High-density lipoprotein cholesterol as a predictor of poor survival in patients with nasopharyngeal carcinoma
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Yan-Yan Liu1,2,#, Shao-Jun Lin3,#, Yuan-Yuan Chen4,#, Li-Na Liu5, Liu-Bin Bao5, Lin-Quan Tang1, Jing-Song Ou6, Zhi-Gang Liu7, Xiao-Zhong Chen4, Yan Xu4, Jun Ma1, Anthony T. Chan8, Ming Chen4, Yun-Fei Xia1, Wan-Li Liu1, Yi-Xin Zeng1, Hai-Qiang Mai1, Mu-Sheng Zeng1, Jian-Ji Pan3,*, Xing Zhang1,*
1Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
2Division of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
3Department of Radiation Oncology, Fujian Provincial Cancer Hospital Affiliated to Fujian Medical University, Fuzhou, China
4Department of Radiation Oncology, Zhejiang Cancer Hospital/Zhejiang Key Laboratory, Hangzhou, China
5Department of Oncology, The Second Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
6Division of Cardiac Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
7Department of Radiation Oncology, Hunan Provincial Tumor Hospital, Tumor Hospital Xiangya School of Medicine of Central South University, Changsha, China
8Partner State Key Laboratory of Oncology in South China at Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Shatin, Hong Kong
*These authors have contributed equally and share senior authorship
#These authors have contributed equally to this work
Xing Zhang, email: firstname.lastname@example.org
Keywords: high-density lipoprotein cholesterol, nasopharyngeal carcinoma, prognosis
Received: November 22, 2015 Accepted: January 19, 2016 Published: February 03, 2016
Purpose: We aimed to assess the prognostic value of pretreatment high density lipoprotein cholesterol (HDL-C) levels in patients with nasopharyngeal carcinoma (NPC) and investigate the possible biological effects of these lipoproteins on NPC cells in vitro.
Experimental Design: We examined the prognostic value of pretreatment HDL-C levels in 2443 patients with non-metastatic NPC from three independent institutions. The Cox proportional hazard model and log-rank test were used to analyze the correlation between HDL-C levels and overall survival (OS). Cell growth, colony formation, and apoptotic assays were used to determine the biological functions of HDL on NPC cells in vitro. All of the statistical tests were two-sided.
Results: OS was decreased in patients with high pretreatment HDL-C levels compared with those with low HDL-C levels (P < 0.05). Similarly, a decreased OS was noted in advanced stage (stage III-IV), NPC patients with high pretreatment HDL-C levels (P < 0.01). Multivariate analyses indicated that HDL-C was an independent prognostic factor associated with shorter OS in training cohorts. These findings were confirmed in both independent validation cohorts (P < 0.01). In vitro experiments demonstrated that HDL could increase cell proliferation, invasion, and colony formation, which were largely dependent on the expression of its receptor SR-B1. Finally, HDL could enhance chemoresistance by protecting cancer cells from apoptosis.
Conclusions: Pretreatment HDL-C is a poor prognostic factor for patients with NPC. This effect may be associated with the ability of HDL to enhance proliferation, colony formation, migration, and chemoresistance in NPC cells.
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