Pre-operative hypoalbuminemia is associated with complication rate and overall survival in patients with vulvar cancer undergoing surgery

Abstract

ObjectiveHypoalbuminemia, a known marker for malnutrition, has been associated with an increased risk for perioperative morbidity and poor prognosis in patients with solid tumors. The aim of this study was to investigate the prognostic and predictive value of pre-treatment serum albumin levels for survival and postoperative complications in patients with vulvar cancer undergoing surgery.MethodsWithin in this retrospective study, we assessed data of 103 consecutive patients with vulvar cancer undergoing primary surgery into this study. Pre-treatment serum albumin levels were correlated with clinico-pathological parameters and complications. We performed univariate log-rank test and multivariable Cox regression models to evaluate the association between pre-treatment serum albumin and survival.ResultsWe found hypoalbuminemia (< 35 mg/dl) in 9 of 103 (8.7%) patients. No difference in tumor characteristics was observed between patients with hypoalbuminemia and normal serum albumin levels. Difference in postoperative complications (55.6% and 37.8% of patients with hypoalbuminemia and normal serum albumin levels, respectively) was not statistically significant (p = 0.345). Shorter overall survival (OS) was observed in patients with hypoalbuminemia (5-year OS rate 17.1%) when compared to patients with normal serum albumin levels (5-year OS rate 58.6%, p = 0.004). In multivariable analysis, age (p = 0.017), FIGO stage (p = 0.011) and serum albumin levels (p = 0.013) were independently associated with OS.ConclusionPre-treatment hypoalbuminemia is an independent prognostic biomarker for OS in patients with vulvar cancer. We did not find an association between pre-treatment hypoalbuminemia and a higher risk for postoperative complications.Electronic supplementary materialThe online version of this article (10.1007/s00404-019-05278-7) contains supplementary material, which is available to authorized users.

Prognostic role of pretreatment albumin-to-alkaline phosphatase ratio in locally advanced laryngeal and hypopharyngeal cancer: Retrospective cohort study

“…Another study investigated the prognostic role of serum ALB in patients with advanced HNSCC who underwent surgery and flap reconstruction and determined that preoperative hypoalbuminemia was a poor prognostic indicator in this population [29]. Also, studies have shown that low serum ALB is an unfavorable determinant in other malignancies, including oral, breast, and vulvar cancers [30][31][32].…”

Hypoalbuminemia as Surrogate and Culprit of Infections

“…Preexisting hypoalbuminemia is a prognostic indicator of worse outcome for a broad spectrum of diseases ranging from medical conditions [ 64 , 65 , 66 ] to surgery [ 67 ]. Evidence in support of a prognostic role of serum albumin level is abundant and established for orthopedic [ 68 , 69 , 70 , 71 ], cardiovascular [ 72 , 73 ], gynecologic [ 74 , 75 ], and visceral surgery [ 76 , 77 , 78 ].…”

Risk Factors for Postoperative Complications After Vulvar Surgery

“…Among these patients, the rates of postoperative complications were higher when compared to patients with a normal nutritional status. Moreover, the authors underlined the fact that lower preoperative serum albumin levels were associated with significantly poorer rates of overall survival in both univariate and multivariate analyses, and thus, demonstrating the importance of this parameter (18). In another study that also investigated the influence of the preoperative serum levels of albumin on the postoperative outcomes, the authors demonstrated that hypoalbuminemia is significantly associated with the risk of wound complication even after adjusting for age, body mass index, preoperative hematocrit or association of diabetes (19).…”

“…More specifically, a lower level of preoperative albumin caused by malnutrition and albumin synthesis suppression as a consequence of a systemic inflammatory response is responsible for a higher rate of postoperative morbidity (14)(15)(16)(17). In a recent study conducted by Bekos et al in 2019, the authors included 103 patients submitted to vulvar cancer surgery, nine of whom presented with preoperative hypoalbuminemia (18). Among these patients, the rates of postoperative complications were higher when compared to patients with a normal nutritional status.…”