0.497
|
0.857
|
0.517–1.420
|
0.549
|
≥ 25
|
0.462
|
0.214–0.997
|
0.049
|
0.503
|
0.249–1.017
|
0.056
|
Albumin (g/dL)
|
Reference (< 3.5)
|
Reference (< 3.5)
|
||||
3.5–4.3
|
0.882
|
0.498–1.561
|
0.665
|
0.789
|
0.468–1.327
|
0.371
|
≥ 4.3
|
0.892
|
0.437–1.821
|
0.753
|
0.769
|
0.401–1.473
|
0.428
|
Heng’s criteria
|
Reference (Low risk)
|
Reference (Low risk)
|
||||
Intermediate
|
1.060
|
0.601–1.870
|
0.840
|
1.024
|
0.613–1.712
|
0.927
|
High risk
|
1.235
|
0.576–2.649
|
0.588
|
1.193
|
0.596–2.389
|
0.618
|
Cholesterol level (con.)
|
0.993
|
0.987–0.999
|
0.032
|
0.995
|
0.989–1.000
|
0.063
|
Cancer-specific survival
|
Overall survival
|
|||||
---|---|---|---|---|---|---|
HR
|
95% CI of HR
|
p-value
|
HR
|
95% CI of HR
|
p-value
|
|
Entire cohorts
|
2.162
|
1.221–3.829
|
0.008
|
2.013
|
1.206–3.361
|
0.007
|
Subgroups according to the tumor histology
|
||||||
Clear cell histology
|
2.312
|
1.274–4.193
|
0.006
|
2.204
|
1.279–3.799
|
0.004
|
Other histology
|
0.767
|
0.076–7.771
|
0.822
|
0.285
|
0.043–1.879
|
0.192
|
Subgroups according to the Heng’s model
|
||||||
Favorable risk
|
1.556
|
0.487–4.967
|
0.455
|
1.767
|
0.602–5.185
|
0.300
|
Intermediate
|
1.809
|
0.907–3.611
|
0.093
|
1.583
|
0.851–2.947
|
0.147
|
Poor
|
1.538
|
0.339–6.972
|
0.577
|
1.735
|
0.406–7.416
|
0.457
|