***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose : Temsirolimus is an effective treatment for renal cell carcinoma . It is associated with increases in serum cholesterol , triglyceride , and glucose . We investigated whether changes of these biomarkers could predict its efficacy . Experimental Design : We examined serial measurements of cholesterol , triglycerides , and glucose from patients r and omized to IFN or temsirolimus in the Global Advanced Renal Cell Carcinoma Trial . Using time-dependent proportional hazards models , we quantified the association between changes in these biomarkers from baseline with overall survival ( OS ) and progression-free survival ( PFS ) . We also assess the extent to which changes of these biomarkers predict the effects of temsirolimus on survival . Results : Temsirolimus was associated with larger mean increases in cholesterol ( 1.02 mmol/L ; P < 0.0001 ) , triglycerides ( 0.32 mmol/L ; P = 0.0008 ) , and glucose ( 1.28 mmol/L ; P < 0.0001 ) compared with IFN and improved survival rate ( OS : HR = 0.76 , P = 0.02 ; PFS : HR = 0.70 , P = 0.001 ) . Cholesterol increase during study was associated with longer survival ( OS : HR = 0.77 per mmol/L , P < 0.0001 ; PFS : HR = 0.81 per mmol/L ; P < 0.0001 ) . Temsirolimus effect on cholesterol predicted its effect on survival with no additional survival advantage observed after adjusting for cholesterol change during study ( OS : HR = 1.14 , P = 0.37 ; PFS : HR = 0.88 , P = 0.35 ) . Temsirolimus effect on triglycerides or glucose did not predict its effect on survival , with survival advantage in favor of temsirolimus still observed after adjusting for these factors ( P = 0.003 and P = 0.002 ) . Conclusion : Cholesterol increase is a potential predictor for temsirolimus efficacy . Longer survival in patients treated with temsirolimus  was observed in those with larger increases in cholesterol . Prospect ively design ed biomarker studies of temsirolimus or other mTOR inhibitors are recommended . Clin Cancer Res ; 18(11 ) ; 3188–96 . © 2012 AACR Background Abnormal glucose and lipids levels may impact survival after breast cancer ( BC ) diagnosis , but their association to other causes of mortality such as cardiovascular ( CV ) disease may result in a competing risk problem . Methods We assessed  serum glucose , triglycerides ( TG ) and total cholesterol ( TC )  measured prospect ively 3 months to 3 years before diagnosis in 1798 Swedish women diagnosed with any type of BC between 1985 and 1999 . In addition to using Cox regression , we employed latent class proportional hazards models to capture any heterogeneity of associations between these markers and BC death . The latter method was extended to include the primary outcome ( BC death ) and competing outcomes ( CV death and death from other causes ) , allowing latent class-specific hazard estimation for cause-specific deaths . Results A lack of association between prediagnostic glucose , TG or TC with BC death was observed with Cox regression . With latent class proportional hazards model , two latent classes ( Class I and II ) were suggested . Class I , comprising the majority ( 81.5 % ) of BC patients , had an increased risk of BC death following higher TG levels ( HR : 1.87 , 95 % CI : 1.01–3.45 for every log TG increase ) . Lower overall survival was observed in Class II , but no association for BC death was found . On the other h and , TC positively corresponded to CV death in Class II , and similarly , glucose to death from other causes . Conclusion Addressing cohort heterogeneity in relation to BC survival is important in underst and ing the relationship between metabolic markers and cause-specific death in presence of competing outcomes Summary Purpose . The prognosis of women with early-stage breast cancer is influenced by insulin and body mass index ( BMI ) . High levels of serum insulin and obesity often coexist with dyslipidemia in the insulin resistance syndrome ( IRS ) , but the contribution of lipids to breast cancer outcome is unclear . Here , we examine whether serum levels of total cholesterol ( TC ) and triglycerides ( TG )  influence breast cancer outcome . Patients and methods . A cohort of 520 women without known hyperlipidemia or diabetes , with stage T1–T3 , N0–N1 , M0 breast cancer , was assembled from July 1989 to June 1996 .  Fasting blood was collected at baseline . Subjects were followed prospect ively , for recurrence ( local , regional , distant ) and death . Cox models were used to calculate the prognostic effect of TC and TG levels . Two-sided significance levels were set at 0.025 . Results . TC was correlated with age ( Spearman ’s r = 0.44 ) and low tumor grade ( p = 0.01 ) , while TG was correlated with insulin ( r = 0.43 ) and BMI ( r = 0.45 ) . At a median follow-up of 8.7 years , TC and TG were not associated with breast cancer recurrence or death before of after adjustment for age , tumor-related variables , BMI or fasting insulin levels . In multivariate analysis adjusting for age , tumor-related variables and BMI , a trend towards an adverse effect of TC on disease recurrence was seen ( HR recurrence = 1.62 for the 4th versus . 