Abstract
ABSTRACTPurpose Several studies have demonstrated the strong correlation between the levels of preoperative serum total cholesterol (TC) and the survival of patients with surgically treated renal cell carcinoma (RCC). However, this association remains controversial. We performed a meta-analysis of published reports to evaluate the prognostic significance of the preoperative serum TC levels for patients with surgically treated RCC.Material and Methods The databases from MEDLINE (via PubMed), Embase, Web of Science and Cochrane Library were systematically searched to identify the eligible studies published before August 2019. Multivariate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated through inverse variance by using random-effects models.Results Nine cohort studies comprising 15.609 patients were identified. Low preoperative serum TC levels were associated with poor cancer-specific survival (CSS; HR=0.98, 95% CI: 0.97-0.99; P=0.005; I2=74.2%) and progression-free survival (PFS; HR=0.69, 95% CI: 0.49-0.98; P=0.036; I2=80%) in patients with surgically treated RCC. However, no significant association was observed between low preoperative serum TC levels and shorter overall survival (HR=0.93, 95% CI: 0.87-1.00; P=0.057; I2=86.2%). Sensitivity analyses validated the reliability and rationality of the results.Conclusions Preoperative serum TC level is an independent poor prognostic factor for patients with surgically treated RCC, with lower levels associated with worse CSS and PFS. Hence, this parameter may provide additional guidance in the selection of therapeutic strategies to improve prognosis, considering that cholesterol is a broadly applied routine marker in clinical practice.
Highlights
Renal cell carcinoma (RCC) has long been the third most common malignancy of the urinary tract and accounts for 2%-3% of adult malignant tumours [1, 2]
The results indicated no association between low preoperative serum total cholesterol (TC) levels and Overall survival (OS) (HR=0.93, 95% confidence intervals (CIs): 0.87-1.00; P=0.057; I2=86.2%) (Figure 2)
In the subgroup analysis according to different countries, low preoperative serum TC levels were associated with poor cancer-specific survival (CSS) in studies conducted in Austria [21] and China [25], whereas no significant association was observed in studies conducted in Korea [14, 22, 23] and Japan [24]
Summary
Renal cell carcinoma (RCC) has long been the third most common malignancy of the urinary tract and accounts for 2%-3% of adult malignant tumours [1, 2]. Nephrectomy remains the standard treatment for clinically localised RCC, but 10%-20% of cases may develop metastases [5, 6]. Several clinical risk factors, such as body mass index and nutritional status, have been considered as potential prognostic factors for RCC [10, 11]. A comprehensive systematic review or meta-analysis of the association between levels of preoperative serum TC and survival outcomes of patients with surgically treated RCC has not been performed. Few studies have directly suggested the association between preoperative serum TC levels with worse survival in patients with surgically treated RCC [12,13,14], but conflicting results have been reported [15]. Comprehensive systematic review and meta-analysis are necessary to evaluate the prognostic value of preoperative serum TC levels in patients with surgically treated RCC. The results may be beneficial for treatment selection and postoperative monitoring
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