Abstract
BackgroundCancer 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.MethodsNSCLC 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.ResultsSerum 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).ConclusionsAdjuvant 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.
Highlights
Cancer patients often exhibit chemotherapy-associated changes in serum lipid profiles, their prognostic value before and after adjuvant chemotherapy on survival among non-small-cell lung cancer (NSCLC) patients is unknown
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
The results suggested that NSCLC patients with a serum HDL-C level that increased by 0.32 mmol/L or above after chemotherapy had an inferior disease-free survival (DFS) (HDL-C fluctuation < 0.32 vs. ≥0.32mmol/L: median DFS: 49.70 vs. 19.17 months, P = 0.0069) (Table 5, and Fig. 3C)
Summary
Cancer patients often exhibit chemotherapy-associated changes in serum lipid profiles, their prognostic value before and after adjuvant chemotherapy on survival among non-small-cell lung cancer (NSCLC) patients is unknown. Lung cancer (LC) is the most common cancer, with 80 −85% of cases non-small-cell lung cancer (NSCLC) [1,2,3]. Almost one-third of NSCLC patients are candidates for resection [4, 5], and the number is increasing thanks to more and improved lung cancer screening [6]. For stage II–IIIA patients undergoing radical resection, adjuvant chemotherapy is recommended as the standard of care to improve outcomes [8]. The tumor, node, and metastasis staging system is the most discriminative indicator of prognostic value [7].
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