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Lipids have immunomodulatory functions and the potential to affect cancer immunity. The associations of pretreatment serum cholesterol and long-chain fatty acids with the objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were evaluated in 148 patients with non-small cell lung cancer who received nivolumab. When each lipid was separately evaluated, increased low-density lipoprotein (LDL)-cholesterol (P 0.001), high-density lipoprotein (HDL)-cholesterol (P = 0.014), total cholesterol (P = 0.007),