DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161774

Pretreatment serum albumin: a prognostic indicator of survival inoral cancer

Saurabh Bobdey, Aanchal Jain, Jignasa Sathwara, Ganesh B

Abstract


Background: Malnutrition has been recognized as a poor prognostic indicator for cancer. In recent years, the role of serum albumin as a predictor of survival in cancer has received considerable attention. Therefore, the present study was carried out to investigate whether the pretreatment serum albumin can predict the prognosis of patients with oral cancer.

Methods: Medical records of 433 pathologically proven oral cancer patients diagnosed and treated from 01st January 2006 to 31st December 2008 were retrospectively analyzed. We used Receiver operating characteristic curve analysis to establish most appropriate cut-off for serum albumin, Kaplan-Meier method for survival analysis and the Cox proportional hazard models to investigate the prognosticators.

Results: The overall 5 year’s survival of the cohort was found to be 54.4%.  On univariate analysis, serum albumin of ≤4.34 g/dl was associated with poor overall survival (OS) (p=0.029). Multivariate Cox proportional hazard analysis revealed that lower serum albumin (<4.35g/dl) was a significant independent predictors for worse OS (HR=1.350, 95% CI = 1.013 - 1.817; P< 0.038). Lymph nodal involvement was also found to be independent indicator for poor OS. Furthermore, serum albumin was found to be positively correlated with both body weight (r=0.142, p=0.003) and heamoglobin (r=0.304, p=0.000).

Conclusion: Pretreatment serum albumin levels are of useful prognostic significance in oral cancer patients. Thus, this easily accessible variable may not only serve as a potent marker to predict the outcomes, but more importantly as an indicator for initiating aggressive nutrition intervention in oral cancer patients.


Keywords


Serum albumin, Oral cancer, Survival, Nutrition

Full Text:

PDF

References


Byakodi R, Byakodi S, Hiremath S, Byakodi J, Adaki S, Marathe K et al. Oral Cancer in India: An Epidemiologic and Clinical Review. J Community Health. 2012;37(2):316-9.

Sankaranarayanan R, Swaminathan R, Brenner H, Chen K, Chia KS, Chen JG et al. Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol. 2010;11(2):165-73.

Baatenburg de Jong RJ, Hermans J, Molenaar J, Briaire JJ, le Cessie S. Prediction of survival in patients with head and neck cancer. Head Neck. 2001;23(9):718-24.

Sayed S, Sharma S, Rane P, Vaishampayan S, Talole S, Chaturvedi P et al. Can metastatic lymph node ratio (LNR) predict survival in oral cavity cancer patients? J Surg Oncol. 2013;108(4):256-63.

Woolgar JA, Scott J, Vaughan ED, Brown JS, West CR, Rogers S. Survival, metastasis and recurrence of oral cancer in relation to pathological features. Ann R Coll Surg Engl. 1995;77(5):325-31.

Larsen SR, Johansen J, Sørensen JA, Krogdahl A. The prognostic significance of histological features in oral squamous cell carcinoma. J Oral Pathol Med. 2009;38(8):657-62.

Kademani D, Bell RB, Bagheri S, Holmgren E, Dierks E, Potter B, et al. Prognostic factors in intraoral squamous cell carcinoma: the influence of histologic grade. J Oral Maxillofac Surg. 2005;63(11):1599-605.

Liu SA, Tsai WC, Wong YK, Lin JC, Poon CK, Chao SY, et al. Nutritional factors and survival of patients with oral cancer. Head Neck. 2006;28:998-1007.

Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: A systematic review of the epidemiological literature. Nutrition Journal 2010;9:69.

Von Meyenfeldt M. Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs. 2005;9(Suppl 2):S35-8.

Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980,69:491-7.

Sarhill N, Mahmoud FA, Christie R, Tahir A. Assessment of nutritional status and fluid deficits in advanced cancer. Am J Hosp Palliat Care. 2003;20:465-73.

Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002;56:779-85.

Gupta D, Lammersfeld CA, Vashi PG, Burrows J, Lis CG, Grutsch JF. Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr. 2005;59:35-40.

Gupta D, Lammersfeld CA, Burrows JL, Dahlk SL, Vashi PG, Grutsch JF, et al. Bioelectrical impedance phase angle in clinical practice: implications for prognosis in advanced colorectal cancer. Am J Clin Nutr. 2004;80:1634-8.

McIntosh EN, Laurent LL. Nutritional assessment of the hospitalized patient. Am Fam Physician. 1983;27:169-75.

Delmore G. Assessment of nutritional status in cancer patients: widely neglected? Support Care Cancer. 1997;5:376-80.

