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

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 aimed to investigate whether cholesterol levels are associated with clinical outcomes and can serve as survival predictors. Methods This retrospective study was conducted on a Danish cohort of patients that underwent elective curative-intended surgery for stage I-III colorectal cancer between 2015–2020. The primary and secondary outcome were association between a total cholesterol (TC) level of > 4 mmol/L or below ≤ 4 mmol/L within 365 days prior to surgery and overall survival (OS) and disease free survival (DFS). Propensity scores were calculated using all available preoperative data and used to match patients in a 1:1 ratio. Results A total of 3,723 patients were included in the study. Median follow-up time was 3.8 years. Following propensity score matching, 1,572 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 association with OS (HR: 0.74, 95% CI, 0.54–0.99). Conclusion TC levels alone did 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.