Gyu Young Pih and Eun Jeong Gong contributed equally to this work.
The association of serum lipids with gastric cancer is controversial. We clarified the role of serum lipids in the development, progression, and prognosis of gastric cancer.
In total, 412 patients diagnosed with gastric cancer were prospectively recruited, and 2,934 control subjects who underwent screening endoscopy were enrolled from December 2013 to March 2017 to conduct a case-control study in a tertiary center. Serum lipid profiles, including total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), apolipoprotein A-I (apoA-I), and apolipoprotein B, and clinicopathologic characteristics were analyzed.
The gastric cancer group showed significantly lower HDL-C, higher LDL-C, and lower apoA-I level than the control group. In multivariate analysis, old age (odds ratio [OR], 1.051; p < 0.001), smoking (OR, 1.337; p < 0.001), a family history of gastric cancer (OR, 2.038; p < 0.001),
Lower HDL-C and higher LDL-C were associated with the risk of gastric cancer, even after adjusting for age, sex, and other factors. In the gastric cancer group, undifferentiated histology was associated with lower TG levels.
Gastric cancer is the second most common cancer worldwide and the third leading cause of cancer-related death [
However, previous studies have shown contradictory results about the effect of lipids on various cancers, including gastric cancer. TC had negative [
Therefore, we conducted a prospective case-control study to clarify the association of serum lipids level including TC, HDL-C, LDL-C, TG, apolipoprotein A-I (apoA-I), and apolipoprotein B (apoB), with gastric cancer by analyzing their significance in cancer risk, pathology, and prognosis.
A case-control study was conducted between December 2013 and March 2017 at Asan Medical Center, Seoul, Korea. A total of 498 patients with pathologically confirmed gastric cancer were prospectively screened. To assess the association between serum lipid profile and gastric cancer, a control group was formed from a cohort of the health promotion center. Patients with diabetes mellitus, chronic liver disease, thyroid disease, a previous history of malignancy, and use of lipid-lowering agents were excluded. Subjects who did not complete a laboratory examination for lipid profiles or those who were lost to follow-up were also excluded. Finally, 412 patients with gastric cancer and 2,934 controls were analyzed (
All participants completed a questionnaire including information on personal and family histories of cancer. Smoking status was divided into three categories: never smokers, former smokers, and current smokers. Serologic positivity for
Gastric cancer was classified into two groups according to histopathologic findings. The differentiated group included well or moderately differentiated cancer and the undifferentiated group included poorly differentiated or signet ring cell carcinoma. Clinical staging was performed based on the 7th American Joint Committee on Cancer TNM staging system. Informed consent was obtained from patients with gastric cancer and those in the control group.
All subjects were measured the serum lipids profile as the baseline level at the time of inclusion in the study. The profiles of serum lipids, including TC, HDL-C, LDL-C, TG, and apolipoproteins, were measured using a Beckman Coulter AU 5800 chemistry analyzer (Beckman Coulter, Brea, CA) after at least 12 hours of fasting. TC was categorized using cutoff values of < 160, 160–179, 180–199, 200–239, and ≥ 240 mg/dL. LDL-C was classified using cutoff values of < 100, 100–129, 130–159, and ≥ 160 mg/dL. The low and high reference values were 40 mg/dL for HDL-C, 150 mg/dL for TG, 178 mg/dL for apoA-1, and 122 mg/dL for apoB.
Sample size was calculated with a significance level (alpha) of 0.05 using a two-sided two-sample t test. This was based on a previous report comparing a gastric cancer group with an age- and sex-matched control group with mean LDL-C of 121 mg/dL and 127 mg/dL, respectively, and standard deviation of 35.0 [
Categorical variables were analyzed using chi-square or Fisher exact tests, and continuous variables were analyzed using a Mann-Whitney U test. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of developing gastric cancer associated with lipid components. Models adjusted for age, sex, and multivariate factors (including age, sex,
Median age was 56 years (interquartile range [IQR], 49 to 64) in the gastric cancer group and 53 years (IQR, 48 to 57) in the control group. Overall, 2,242 men and 1,104 women were included in the study. Baseline characteristics of the two groups are shown in
Regarding serum lipid profiles, the gastric cancer group had significantly lower HDL-C (p < 0.001), higher LDL-C (p=0.011), and lower apoA-I (p < 0.001) levels (
The clinicopathologic characteristics of 412 patients with gastric cancer, including 277 men and 135 women, are summarized in
The male group had significantly lower HDL-C (median, 45 mg/dL vs. 54 mg/dL; p < 0.001), higher TG (median, 103 vs. 88 mg/dL; p < 0.001), and lower apoA-I (median, 133.6 mg/dL vs. 147.6 mg/dL; p < 0.001) levels than the female group, but there were no remarkable differences in serum TC and LDL-C levels between the male and female groups.
