Original Study| Volume 15, ISSUE 6, e935-e941, December 2017

Preoperative Cholesterol Level Is Associated With Worse Pathological Outcomes and Postoperative Survival in Localized Renal Cell Carcinoma Patients: A Propensity Score–Matched Study



      Lipid metabolism has been suggested to be associated with clinical outcomes of renal cell carcinoma (RCC). In this study, we aimed to investigate the relationship between preoperative cholesterol level (PCL) and postoperative outcomes of patients with localized RCC.

      Materials and Methods

      We retrospectively analyzed the data of 5022 patients surgically treated for nonmetastatic RCC. According to the receiver operating curve of PCL for cancer-specific mortality, we stratified the patients into 2 groups by using a cutoff value of 161 mg/dL. The propensity scores for having low PCL were calculated, and the low PCL group was matched with the high PCL group at a 1:2 ratio. The oncological profiles and postoperative survival of patients were compared.


      A low cholesterol level was significantly associated with adverse pathologic findings, such as higher pathologic stage (P < .001) and large tumor size (P = .002). Furthermore, the low cholesterol group showed significantly worse progression-free, cancer-specific, and overall survival (all P values < .001) compared with the high cholesterol group. Multivariate analysis exhibited a higher PCL as an independent predictor of better progression-free (P < .001), cancer-specific (P = .018), and overall survival (P = .001) after matching. Subgroup analysis according to tumor histology revealed that PCL had a significant relationship with patients' survival in clear cell RCC, but not in non–clear cell RCC.


