Low Pretherapeutic Serum Albumin as a Risk Factor for Poor Outcome in Esophageal Squamous Cell Carcinomas

Abstract

The number of esophageal cancer patients is increasing worldwide and lots of patients suffer from malnutrition and hypoalbuminemic. Serum albumin is a widely acceptable method of assessing nutritional and inflammation status in cancer patients. But whether serum albumin has prognostic value with regard to short-term and long-term outcomes in patients who undergo esophagectomy for cancer is still unclear. We therefore investigated the prognostic role of serum albumin in patients with esophageal cancer. We retrospectively reviewed 208 patients who underwent esophagectomy from September 1, 2003 to December 31, 2008. Clinico-pathological characteristics and postoperative outcomes were compared between different pretherapeutic serum albumin classes: low (hypoalbuminemic), <35 g/l; middle, 35-40 g/l and high, >40 g/l. Older, female, and higher T-stages were more likely to be associated with hypoalbuminemic. Meanwhile, hypoalbuminemic patients had a higher rate of postoperative mortality and complications including sepsis, respiratory insufficiency, arrhythmia, and cardiac insufficiency. But for preoperative comorbidities, no significant difference was found between different pretherapeutic serum albumin classes. The overall 5-year survival rate was 28.6%, 43.9%, and 50.8% for patients with low, middle, and high pretherapeutic serum albumin levels, respectively. Hypoalbuminemic was associated with poor survival (P = 0.016). In a multivariate analysis, the pretherapeutic albumin level was proved to be an independent predictor of survival (hazard ratio = 0.731; 95% confidence interval: 0.544-0.982, P = 0.037). Pretherapeutic serum albumin level is a significant prognostic factor for short-term and long-term outcomes in patients who undergo esophagectomy for cancer, which therefore should be taken into consideration along with other well-defined prognostic factors for better preoperative assessment and prognostic evaluation.

Comparison of Inflammation-Based Prognostic Scores in a Cohort of Patients with Resectable Esophageal Cancer

“…The connection of hypoalbuminemia, inflammation, and deprived survival in colorectal cancer patients could previously be shown by Al-Shaiba et al [49]. In addition, increasing evidence indicates that hypoalbuminemia is strongly connected with poor survival in gastric and esophageal cancer [26, 48, 50]. Especially against that background, it is quite surprising that we did not find significant correlation between hypoalbuminemia and OS ( p = 0.76) and DFS ( p = 0.88) in our patients' collective.…”

Clinical predictive factors of long‐term survival after curative resection of pancreatic cancer: a retrospective study

“…Second, it was unclear whether improving preoperative serum albumin levels resulted in long‐term survival benefits after resection. Although the relationship between improving serum albumin levels and variations in oncological behavior is not well understood, several studies have demonstrated an association between hypoalbuminemia and poor postoperative short‐/long‐term survival in patients with various types of malignancies. We believe that preoperative serum albumin levels represent a potential biomarker for predicting prognosis in PDAC patients after curative resection.…”

Prognostic significance of pretreatment albumin/globulin ratio in patients with hepatocellular carcinoma

“…Increasing evidence showed that hypoalbuminemia indicated persons’ malnutrition, which was associated with poor OS and high recurrence in patients with gastric, colorectal, pancreatic, lung, ovarian, breast, and liver cancer 8,26,27. Even though the mechanism by which low albumin may impact on OS or recurrence is not completely discovered, there are several reasons to explain it.…”