Serum HDL-C as a potential biomarker for nodal stages in gastric cancer

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.