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

Micro-Abstract In patients with localized renal cell carcinoma, those with low cholesterol level showed worse pathologic outcomes and inferior postoperative survival. We found that those relationships were related to the clear cell subtype. Further basic research focusing on the underlying mechanism is required. Introduction 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. Results 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. Conclusion 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.