1st quartile , 2-sided p = 0.03 ) . Conclusions . Fasting TG was not associated with outcome . A trend towards risk of recurrence was seen with higher TC in multivariate analysis . This potential association should be explored in future studies BACKGROUND : Few studies that meticulously match individual lymph nodes seen on MRI with their precise histologic counterparts after total mesorectal excision have been reported . OBJECTIVE : The objective of this study was to determine whether preoperative MRI could detect lymph node metastases accurately in the node-by-node analysis . DESIGN : This was a prospect i ve , observational cohort study . SETTING S : The study was conducted at a tertiary-care hospital . PATIENTS : Forty patients with rectal cancer were enrolled . MAIN OUTCOME MEASURES : Specimens were assessed using  MRI for clinical staging . After surgical resection of the tumor , the specimens were again imaged with ex vivo ultrasound scan to localize the perirectal node . The locations of each lymph node were precisely matched with its corresponding magnetic resonance image to enable a node-for-node comparison of magnetic resonance images and histologic findings . RESULTS : Agreement between MRI and histologic assessment of T stage was 82.5 % . Of the 341 nodes harvested , 120 were too small ( <3 mm ) to be depicted on magnetic resonance images , and 18 of these contained metastasis ( 15 % ) . A correlation between the results of  MRI  and histopathology was feasible for 205 lymph nodes , and the overall success rate of matching between the 2 techniques was 91.1 % ( 205 of 221 ) . Preoperative MRI revealed a node-by-node sensitivity and positive predictive value of 58.0 % , and 61.7 % . There was no difference in the diagnostic accuracy between the primary surgery subgroup and preoperative radiation subgroups . LIMITATIONS : The study is limited by its heterogeneity of cohorts including the subgroup with preoperative chemoradiation and the lack of preoperative ultrasound assessment . CONCLUSIONS : Preoperative MRI was moderately accurate for the prediction of mesorectal lymph node metastasis . Moreover , preoperative MRI was insufficient for detecting small lymph nodes ( <3 mm ) with metastasis A nested case-control study was conducted to investigate the hypothesis that women with high levels of high-density lipoprotein cholesterol ( HDL-C ) are at an increased risk of  breast cancer . The source population was a cohort of 95,000 women enrolled in the Kaiser Permanente Medical Care Program who underwent a routine multiphasic health examination between 1964 and 1971 . From the more than 2,000 breast cancer cases diagnosed in this cohort , 200 cases were r and omly selected for this study . For each case , one control who matched on age and date of examination was chosen .  Lipid and lipoprotein levels  were measured in archived serum sample s collected at the time of the women 's examinations . Breast cancer risk factor information was obtained from question naires completed by the women when their blood was drawn and was supplemented with information from medical records . HDL-C levels were not significantly different between the cases and controls overall ; however , a statistically significant interaction between the HDL-C level and menopausal status at diagnosis was detected . Premenopausal cases had mean HDL-C levels 3.48 mg/dl lower than matched controls [ 95 % confidence interval ( CI ) , -7.05 , 0.09 ] , whereas postmenopausal cases had levels 2.05 mg/dl higher than controls ( 95 % CI , -0.94 , 5.03 ) . In multivariate conditional logistic regression analyses , the odds ratio associated with each 1 mg/dl increase in HDL-C was 0.96 ( 95 % Cl , 0.93 - 1.0 ) for premenopausal women and 1.02 ( 95 % CI , 0.99 - 1.05 ) for postmenopausal women . Although many breast cancer risk factors are associated with high HDL-C , the relationship between breast cancer and HDL-C was independent of other factors evaluated Lymphoma patients often exhibit abnormal lipid metabolism . Recent evidence , however , suggests that a decrease in circulating high-density lipoprotein cholesterol ( HDL-C ) may occur during lymphomagenesis , reflecting underlying etiology such as inflammation . We investigated the relationship between prediagnostic HDL-C and non-Hodgkin lymphoma ( NHL ) in the Alpha-Tocopherol  Beta-Carotene Cancer Prevention Study cohort . At baseline , serum HDL-C and total cholesterol concentrations from fasting blood , information on diet and lifestyle , and direct measurements of height , weight , and blood pressure were obtained from 27,074 healthy male smokers of ages 50 to 69 years . Cox proportional hazards models with age as underlying time metric was used to estimate relative risks ( RR ) and 95 % confidence intervals ( 95 % CI ) . We found no association between total or non-HDL cholesterol and the 201 incident NHL cases ascertained during the follow-up ( 1985 - 2002 ) , but observed an inverse association between HDL-C and NHL , which changed with length of follow-up . High HDL-C was associated with lower risk of all NHL during the first 10 years ( n = 148 ; RR for 5th versus 1st quintile , 0.35 ; 95 % CI , 0.19 - 0.62 ; P(trend ) < 0.0001 ) , but not with diagnoses during later follow-up ( n = 53 ; RR , 1.31 ; 95 % CI , 0.55 - 3.10 ) . The inverse association was similar for NHL subtypes and was not modified by obesity , blood pressure , physical activity , or alcohol intake , but seemed to be stronger in men with lower duration of smoking ( P(interaction ) = 0.06 ) . Our findings implicate HDL-C as a pre clinical indicator of NHL and warrant further prospect i ve investigations for its etiologic contribution 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 prospect ively 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 prospect i ve 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 pro 
    Output:
    
After pooled analysis , only TC and HDL-C were significantly associated with cancer survival .
Our findings demonstrate for the first time that serum TC and HDL-C was identified as a protective factor for overall survival in cancer patients