Univariate analysis showed that old age, smoking, a family history of gastric cancer,
The ORs for gastric cancer based on serum lipid level categories are shown in
Serum lipids levels (TC, TG, HDL-C, LDL-C, apoA-I, and apoB) showed no correlation with cancer size or stage according to pathology reports in the total population group. Lower TG was correlated with undifferentiated histology in the total population group (p=0.001) and the male group (p=0.013) (
During a median follow-up of 55 months (IQR, 42 to 61), 41 patients (10%) in the gastric cancer group died. In Cox-regression multivariate analysis, smoking (hazard ratio [HR], 4.283; p=0.003), advanced stage (stage II: HR, 3.022; p=0.094; stage III: HR, 3.298; p=0.031, and stage IV: HR, 376.884; p < 0.001), and hsCRP (HR, 2.161; p=0.003) were significant factors for overall survival of patients with gastric cancer (
The association of gastric cancer with serum lipid levels, including TC, HDL-C, LDL-C, TG, and apolipoproteins, has been researched with inconsistent and contradictory results, and no consensus of their significance has been established. This study was conducted to clarify the association between serum lipid components and gastric cancer. Lower HDL-C and higher LDL-C were determined to be risk factors for gastric cancer, and TG was correlated with cancer differentiation. None of the serum lipids were shown to be prognostic factors for the overall survival of gastric cancer. Analysis of risk and prognostic factors were identical in the male, female, and total population groups.
Previous epidemiologic studies reported that HDL-C and LDL-C were involved in cancer development. Lower HDL-C levels have been associated with increased gastric cancer risk, regardless of ethnicity [
Elevated LDL-C and reduced HDL-C are reportedly related to pro-inflammatory activity, and tumors including gastric cancer exhibit abnormal regulation of specific genes related to the LDL receptor [
Similar to our study where no association of TG or TC with gastric cancer was shown, previous large cohort studies have shown the irrelevance of TG [
TG has been reported as an independent indicator for fatty acid oxidation involving tumor cell proliferation and growth [
To date, few studies have investigated the association between gastric cancer differentiation and serum lipid components. One previous study suggested that TG was associated with poor gastric cancer differentiation [
Despite research predicting the prognosis of gastric cancer by serum lipid levels, there have been no remarkable findings published showing an association. A previous study reported that lipid markers including HDL-C, LDL-C, and TG did not have a prognostic significance in gastric cancer [
This study has several limitations. First, serum lipid levels were measured only once when the patients were enrolled in the study as a baseline value; however the serum lipids level may change over time depending on the patient’s clinical course and disease status. In addition, 311 patients (75.5%) were diagnosed with early gastric cancer which is higher proportion than advanced gastric cancer. Considering that weight loss is presented more frequently in patients with advanced gastric cancer than early gastric cancer, comparison between the two groups would be necessary to further clarify the association between lipid profile and gastric cancer. Second, this is a case-control study from a single tertiary center. Several studies on serum lipid levels have shown inconsistent results between different ethnicities, and multinational and multicenter research will further clarify the role of lipids in patients with gastric cancer. Third, the gastric cancer group included patients who visited an out-patient clinic after diagnosis or suspicion of cancer, while the control group comprised of people who visited the health care center for regular health examinations. Although we had adjusted for sex, age,
In conclusion, serum lipid profiles are associated with the development of gastric cancer, but not with prognosis. Lower HDL-C and higher LDL-C levels were risk factors for gastric cancer, suggesting that serum lipid levels may be used as predictive factors for screening and follow-up of gastric cancer. In addition, TG levels were correlated with gastric cancer differentiation, but no serum lipid components were associated with overall survival. Ultimately, studies showing the association of serum lipid levels and gastric cancer will be fundamental in determining screening models related to lipid metabolism.
The study protocol was reviewed and approved by the Institutional Review Board of Asan Medical Center (number: 2013-0973) and performed according to the ethical principles of the Declaration of Helsinki (
Conceived and designed the analysis: Pih GY, Gong EJ, Choi JY, Ahn JY, Choe J.
