Association of cholesterol and triglyceride levels with the recurrence of early-stage lung adenocarcinoma with micropapillary pattern

Abstract

Background: Lung cancer remains the predominant cause of cancer-related mortality, with adenocarcinoma being the most prevalent histological subtype. Within our nation, lung adenocarcinoma (LUAD) exhibits the highest incidence and mortality rates among all malignant neoplasms. Specifically, the micropapillary subtype of adenocarcinoma is characterized by particularly poor prognosis and significantly reduced survival rate. Accumulated evidence from prior investigations has identified the micropapillary subtype of LUAD as a high-risk factor for distant metastasis and local recurrence. Nevertheless, the precise correlation between postoperative alterations in cholesterol levels, triglyceride levels and the prognosis of patients with micropapillary LUAD remains to be elucidated. This study aimed to the identify factors influencing postoperative metastatic and recurrence in patients with LUAD with micropapillary pattern (MPP).

Methods: A retrospective analysis of 261 patients with MPP and 658 without MPP was conducted, with postoperative pathological analysis determining the MPP. The patients were divided into recurrence (n=58) and non-recurrence (n=203) groups. Postoperative pathological analysis determined the content of micropapillary components in each LUAD case. Patients were categorized into a positive recurrence group (n=58) and a negative recurrence group (n=203). Univariate analyses, logistic multivariate analyses, and survival analyses were performed on the clinical data.

Results: Univariate and multivariate analyses revealed that high MPP, tumor size, and abnormal total cholesterol (TC) and triglyceride levels were independent risk factors for recurrence in patients with MPP but not in patients of pattern without it. Survival analysis showed that abnormal cholesterol and triglyceride levels are risk factors for a poor prognosis in patients with MPP. Additionally, a scoring system was developed to identify high-risk patients among those with MPP.

Conclusions: Abnormal cholesterol levels and abnormal triglyceride levels are high-risk factors for postoperative recurrence and metastasis in patients with LUAD containing micropapillary components. However, for patients with LUAD that does not contain micropapillary components in the postoperative pathology, there is no significant correlation between prognosis and abnormal cholesterol levels or triglyceride levels.

Keywords: Micropapillary; lung adenocarcinoma (LUAD); metastasis; total cholesterol (TC); total triglyceride.

Figure 1

Screening process of MPP cohort and non-MPP cohort. MPP, micropapillary pattern.

Figure 2

Comparison of cholesterol and triglyceride levels between postoperative progression and postoperative non progression patients in the two cohorts. (A) Comparison of cholesterol levels between postoperative progression and postoperative non-progression group. (B) Comparison of triglyceride levels between postoperative progression and postoperative non-progression group. (C) Comparison of MPP between postoperative progression and postoperative non-progression group, the Y axis represents the percentage of micropapillary content. P value is calculated using t-test. MPP, micropapillary pattern.

Figure 3

Survival analysis of MPP cohort. (A) PFS analysis indicated that high cholesterol level and high triglyceride level are associated with poor postoperative prognosis in lung adenocarcinoma patients. (B) OS analysis indicated high cholesterol level and high triglyceride level are associated with poor postoperative prognosis in lung adenocarcinoma patients. MPP, micropapillary pattern; OS, overall survival; PFS, progression-free survival.

Figure 4

The sites for postoperative metastasis and recurrence in MPP cohort. The metastatic sites in patients of MPP cohort with (A) high cholesterol level, (B) low cholesterol level, (C) high triglyceride level. (D) The metastatic sites in patients of MPP cohort with low triglyceride level. MPP, micropapillary pattern.

Figure 5

Prediction of the efficacy of postoperative adjuvant therapy. (A) PFS analysis of patients who received postoperative adjuvant therapy. (B) ROC curve analysis to determine cut-off values. AUC was calculated. (C) Survival analysis results indicated that patients with CHOL-MPP value ≥2.584 and TG-MPP value ≥0.8065 exhibited significantly lower efficacy from postoperative adjuvant therapy. AUC, area under curve; CHOL, cholesterol; CI, confidence interval; MPP, micropapillary pattern; PFS, progression-free survival; ROC, receiver operating characteristic; TG, triglyceride.

Figure 6

Survival analysis of non-MPP cohort. (A) PFS analysis indicated that high cholesterol level and high triglyceride level are not associated with poor postoperative prognosis in non-MPP cohort. (B) OS analysis indicated high cholesterol level and high triglyceride level are not associated with poor postoperative prognosis in non-MPP cohort. MPP, micropapillary pattern; OS, overall survival; PFS, progression-free survival.