Albumin Concentrations Are Primarily Determined by the Body Cell Mass and the Systemic Inflammatory Response in Cancer Patients With Weight Loss

McMillan, Donald C.; Watson, W. S.; O'Gorman, Patricia; Preston, Tom; Scott, H R; McArdle, C. S.

doi:10.1207/s15327914nc392_8

Cited by 397 publications

(319 citation statements)

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“…It may be that the presence of a chronic systemic inflammatory response, with its increased demand for specific amino acids for acute phase protein synthesis, promotes the degradation of available body protein including albumin (Preston et al, 1998;McMillan et al, 2001). Indeed, this relationship between nutritional decline, albumin concentrations and the systemic inflammatory response has recently been exploited to form a new prognostic score in patients with advanced non-small-cell lung cancer (Forrest et al, 2003).…”

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confidence: 99%

“…In the past, this hypoalbuminaemia has been thought to be the result of nutritional depletion secondary to the tumour. Recently, however, it has been postulated that the reduction in albumin concentration is secondary to the presence of a systemic inflammatory response, as evidenced by elevated circulating concentrations of C-reactive protein (McMillan et al, 2001).The nature of the relationship between circulating albumin concentration, tumour burden and the systemic inflammatory response has not been established. However, if the presence of a systemic inflammatory response rather than tumour burden were to determine the development of the hypoalbuminaemia associated with advanced cancer, then it might be expected that there would be a stronger relationship between the presence of hypoalbuminaemia and the systemic inflammatory response compared with that between hypoalbuminaemia and tumour volume.…”

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The relationship between hypoalbuminaemia, tumour volume and the systemic inflammatory response in patients with colorectal liver metastases

et al. 2004

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The relationship between hypoalbuminaemia, tumour volume and C-reactive protein was examined in patients with colorectal liver metastases (n ¼ 57). On multiple regression analysis, albumin concentrations were independently associated with C-reactive protein (r ¼ 0.56, Po0.001) but not percentage hepatic replacement (P ¼ 0.34). These results show that hypoalbuminaemia is associated with the presence of a systemic inflammatory response rather than tumour volume in patients with colorectal liver metastases. It has long been recognised that, in patients with advanced cancer, the presence of hypoalbuminaemia is associated with poor outcome (Franch-Arcas, 2001). In the past, this hypoalbuminaemia has been thought to be the result of nutritional depletion secondary to the tumour. Recently, however, it has been postulated that the reduction in albumin concentration is secondary to the presence of a systemic inflammatory response, as evidenced by elevated circulating concentrations of C-reactive protein (McMillan et al, 2001).The nature of the relationship between circulating albumin concentration, tumour burden and the systemic inflammatory response has not been established. However, if the presence of a systemic inflammatory response rather than tumour burden were to determine the development of the hypoalbuminaemia associated with advanced cancer, then it might be expected that there would be a stronger relationship between the presence of hypoalbuminaemia and the systemic inflammatory response compared with that between hypoalbuminaemia and tumour volume.The aim of the present study was to examine the relationship between circulating albumin concentration, the tumour burden and the systemic inflammatory response in patients with colorectal liver metastases. MATERIAL AND METHODS PatientsPatients who had undergone resection of a primary colorectal cancer, who then developed liver metastases and who were referred for assessment for liver resection, were considered eligible for study. As part of their assessment, patients underwent dual phase spiral-computed tomography of the liver. In addition a blood sample was taken for measurement of routine liver enzymes, albumin and C-reactive protein. Only those patients who had no evidence of extrahepatic disease were included in the study. None of the patients had recent chemotherapy.The study was approved by the Research Ethics Committee of Glasgow Royal Infirmary. Biochemical profileAlbumin, C-reactive protein, alkaline phosphatase, aspartate transaminase, alanine transaminase and bilirubin concentrations were assayed using standard methods. Intra-and inter-assay coefficients of variation were better than 5 and 10% respectively. Tumour volume and PHRTumour volume and percentage hepatic replacement (PHR) were measured using a similar approach to that previously described (Purkiss and Williams, 1992;Dworkin et al, 1995). Contrast enhanced CT-scans were performed using a Somatom plus 4 spiral-CT scanner (Siemens AG, Erlangen, Germany).The cross-sectional areas of all the metastat...