Collected the data: Pih GY, Gong EJ, Choi JY, Bae SE, Chang HS, Na HK, Lee JH, Jung KW, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY.
Contributed data or analysis tools: Pih GY, Gong EJ, Ahn JY, Choe J, Bae SE, Chang HS, Na HK, Lee JH, Jung KW, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY.
Performed the analysis: Pih GY, Gong EJ, Kim MJ, Ahn JY, Choe J.
Wrote the paper: Pih GY.
Conflict of interest relevant to this article was not reported.
This work was supported by the Korean College of Helicobacter and Upper Gastrointestinal Research Foundation Grant.
Study flowchart.
Comparison of serum lipid levels the between control and gastric cancer groups. Comparison of total cholesterol levels between the gastric cancer and control groups among the total population (A), male (B), and female (C) groups. High-density lipoprotein cholesterol levels were significantly lower in the gastric cancer group than in the total population (D), male (E), and female (F) control groups. Low-density lipoprotein cholesterol levels were higher in the gastric cancer group (G-I). No significant association was found between triglyceride levels and gastric cancer in the (J) total population or (K) male group, but a significant association was found in the (L) female group.
Comparison of serum lipid levels between differentiated and undifferentiated gastric cancer groups. Total cholesterol levels showed no significant difference between the differentiated and undifferentiated gastric cancer subgroups among the total population (A) and male groups (B), but a significant difference was seen in the female group (C). No significant association was found between high-density lipoprotein cholesterol and differentiation in the total population (D), male (E), and female (F) groups. Low-density lipoprotein had no significant difference between the differentiated and undifferentiated gastric cancer subgroups in the total population (G) and male groups (H), but a significant difference was seen in the female group (I). Triglyceride levels were lower in the undifferentiated subgroup than in the total population (J), male (K), and female (L) groups.
Baseline characteristics of gastric cancer and control groups
Total | Male group | Female group | |||||||
---|---|---|---|---|---|---|---|---|---|
|
|
| |||||||
Gastric cancer (n=412) | Control (n=2,934) | p-value | Gastric cancer (n=277) | Control (n=1,965) | p-value | Gastric cancer (n=135) | Control (n=969) | p-value | |
56 (49–64) | 53 (48–57) | < 0.001 | 58 (51–66) | 53 (48–57) | < 0.001 | 52 (47–59) | 53 (48–58) | 0.954 | |
| |||||||||
23.7 (21.9–25.7) | 23.8 (21.9–25.7) | 0.769 | 24.1 (22.2–25.9) | 24.3 (22.7–26.0) | 0.194 | 22.6 (21.2–24.5) | 22.2 (20.5–24.4) | 0.152 | |
| |||||||||
| |||||||||
Total cholesterol | 191 (172–216) | 192 (170–215) | 0.513 | 189 (169–213) | 191 (170–214) | 0.877 | 193 (178–220) | 193 (172–218) | 0.180 |
| |||||||||
HDL-C | 49 (41–57) | 53 (44–64) | < 0.001 | 45 (39–54) | 50 (42–59) | < 0.001 | 54 (48–62) | 61 (51–73) | < 0.001 |
| |||||||||
LDL-C | 133 (115–154) | 130 (110–152) | 0.011 | 133 (115–153) | 131 (112–152) | 0.193 | 137 (114–157) | 127 (106–150) | 0.013 |
| |||||||||
Triglyceride | 97 (74–139) | 96 (67–140) | 0.753 | 103 (78–157) | 108 (76–154) | 0.534 | 88 (69–114) | 75 (54–108) | 0.049 |
| |||||||||
Apolipoprotein A-I | 140.5 (121.1–155.6) 145.0 (129.8–162.5) | < 0.001 | 133.6 (117.5–150.8) 140.0 (126.9–156.8) | < 0.001 | 147.6 (132.9–162.0) | 154.2 (138.5–171.6) < 0.001 | |||
| |||||||||
Apolipoprotein B | 99.8 (84.1–113.8) | 102.0 (87.4–117.1) | 0.107 | 100.0 (86.4–114.5) | 104.0 (90.5–119.3) | 0.044 | 98.4 (80.5–113.0) | 96.6 (82.0–113.1) | 0.961 |
| |||||||||
0.07 (0.03–0.17) | 0.05 (0.03–0.10) | < 0.001 | 0.07 (0.04–0.18) | 0.06 (0.04–0.11) | 0.001 | 0.05 (0.03–0.14) | 0.04 (0.03–0.09) | 0.031 | |
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Never smoker | 201 (48.8) | 1,350 (46.0) | < 0.001 | 73 (26.4) | 456 (23.2) | < 0.001 | 128 (94.8) | 894 (92.4) | 0.120 |
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Former smoker | 85 (20.6) | 921 (31.4) | 84 (30.3) | 880 (44.8) | 1 (0.7) | 41 (4.2) | |||
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Current smoker | 126 (30.6) | 661 (22.5) | 120 (43.3) | 628 (32.0) | 6 (4.4) | 33 (3.4) | |||
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88 (21.4) | 340 (11.6) | < 0.001 | 50 (18.1) | 218 (11.1) | 0.001 | 38 (28.1) | 122 (12.6) | < 0.001 | |
| |||||||||
328 (79.6) | 1,368 (46.6) | < 0.001 | 217 (78.3) | 916 (46.6) | < 0.001 | 111 (82.2) | 452 (46.6) | < 0.001 |
Values are presented as median (IQR) or number (%). BMI, body mass index; HDL-C, high-density lipoprotein cholesterol; hsCRP, high-sensitivity C-reactive protein; IQR, interquartile range; LDL-C, low-density lipoprotein cholesterol.
