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Serum HDL-C as a Potential Biomarker for Nodal Stages in Gastric Cancer

¹ Department of Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, P.R. China 310009
² Department of Pathology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

Correspondence: Address correspondence and reprint requests to: Yulian Wu, MD; E-mail: wuyulian{at}medmail.com.cn

Background: Although changes in lipid profile have been documented in gastrointestinal cancers, the specific relationship between serum lipid levels and lymph node (N) stages in gastric cancer remains uncertain.

Methods: Preoperative serum lipid concentrations were retrospectively examined in 501 patients who underwent curative resection for primary gastric cancer. Univariate and multivariate analyses were carried out to investigate the association of serum lipid levels with nodal stages.

Results: The serum high-density lipoprotein cholesterol (HDL-C) levels in gastric cancer patients correlated well with N stages. Cases with low HDL-C (<40 mg/dl) presented more advanced pN_2–3 disease (57.6%, 83/144) than those with normal HDL-C (36.4%, 130/357; P<0.05). The observed elevation of the TC/HDL-C ratio for patients with pN_2–3 disease was statistically significant when compared with that for patients with pN_0–1 disease (mean values 3.57 vs. 3.31, P < 0.05). By receiver operating characteristic analysis, the combination of serum HDL-C concentration and TC/HDL-C ratio led to a sensitivity of 70.0% and a specificity of 51.0% in predicting stage pN_2–3. A logistic regression model revealed that both low HDL-C (<40 mg/dl) and high TC/HDL-C ratio ( 3.32) had an independent association with advanced pN_2–3 stages. When patients’ lipid levels were stratified by means of histological differentiation, the significant correlation of serum HDL-C levels with nodal stages was only detected in differentiated gastric cancer.

Conclusions: For gastric cancer patients, preoperative low serum HDL-C concentration or high TC/HDL-C ratio might be a potential biomarker of advanced pN_2–3 stages, especially for those with the histologically differentiated type.

Key Words: Gastric cancer • HDL-C • Lymph node (N) stages • TC/HDL-C ratio