Preoperative total serum cholesterol as a prognostic factor for survival in patients with resectable non-small-cell lung cancer
BACKGROUND: Coexisting hypocholesterolemia in cancer has been known for a very long time but its relationship to cancer is still controversial. Hypocholesterolemia has been reported in patients with lung cancer, although its association with survival has not been explored. OBJECTIVES: The purpose of the study was to determine whether preoperative total serum cholesterol is a prognostic factor for survival after lung cancer resection. METHODS: The retrospective study comprised 198 patients (162 men, 36 women) operated upon for resectable non-small-cell lung cancer (clinical stages I–IIIB) between January 1992 and April 1994. Total serum cholesterol concentration was determined preoperatively in each patient. The effects of sex, age, stage, histological type and preoperative total serum cholesterol concentration on survival were tested in univariate and multivariate analysis. RESULTS: Preoperative total serum cholesterol was a significant prognostic factor in both univariate and multivariate analysis. The median value for total serum cholesterol was 5.3 mmol/l and patients below that cut-off had significantly shorter overall survival times than patients in the high cholesterol group (5-year survival 41% vs. 56%, P < 0.05). In a multivariate Cox proportional-hazard regression model, only stage and preoperative total serum cholesterol were found to be of significance for survival (relative risk 0.84 for each mmol/l increase in concentration, CI 0.71–1.00, P < 0.05). CONCLUSIONS: Our results suggest that preoperative total serum cholesterol may be an important prognostic factor for overall survival after lung cancer resection. It may prove to be a valuable tool in the follow-up of patients with lung cancer and in detection of high-risk cases.