Clinicopathologic characteristics of patients with gastric cancer
Total (n=412) | Men (n=277) | Women (n=135) | p-value | |
---|---|---|---|---|
56 (49–64) | 58 (51–66) | 52 (47–59) | < 0.001 | |
23.7 (21.9–25.7) | 24.1 (22.2–25.9) | 22.6 (21.2–24.5) | 0.001 | |
Early gastric cancer | 311 (75.5) | 201 (72.6) | 110 (81.5) | 0.051 |
Advanced gastric cancer | 101 (24.5) | 76 (27.4) | 25 (18.5) | |
Proximal | 69 (16.7) | 45 (16.2) | 24 (17.8) | 0.779 |
Distal | 343 (83.3) | 232 (83.8) | 111 (82.2) | |
2.5 (1.5–4.2) | 2.6 (1.6–4.3) | 2.4 (1.4–4.0) | 0.825 | |
Differentiated | 190 (46.1) | 146 (52.7) | 44 (32.6) | < 0.001 |
Undifferentiated | 222 (53.9) | 131 (47.3) | 91 (67.4) | |
I | 317 (77.5) | 209 (76.3) | 108 (80.0) | 0.797 |
II | 31 (7.6) | 23 (8.4) | 8 (5.9) | |
III | 44 (10.8) | 30 (10.9) | 14 (10.4) | |
IV | 17 (4.2) | 12 (4.4) | 5 (3.7) | |
Total cholesterol | 191 (172–216) | 189 (169–213) | 193 (178–220) | 0.058 |
HDL-C | 49 (41–57) | 45 (39–54) | 54 (48–62) | < 0.001 |
LDL-C | 133 (115–155) | 133 (115–153) | 137 (114–157) | 0.590 |
Triglyceride | 97 (74–139) | 103 (78–157) | 88 (69–114) | < 0.001 |
Apolipoprotein A-I | 140.5 (121.1–155.6) | 133.6 (117.6–150.8) | 147.6 (132.9–162.0) | < 0.001 |
Apolipoprotein B | 99.8 (84.1–113.8) | 100.0 (86.4–114.5) | 98.4 (80.5–113.0) | 0.097 |
Never smoker | 201 (48.8) | 73 (26.4) | 128 (94.8) | < 0.001 |
Former smoker | 85 (20.6) | 84 (30.3) | 1 (0.7) | |
Current smoker | 126 (30.6) | 120 (43.3) | 6 (4.4) | |
88 (21.4) | 50 (18.1) | 38 (28.1) | 0.021 | |
328 (79.6) | 217 (78.3) | 111 (82.2) | 0.435 |
Values are presented as median (IQR) or number (%). BMI, body mass index; HDL-C, high-density lipoprotein cholesterol; IQR, interquartile range; LDL-C, low-density lipoprotein cholesterol.