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The relationship between hypoalbuminaemia, tumour volume and the systemic inflammatory response in patients with colorectal liver metastases

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“…Malnutrition and inflammation suppress albumin synthesis and affect the survival of cancer patients 31, 39. In fact, it has been reported that hypoalbuminemia in cancer patients is associated with poor outcome 31, 38, 39. In fact, patients in the high GAR group (>0.80) had decreased serum albumin level and poor outcome after curative surgery compared as low GAR group (Table 2 and Figure 2).…”

Section: Discussionmentioning

confidence: 93%

“…On the other hand, albumin plays an important role in suppressing the growth of cancer cell through its antioxidant effect and stabilization of DNA replication 38. Malnutrition and inflammation suppress albumin synthesis and affect the survival of cancer patients 31, 39. In fact, it has been reported that hypoalbuminemia in cancer patients is associated with poor outcome 31, 38, 39.…”

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confidence: 99%

Preoperative globulin‐to‐albumin ratio predicts outcome after curative resection in patients with gastric cancer

Shioiri

Ishizuka

Shibuya

et al. 2018

Annals of Gastroent Surgery

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AimThe globulin‐to‐albumin ratio (GAR) is useful for prognostication of patients with various cancers. However, the significance of GAR in gastric cancer (GC) remains unclear. Our purpose was to investigate the relationship between the GAR and outcome after curative resection in GC patients.MethodsThree‐hundred and seventy‐six patients who had undergone curative resection for GC were retrospectively reviewed. Univariate and multivariate analyses using the Cox proportional hazard model were performed to detect clinical characteristics that correlated with overall survival (OS), and their cut‐off values were identified using receiver operating characteristic (ROC) curve analyses. Kaplan–Meier analysis and log‐rank test were used for comparison of OS and relapse‐free survival (RFS).ResultsMultivariate analysis using 17 clinical characteristics selected by univariate analyses revealed that GAR (>0.80/≤0.80) was significantly associated with OS (hazard ratio [HR], 2.305; 95% CI, 1.122‐4.735; P = 0.023), as well as lymph node metastasis (presence/absence) (HR, 2.417; 95% CI, 1.077‐5.426; P = 0.032), neutrophil‐to‐lymphocyte ratio (>2.7/≤2.7) (HR, 2.368; 95% CI, 1.138‐4.930; P = 0.002), and serosal invasion (presence/absence) (HR, 3.443; 95% CI, 1.048‐11.31; P = 0.042). Kaplan–Meier analysis and log‐rank test demonstrated that the OS and RFS of patients with a high GAR (>0.80) were significantly poorer than those with low GAR (≤0.80).ConclusionsThe GAR is a useful predictor of postoperative outcome among GC patients undergoing curative resection.

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Carcinoembryonic Antigen and Albumin Predict Survival in Patients With Advanced Colon and Rectal Cancer

Dixon¹

2003

Arch Surg

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Hypothesis: Patients with stage IV colon or rectal cancer at initial diagnosis have characteristics that will predict subsequent survival time. Design: Retrospective cohort study. Setting: Urban county teaching hospital providing tertiary care. Patients: Patients who came to the study institution with stage IV colon or rectal cancer between 1991-1999. Main Outcome Measure: Survival duration (days) after diagnosis. Results: One hundred five patients were identified, with a median survival of 225 days (interquartile range, 72-688 days). Univariate analysis identified carcinoembryonic antigen (CEA) and albumin (ALB) as possible predictors for survival. Classification and regression tree analysis, a form of binary recursive partitioning, was used to identify optimal cut points for CEA (275 ng/mL) and ALB (2.7 g/dL) levels. Based on the cut points, patients were stratified into the following groups: (1) low CEA, high ALB; (2) low CEA, low ALB; (3) high CEA, high ALB; and (4) high CEA, low ALB. The median survival times for the first group and the fourth group were 287 days (interquartile range, 150-851 days) and 39 days (interquartile range, 14-168 days), respectively. A Kaplan-Meier analysis was performed, and a statistically significant difference was identified across all strata (P=.004). Additionally, groups 1 and 4 demonstrated the largest overall survival difference (PϽ.001). Conclusions: Patients with stage IV colon and rectal cancer with a CEA level greater than or equal to 275 ng/mL and an ALB level less than 2.7g/dL had a significantly shorter survival time. Conversely, patients with an ALB level greater than or equal to 2.7 g/dL and a CEA level less than 275 ng/mL had a longer survival time.

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Albumin Concentrations Are Primarily Determined by the Body Cell Mass and the Systemic Inflammatory Response in Cancer Patients With Weight Loss

Cited by 397 publications

References 19 publications

The relationship between hypoalbuminaemia, tumour volume and the systemic inflammatory response in patients with colorectal liver metastases

The relationship between hypoalbuminaemia, tumour volume and the systemic inflammatory response in patients with colorectal liver metastases

Preoperative globulin‐to‐albumin ratio predicts outcome after curative resection in patients with gastric cancer

Carcinoembryonic Antigen and Albumin Predict Survival in Patients With Advanced Colon and Rectal Cancer

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