Introduction
Gastric cancer is the second leading cause of cancer-related deaths worldwide.1 High-density lipoprotein cholesterol (HDL-C) reduces cardiovascular disease and related mortality. Moreover, HDL-C has been reported to contribute to the development and prognosis of several cancers.2-4 However, studies on the effects of HDL-C on gastric cancer mortality are few, and the results are inconsistent.
Aims & Methods
In this study, we investigated the effects of HDL-C on gastric cancer mortality and conducted sub-group analysis by sex and treatment modality. We used data from the National Health Insurance Service System (NHISS) to investigate the effects of HDL-C levels on mortality in patients with gastric cancer. Newly diagnosed patients with gastric cancer (n=22,468) who underwent gastric cancer screening between January 2011 and December 2013 were included and followed-up until 2018. We validated our main results using data from a university hospital cohort. A validation cohort (n=3,379) that had newly diagnosed gastric cancer from 2005 to 2013 at a university hospital, was followed up until 2017. Furthermore, we analyzed the effects of HDL-C levels according to sex and treatment modality (endoscopic resection and gastrectomy).
Results
HDL-C was inversely related with mortality; adjusted hazard ratio (aHR) 0.90 (95% confidence interval [CI], 0.83–0.98) for HDL-C of 40–49 mg/dL, 0.86 (0.79–0.93) for HDL-C of 50–59 mg/dL, 0.82 (0.74–0.90) for HDL-C of 60–69 mg/dL, and 0.78 (0.69–0.87) for HDL-C ≥ 70 mg/dL compared to HDL-C < 40 mg/dL. In the validation cohort, HDL-C was also inversely associated with mortality; aHR 0.81 (0.65–0.99) for HDL-C of 40–49 mg/dL, 0.64 (0.50–0.82) for HDL-C of 50–59 mg/dL, and 0.46 (0.34–0.62) for HDL-C ≥ 60 mg/dL compared to HDL-C < 40 mg/dL. The two cohorts demonstrated consistent favorable effects of higher HDL-C on mortality in both sexes. In validation cohort, the beneficial effect of HDL-C was observed in both gastrectomy and endoscopic resection (P for trend <0.001) with more remarkable in endoscopic resection group.
Conclusion
In this study, we explored that an increased HDL-C reduced mortality in both sexes and curative resection group. Hence, HDL-C could be considered in the prognosis of gastric cancer.
References
1. Sung, H.; Ferlay, J.; Siegel, R.L.; Laversanne, M.; Soerjomataram, I.; Jemal, A.; Bray, F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021, 71, 209–249.
2. Katzke, V.A.; Sookthai, D.; Johnson, T.; Kühn, T.; Kaaks, R. Blood lipids and lipoproteins in relation to incidence and mortality risks for CVD and cancer in the prospective EPIC-Heidelberg cohort. BMC Med. 2017, 15, 218.
3. Cedó, L.; Reddy, S.T.; Mato, E.; Blanco-Vaca, F.; Escolà-Gil, J.C. HDL and LDL: Potential New Players in Breast Cancer Development. J Clin Med. 2019, 8.
4. Nam, S.Y.; Park, B.J.; Nam, J.H.; Kook, M.C. Effect of Helicobacter pylori eradication and high-density lipoprotein on the risk of de novo gastric cancer development. Gastrointest Endosc. 2019, 90, 448-456.e1.