Univariate and multivariate analyses for gastric cancer risk factors
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
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| |||||
OR | 95% CI | p-value | OR | 95% CI | p-value | |
1.048 | 1.036–1.059 | < 0.001 | 1.051 | 1.039–1.065 | < 0.001 | |
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0.988 | 0.793–1.231 | 0.916 | ||||
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0.995 | 0.963–1.029 | 0.769 | ||||
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Never smoker | > 0.99 | > 0.99 | ||||
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Former smoker | 0.620 | 0.475–0.810 | < 0.001 | 0.598 | 0.452–0.792 | < 0.001 |
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Current smoker | 1.280 | 1.006–1.630 | 0.045 | 1.377 | 1.054–1.800 | 0.019 |
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2.072 | 1.596–2.691 | < 0.001 | 2.038 | 1.539–2.698 | < 0.001 | |
| ||||||
4.470 | 3.480–5.742 | < 0.001 | 4.240 | 3.281–5.481 | < 0.001 | |
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1.021 | 0.939–1.111 | 0.624 | ||||
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0.624 | 0.482–0.806 | < 0.001 | 0.712 | 0.535–0.947 | 0.020 | |
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< 100 | > 0.99 | > 0.99 | ||||
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100–129 | 1.775 | 1.213–2.597 | 0.003 | 1.792 | 1.202–2.670 | 0.004 |
| ||||||
130–159 | 1.938 | 1.322–2.839 | 0.001 | 1.854 | 1.243–2.766 | 0.002 |
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≥ 160 | 1.743 | 1.152–2.638 | 0.009 | 1.542 | 0.998–2.382 | 0.051 |
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0.976 | 0.757–1.259 | 0.853 | ||||
| ||||||
0.564 | 0.376–0.847 | 0.006 | 0.691 | 0.452–1.057 | 0.089 | |
| ||||||
0.843 | 0.638–1.113 | 0.228 |
BMI, body mass index; CI, confidence interval; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; OR, odds ratio.
Serum lipid levels associated with gastric cancer (age-, sex-, and multivariate-adjusted ORs and 95% CIs)
Gastric cancer/Total (%) | Age- and sex-adjusted model | Multivariate-adjusted model | |||||
---|---|---|---|---|---|---|---|
|
| ||||||
OR | 95% CI | p-value | OR | 95% CI | p-value | ||
| |||||||
< 160 | 63/519 (12.1) | > 0.99 | > 0.99 | ||||
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160–179 | 75/637 (11.8) | 1.021 | 0.711–1.467 | 0.909 | 1.041 | 0.711–1.524 | 0.836 |
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180–199 | 103/800 (12.9) | 1.136 | 0.808–1.597 | 0.462 | 1.125 | 0.786–1.610 | 0.520 |
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200–239 | 172/1,084 (11.7) | 0.981 | 0.708–1.361 | 0.910 | 0.965 | 0.683–1.363 | 0.839 |
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≥ 240 | 44/306 (14.4) | 1.346 | 0.883–2.051 | 0.167 | 1.281 | 0.824–1.992 | 0.272 |
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< 40 | 88/513 (17.2) | > 0.99 | > 0.99 | ||||
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≥ 40 | 324/2,833 (11.4) | 0.620 | 0.475–0.809 | < 0.001 | 0.723 | 0.542–0.965 | 0.028 |
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< 100 | 36/476 (7.6) | > 0.99 | > 0.99 | ||||
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100–129 | 149/1,175 (12.7) | 1.831 | 1.245–2.693 | 0.002 | 1.815 | 1.215–2.713 | 0.004 |
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130–159 | 146/1,067 (13.7) | 1.915 | 1.301–2.819 | 0.001 | 1.897 | 1.267–2.841 | 0.002 |
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≥ 160 | 78/625 (12.5) | 1.774 | 1.167–2.698 | 0.007 | 1.554 | 1.002–2.409 | 0.049 |
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< 150 | 327/2,644 (12.4) | > 0.99 | > 0.99 | ||||
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≥ 150 | 85/702 (12.1) | 1.047 | 0.805–1.361 | 0.731 | 0.994 | 0.753–1.313 | 0.968 |
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< 178 | 279/2,984 (12.7) | > 0.99 | > 0.99 | ||||
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≥ 178 | 27/356 (7.6) | 0.580 | 0.384–0.878 | 0.010 | 0.657 | 0.430–1.004 | 0.052 |
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< 122 | 337/2,711 (12.4) | > 0.99 | > 0.99 | ||||
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≥ 122 | 67/627 (10.7) | 0.842 | 0.636–1.115 | 0.230 | 0.751 | 0.560–1.008 | 0.056 |
CI, confidence interval; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; OR, odds ratio.
