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Open Access Highly Accessed Research article

Plasma level of LDL-cholesterol at diagnosis is a predictor factor of breast tumor progression

Catarina Rodrigues dos Santos125*, Isabel Fonseca35, Sérgio Dias45 and JC Mendes de Almeida25

Author Affiliations

1 Gulbenkian Programme for Advanced Medical Education, Lisbon, Portugal

2 Department of Surgical Oncology, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Lisbon, Portugal

3 Department of Pathology, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Lisbon, Portugal

4 Instituto de Medicina Molecular, Lisbon, Portugal

5 Faculdade de Medicina de Lisboa, Lisbon, Portugal

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BMC Cancer 2014, 14:132  doi:10.1186/1471-2407-14-132

Published: 26 February 2014

Abstract

Background

Among women, breast cancer (BC) is the leading cancer and the most common cause of cancer-related death between 30 and 69 years. Although lifestyle and diet are considered to have a role in global BC incidence pattern, the specific influence of dyslipidemia in BC onset and progression is not yet completely understood.

Methods

Fasting lipid profile (total cholesterol, LDL-C, HDL-C, and triglycerides) was prospectively assessed in 244 women with BC who were enrolled according to pre-set inclusion criteria: diagnosis of non-hereditary invasive ductal carcinoma; selection for surgery as first treatment, and no history of treatment with lipid-lowering or anti-diabetic drugs in the previous year. Pathological and clinical follow-up data were recorded for further inclusion in the statistical analysis.

Results

Univariate associations show that BC patients with higher levels of LDL-C at diagnosis have tumors that are larger, with higher differentiation grade, higher proliferative rate (assessed by Ki67 immunostaining), are more frequently Her2-neu positive and are diagnosed in more advanced stages. Cox regression model for disease-free survival (DFS), adjusted to tumor T and N stages of TNM classification, and immunohistochemical subtypes, revealed that high LDL-C at diagnosis is associated with poor DFS. At 25 months of follow up, DFS is 12% higher in BC patients within the third LDL-C tertile compared to those in the first tertile.

Conclusions

This is a prospective study where LDL-C levels, at diagnosis, emerge as a prognostic factor; and this parameter can be useful in the identification and follow-up of high-risk groups. Our results further support a possible role for systemic cholesterol in BC progression and show that cholesterol metabolism may be an important therapeutic target in BC patients.

Keywords:
LDL-cholesterol; Breast cancer; Tumor progression