2154P Total cholesterol as an independent prognostic factor in cancer patient survival: A single institution experience

The role of lipid levels in the development and outcomes of cancer patients remains unclear in the literature. In this study, we aimed to analyze whether there is a relationship between total cholesterol levels and the survival of hospitalized cancer patients. This retrospective observational study included patients admitted to the Medical Oncology Hospitalization Unit at La Paz University Hospital between September 2018 and January 2020. Total cholesterol levels, tumor type, treatment received, and mortality were analyzed. A total of 839 patients were included, with no differences in gender distribution. The most frequent tumor was lung (20.7%), followed by digestive tumors, including colorectal, esophagogastric, pancreatobiliary, or hepatic (33.4%), and breast (11.4%). The majority of patients were receiving active cancer-specific treatment, with chemotherapy (51.5%) or targeted treatments (18.6%) at the time of admission. At the end of the median follow-up period (31,8 months), 615 deaths had occurred (78.9%). The median overall survival (OS), regardless of tumor type, was 199 days. Having low total cholesterol values (less than 150 mg/dL) increased the risk of mortality by 25.9% compared to having physiological levels (150-200 mg/dL) (p=0.016, CI95% 1.045, 1.518)) with a Hazard Ratio of 1.259. Having high total cholesterol values (above 200 mg/dL) increased the risk of mortality by 30.6% compared to having physiological levels (p=0.036, CI95%(1.017, 1.677)) with an HR of 1.306. To date, the majority of studies indicate that elevated cholesterol levels in patients with advanced cancer are associated with a higher risk of mortality, both due to a higher burden of comorbidity and the potential effects of cholesterol on oncogenic pathways. On the other hand, low cholesterol levels, possibly reflecting a significant metabolic dysregulation during cachexia, seem to be linked to a worse prognosis as well. Although the mechanisms by which high or low cholesterol levels increase the risk of mortality may differ, their incorporation into prognostic scores can contribute to a more accurate estimation of prognosis in advanced patients.