Multivariate-adjusted for age, sex,
Comparison of serum lipid levels between differentiated and undifferentiated gastric cancer groups
Total population | Male group | Female group | |||||||
---|---|---|---|---|---|---|---|---|---|
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|
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Differentiated | Undifferentiated | p-value | Differentiated | Undifferentiated | p-value | Differentiated | Undifferentiated | p-value | |
Total cholesterol | 194 (176–216) | 188 (169–217) | 0.257 | 190 (169–213) | 187 (168–213) | 0.873 | 204 (189–220) | 188 (169–220) | < 0.001 |
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HDL-C | 46 (40–55) | 51 (42–59) | 0.148 | 44 (38–53) | 47 (39–55) | 0.504 | 54 (47–57) | 55 (50–63) | > 0.99 |
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LDL-C | 138 (119–155) | 129 (111–154) | 0.108 | 134 (118–154) | 130 (114–153) | 0.095 | 142 (125–159) | 129 (108–155) | 0.024 |
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Triglyceride | 108 (81–161) | 92 (69–122) | 0.001 | 109 (83–171) | 98 (74–142) | 0.013 | 102 (78–138) | 83 (63–109) | 0.329 |
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Apolipoprotein A-I | 135.9 (119.9–152.7) 142.3 (123.1–156.5) | 0.690 | 132.8 (117.0–150.5) 135.0 (118.4–152.0) | 0.265 | 145.5 (129.6–160.8) | 147.6 (133.6–162.6) > 0.99 | |||
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Apolipoprotein B | 103.0 (87.9–115.0) | 96.3 (82.3–113.0) | 0.790 | 103.0 (88.6–115.0) | 96.3 (84.8–114.0) | 0.532 | 104.0 (87.8–115.0) | 95.2 (77.6–111.0) | > 0.99 |
Values are presented as median (interquartile range). HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol.
Univariate and multivariate analyses for overall survival of gastric cancer
Univariate | Multivariate | |||||
---|---|---|---|---|---|---|
|
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HR | 95% CI | p-value | HR | 95% CI | p-value | |
1.020 | 0.991–1.049 | 0.185 | - | - | - | |
| ||||||
0.550 | 0.263–1.153 | 0.114 | - | - | - | |
| ||||||
0.961 | 0.883–1.048 | 0.377 | - | - | - | |
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Never smoker | > 0.99 | 0.080 | > 0.99 | 0.003 | ||
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Former smoker | 2.359 | 1.109–5.020 | 0.026 | 4.971 | 1.837–13.446 | 0.002 |
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Current smoker | 1.669 | 0.796–3.501 | 0.175 | 4.283 | 1.660–11.050 | 0.003 |
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0.596 | 0.304–1.168 | 0.132 | ||||
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I | > 0.99 | > 0.99 | ||||
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II | 3.428 | 1.105–10.631 | 0.033 | 3.022 | 0.829–11.014 | 0.094 |
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III | 4.930 | 1.936–12.551 | 0.001 | 3.298 | 1.117–9.738 | 0.031 |
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IV | 222.411 | 80.806–612.169 | < 0.001 | 376.884 | 100.982–1,406.604 | < 0.001 |
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Differentiated | > 0.99 | - | ||||
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Undifferentiated | 1.900 | 0.984–3.668 | 0.056 | - | - | - |
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3.568 | 2.331–5.461 | < 0.001 | 2.161 | 1.292–3.616 | 0.003 | |
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0.919 | 0.719–1.176 | 0.503 | - | - | - | |
| ||||||
0.572 | 0.296–1.104 | 0.096 | - | - | - | |
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< 100 | > 0.99 | - | ||||
| ||||||
100–129 | 0.585 | 0.229–1.496 | 0.263 | - | - | - |
| ||||||
130–159 | 0.412 | 0.152–1.115 | 0.081 | - | - | - |
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≥ 160 | 0.558 | 0.194–1.610 | 0.281 | - | - | - |
| ||||||
1.221 | 0.599–2.491 | 0.583 | - | - | - | |
| ||||||
0.704 | 0.170–2.916 | 0.629 | - | - | - | |
| ||||||
1.252 | 0.578–2.710 | 0.569 | - | - | - |
BMI, body mass index; CI, confidence interval; HDL-C, high-density lipoprotein cholesterol; HR, hazard ratio; hsCRP, high-sensitivity C-reactive protein; LDL-C, low-density lipoprotein cholesterol.