      Decreased PCL was significantly associated with worse pathologic outcomes and also inferior postoperative survival in patients with localized RCC; however, those relationships were significant only in clear cell subtypes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Genitourinary Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ferlay J.
        • Soerjomataram I.
        • Dikshit R.
        • et al.
        Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.
        Int J Cancer. 2015; 136: E359-E386
        • Ferlay J.
        • Steliarova-Foucher E.
        • Lortet-Tieulent J.
        • et al.
        Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012.
        Eur J Cancer. 2013; 49: 1374-1403
        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2016.
        CA Cancer J Clin. 2016; 66: 7-30
        • Motzer R.J.
        • Jonasch E.
        • Agarwal N.
        • et al.
        Kidney cancer, version 3.2015.
        J Natl Compr Canc Netw. 2015; 13: 151-159
        • Choi Y.
        • Park B.
        • Jeong B.C.
        • et al.
        Body mass index and survival in patients with renal cell carcinoma: a clinical-based cohort and meta-analysis.
        Int J Cancer. 2013; 132: 625-634
        • Albiges L.
        • Hakimi A.A.
        • Xie W.
        • et al.
        Body mass index and metastatic renal cell carcinoma: clinical and biological correlations [e-pub ahead of print].
        J Clin Oncol. 2016; (
        • Hakimi A.A.
        • Furberg H.
        • Zabor E.C.
        • et al.
        An epidemiologic and genomic investigation into the obesity paradox in renal cell carcinoma.
        J Natl Cancer Inst. 2013; 105: 1862-1870
        • Lingwood D.
        • Simons K.
        Lipid rafts as a membrane-organizing principle.
        Science. 2010; 327: 46-50
        • Edge S.B.
        • Compton C.C.
        The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.
        Ann Surg Oncol. 2010; 17: 1471-1474
        • Kovacs G.
        • Akhtar M.
        • Beckwith B.J.
        • et al.
        The Heidelberg classification of renal cell tumours.
        J Pathol. 1997; 183: 131-133
        • Fuhrman S.A.
        • Lasky L.C.
        • Limas C.
        Prognostic significance of morphologic parameters in renal cell carcinoma.
        Am J Surg Pathol. 1982; 6: 655-663
        • Ye J.
        • DeBose-Boyd R.A.
        Regulation of cholesterol and fatty acid synthesis.
        Cold Spring Harb Perspect Biol. 2011; 3
        • Heart Protection Study Collaborative Group
        MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial.
        Lancet. 2002; 360: 7-22
        • Warburg O.
        On respiratory impairment in cancer cells.
        Science. 1956; 124: 269-270
        • Menendez J.A.
        • Lupu R.
        Fatty acid synthase and the lipogenic phenotype in cancer pathogenesis.
        Nat Rev Cancer. 2007; 7: 763-777
        • Iso H.
        • Ikeda A.
        • Inoue M.
        • Sato S.
        • Tsugane S.
        • JPHC Study Group
        Serum cholesterol levels in relation to the incidence of cancer: the JPHC study cohorts.
        Int J Cancer. 2009; 125: 2679-2686
        • Asano K.
        • Kubo M.
        • Yonemoto K.
        • et al.
        Impact of serum total cholesterol on the incidence of gastric cancer in a population-based prospective study: the Hisayama study.
        Int J Cancer. 2008; 122: 909-914
        • Ahn J.
        • Lim U.
        • Weinstein S.J.
        • et al.
        Prediagnostic total and high-density lipoprotein cholesterol and risk of cancer.
        Cancer Epidemiol Biomarkers Prev. 2009; 18: 2814-2821
        • Mondul A.M.
        • Clipp S.L.
        • Helzlsouer K.J.
        • et al.
        Association between plasma total cholesterol concentration and incident prostate cancer in the CLUE II cohort.
        Cancer Causes Control. 2010; 21: 61-68
        • Kitahara C.M.
        • Berrington de González A.
        • Freedman N.D.
        • et al.
        Total cholesterol and cancer risk in a large prospective study in Korea.
        J Clin Oncol. 2011; 29: 1592-1598
        • Linehan W.M.
        • Srinivasan R.
        • Schmidt L.S.
        The genetic basis of kidney cancer: a metabolic disease.
        Nat Rev Urol. 2010; 7: 277-285
        • Pinthus J.H.
        • Whelan K.F.
        • Gallino D.
        • Lu J.P.
        • Rothschild N.
        Metabolic features of clear-cell renal cell carcinoma: mechanisms and clinical implications.
        Can Urol Assoc J. 2011; 5: 274-282
        • Chen L.
        • Li H.
        • Gu L.
        • et al.
        The impact of diabetes mellitus on renal cell carcinoma prognosis: a meta-analysis of cohort studies.
        Medicine (Baltimore). 2015; 94: e1055
        • Yu M.C.
        • Mack T.M.
        • Hanisch R.
        • Cicioni C.
        • Henderson B.E.
        Cigarette smoking, obesity, diuretic use, and coffee consumption as risk factors for renal cell carcinoma.
        J Natl Cancer Inst. 1986; 77: 351-356
        • Jeon H.G.
        • Choi D.K.
        • Sung H.H.
        • et al.
        Preoperative prognostic nutritional index is a significant predictor of survival in renal cell carcinoma patients undergoing nephrectomy.
        Ann Surg Oncol. 2016; 23: 321-327
        • Saito K.
        • Arai E.
        • Maekawa K.
        • et al.
        Lipidomic signatures and associated transcriptomic profiles of clear cell renal cell carcinoma.
        Sci Rep. 2016; 6: 28932
        • Gebhard R.L.
        • Clayman R.V.
        • Prigge W.F.
        • et al.
        Abnormal cholesterol metabolism in renal clear cell carcinoma.
        J Lipid Res. 1987; 28: 1177-1184
        • Drabkin H.A.
        • Gemmill R.M.
        Cholesterol and the development of clear-cell renal carcinoma.
        Curr Opin Pharmacol. 2012; 12: 742-750
        • Ohno Y.
        • Nakashima J.
        • Nakagami Y.
        • et al.
        Clinical implications of preoperative serum total cholesterol in patients with clear cell renal cell carcinoma.
        Urology. 2014; 83: 154-158
        • de Martino M.
        • Leitner C.V.
        • Seemann C.
        • et al.
        Preoperative serum cholesterol is an independent prognostic factor for patients with renal cell carcinoma (RCC).
        BJU Int. 2015; 115: 397-404