Associations between pre-operative cholesterol levels with long-term survival after colorectal cancer surgery - a nationwide propensity score–matched cohort study

Sep 21, 2026

Uploaded by Rowan

Altered lipid metabolism commonly occurs in solid cancer patients, and dyslipidemia has been linked to worse outcomes in colorectal cancer. This nationwide retrospective study examined whether pre-operative cholesterol levels are associated with clinical end points and can function as survival predictors in surgically treated Danish patients. Propensity score matching compared total cholesterol thresholds within 365 days prior to surgery and assessed overall survival and disease-free survival.

LanguageEnglish

CategoryResearch & Report

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Pages11

Reading Time28 min

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Abstract

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International Journal of Colorectal Disease (2024) 39:159 [https://doi.org/10.1007/s00384-024-04735-3](https://doi.org/10.1007/s00384-024-04735-3) Associations between pre‑operative cholesterol levels with long‑term survival after colorectal cancer surgery: a nationwide propensity score–matched cohort study Lea Löffler1 · Maliha Mashkoor1 · Ismail Gögenur1,2,3 · Mikail Gögenur1 Accepted: 1 October 2024 / Published online: 10 October 2024 © The Author(s) 2024 Abstract Purpose Altered lipid metabolism frequently occurs in patients with solid cancers and dyslipidemia has been associated with poorer outcomes in patients with colorectal cancer. This study sought to investigate whether cholesterol levels are associated with clinical outcomes and can serve as survival predictors. Methods We conducted a retrospective cohort study with Danish patients diagnosed with colorectal cancer who had surgery with curative intent for UICC stages I to III between 2015 and 2020. Using propensity score adjustment, we matched patients in a 1:1 ratio to examine the impact of total cholesterol (TC) >4 mmol/L vs. ≤ 4 mmol/L within 365 days prior to surgery on overall survival (OS) and disease-free survival (DFS) . Results A total of 3443 patients were included in the study. Median follow-up time was 3.8 years. Following propensity score matching, 1572 patients were included in the main analysis. There was no statistically significant difference in OS or DFS between patients with TC >4 mmol/L compared with TC ≤ 4 mmol/L (HR: 0.82, 95% CI, 0.65–1.03, HR: 0.87, 95% CI, 0.68–1.12, respectively.) . A subgroup analysis investigating TC >4 mmol/L as well as low-density lipoprotein (LDL) >3 mmol/L found a significant correlation with OS (HR: 0.74, 95% CI, 0.54–0.99) . Conclusion TC levels alone were not associated with OS or DFS in patients with colorectal cancer. Interestingly, higher TC and LDL levels were linked to better overall survival, suggesting the need for further exploration of cholesterol's role in colorectal cancer. Trial registration Not applicable. Keywords Colorectal cancer · Cholesterol · Surgery · Survival * Lea Löffler [llof@regionsjaelland.dk](llof@regionsjaelland.dk) Maliha Mashkoor [mamas@regionsjaelland.dk](mamas@regionsjaelland.dk) Ismail Gögenur [igo@regionsjaelland.dk](igo@regionsjaelland.dk) Mikail Gögenur [mgog@regionsjaelland.dk](mgog@regionsjaelland.dk) 1 Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark 2 Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark 3 Danish Colorectal Cancer Group, Copenhagen, Denmark Introduction Lipids, a diverse group of biomolecules, serve as the foundational structure of biological membranes, while also functioning as signaling molecules and a source of energy [1] . One of the most significant metabolic changes in cancer is the modification of lipid metabolism. Cancer cells exhibit increased synthesis or uptake of lipids, which can fuel their rapid growth and promote the formation of cancer cells [2] . Dyslipidemia as well as other sequelae related to metabolic syndrome have been associated with poorer outcomesin patients with breast and colorectal cancer (CRC) [3–5], suggesting dyslipidemia to be a risk factor for other cancers as well. Thus, an increasing body of research links dysregulated cholesterol homeostasis to the pathobiology of solid cancers, as cholesterol is imperative to cell proliferation and growth, being an essential constituent for the membrane of the cell [6] . Moreover, cholesterol metabolites can affect both the innate and adaptive immune system, through the induction of CD8 + T-cell exhaustion when in the tumor microenvironment [7] and have both pro-and anti-inflammatory properties, possibly contributing to the state of chronic inflammation [8] . In both cancer and viral diseases, dyslipidemia may thus contribute to immune dysfunction, exa

FAQs

What was the study’s main purpose?

To determine whether pre-operative cholesterol levels are associated with clinical outcomes and whether they can serve as predictors of survival after colorectal cancer surgery.

How were patients and cholesterol exposure defined in the analysis?

A retrospective cohort of Danish patients who underwent curative-intent surgery for UICC stages I to III between 2015 and 2020 was used. Total cholesterol (TC) >4 mmol/L was compared with TC ≤4 mmol/L within 365 days prior to surgery, using propensity score matching.

What were the key findings regarding total cholesterol and survival?

Total cholesterol levels alone were not statistically associated with overall survival or disease-free survival. A subgroup analysis suggested a significant correlation with overall survival when TC >4 mmol/L was considered together with LDL >3 mmol/L.

Sep 21, 2026

Uploaded by Rowan