High Levels of Low-Density Lipoproteins Correlate with Improved Survival in Patients with Squamous Cell Carcinoma of the Head and Neck

Abstract

Circulating lipoproteins as risk factors or prognostic indicators for various cancers have been investigated previously; however, no clear consensus has been reached. In this study, we aimed at evaluating the impact of serum lipoproteins on the prognosis of patients with squamous cell carcinoma of the head and neck (SCCHN). Levels of total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides and lipoprotein(a) were measured in serum samples from 106 patients and 28 healthy controls. We found that HDL was the only lipoprotein exhibiting a significant difference in concentration between healthy controls and patients (p = 0.012). Kaplan-Meier survival curves indicated that patients with high levels of total cholesterol or LDL had better overall survival than patients with normal levels (p = 0.028 and p = 0.007, respectively). Looking at patients without lipid medication (n = 89) and adjusting for the effects of TNM stage and weight change, multivariate Cox regression models indicated that LDL was an independent prognostic factor for both overall (p = 0.005) and disease-free survival (p = 0.013). In summary, our study revealed that high LDL level is beneficial for survival outcome in patients with SCCHN. Use of cholesterol-lowering medicines for prevention or management of SCCHN needs to be evaluated carefully.

Keywords: SCCHN; lipoprotein; prognosis.

Figure 1

Box plots of serum lipoprotein levels in healthy controls and patients with SCCHN. (A) Levels of total cholesterol, low-density lipoproteins (LDL) and high-density lipoproteins (HDL). (B) Patients were divided into four subgroups according to tumor locations. (C) Levels of triglycerides (TGs) in healthy controls and patients with different timepoints of blood collection. (D) Levels of lipoprotein(a) in healthy controls and patients with different timepoints of blood collection. Small circles indicate outliers and asterisks indicate extreme outliers.

Figure 2

Kaplan–Meier curves showing the impact of lipoprotein levels on the overall survival of patients with SCCHN. (A) Comparison between cholesterol-high and cholesterol-normal patients. (B) The impact of cholesterol levels on the overall survival was investigated only for patients without cholesterol-lowering drugs. (C) Patients were grouped according to the lipid medication status and cholesterol levels. (D) Comparison between LDL-high and LDL-normal patients. (E) The impact of LDL levels on the overall survival was investigated only for patients without cholesterol-lowering drugs. (F) Patients were grouped according to the lipid medication status and LDL levels. (G) Comparison between HDL-low and HDL-normal patients. (H) Comparison between TGs-high and TGs-normal patients (only the samples taken at fasting were analyzed). (I) Comparison between lipoprotein(a)-risk and lipoprotein(a)-normal patients (only the samples taken at fasting were analyzed). (J). Comparison of patients with different BMI levels.