Boles JM, Garre MA, Youinou PY. Simple assessment of the nutritional status in the critically ill patient. Resuscitation. 1984;11:233-41.

Curtas S, Chapman G, Meguid MM. Evaluation of nutritional status. Nurs Clin North Am. 1989;24:301-13.

Slaviero KA, Read JA, Clarke SJ, Rivory LP. Baseline nutritional assessment in advanced cancer patients receiving palliative chemotherapy. Nutr Cancer. 2003;46:148-57.

Davies M. Nutritional screening and assessment in cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9(Suppl 2):S64-73.

Maeda T, Ueoka H, Tabata M, Kiura K, Shibayama T, et al. Prognostic Factors in Advanced Non-small Cell Lung Cancer: Elevated Serum Levels of Neuron Specific Enolase Indicate Poor Prognosis. Jpn J Clin Oncol. 2000;30(12)534-41.

Siddiqui A, Heinzerling J, Livingston EH, Huerta S. Predictors of early mortality in veteran patients with pancreatic cancer. Am J Surg. 2007;194:362-6

Onate-Ocana LF, Aiello-Crocifoglio V, Gallardo-Rincon D, Herrera-Goepfert R, Brom-Valladares R, Carrillo JF et al. Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Ann Surg Oncol. 2007;14:381-9.

Boonpipattanapong T, Chewatanakornkul S. Preoperative carcinoembryonic antigen and albumin in predicting survival in patients with colon and rectal carcinomas. J Clin Gastroenterol. 2006;40:592-5.

Cengiz O, Kocer B, Surmeli S, Santicky MJ, Soran A. Are pretreatment serum albumin and cholesterol levels prognostic tools in patients with colorectal carcinoma? Med Sci Monit. 2006;12:CR240-7.

Heys SD, Walker LG, Deehan DJ, Eremin OE. Serum albumin: a prognostic indicator in patients with colorectal cancer. J R Coll Surg Edinb. 1998;43:163-8.

Lis CG, Grutsch JF, Vashi PG, Lammersfeld CA. Is serum albumin an independent predictor of survival in patients with breast cancer? JPEN J Parenter Enteral Nutr. 2003;27:10-5.

Nguyen TV, Yuek B. Weight loss predicts mortality after recurrent oral cavity and oropharyngeal carcinomas. Cancer. 2002;95:553-62.

Van Bokhorst-de van der Schueren MAE, van Leeuwen PAM, Kuik DJ. The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer. 1999;86:519-27.

Brookes GB. A prognostic indicator in head and neck cancer. Otolaryngol Head Neck Surg. 1985;93:69-74

Greene FL. The American Joint Committee on Cancer: updating the strategies in cancer staging. Bull Am Coll Surg 2002;87:13–15.

Greene FL, Sobin LH. The staging of cancer: a retrospective and prospective appraisal. CA Cancer J Clin. 2008;58:180-90.

Liu S, Tsai W, Wong Y, Lin J, Poon C, Chao S, et al. Nutritional factors and survival of patients with oral cancer. Head Neck. 2006;28: 998-1007.

Lam PT, Leung MW, Tse CY. Identifying prognostic factors for survival in advanced cancer patients: a prospective study. Hong Kong Med J. 2007;13:453-9.

Yeun JY, Kaysen GA. Factors influencing serum albumin in dialysis patients. Am J Kidney Dis. 1998;32:S118-25.

Barber MD, Fearon KC, McMillian DC Slater C, Ross JA, Fearon KC. Liver export protein synthetic rates are increased by oral meat feeding in weight-losing cancer patients. Am J Physiol Endocrinol Metab. 2000;279:E707-4.

McMillian DC, Scott HR, Watson WS, Preston T, Milroy R, McArdle CS. Longitidunal study of body cell mass depletion and the infl ammatory response in cancer patients. Nutr Cancer. 1998;31:101-5.

Heys SD, Walker LG, Deehan DI, Eremin E. Serum albumin: a prognostic indicator in patients with colorectal cancer. JR Coll Surg Edinb. 1998;43:163-8.

Wigmore SJ, Ross IA, Fearon KCH. Pancreatic cancer cells stimulate C-reactive protein production in isolated hepotocytes via IL-6 or IL-8. Br J Surg. 1994;81:184.

Deehan DJ, Heys SD, Simpson W, Herriot R, Broom J, Eremin O.Correlation of serum cytokine and acute phase reactant levels with alteration in weight and serum albumin in patients receiving immunotherapy with recombinant IL-2. Clin Exp Immunol. 1994;35:366-72.

Falconer IS, Slater C, Ross JA, McMillan DC, Ross JA, Preston T. Albumin synthetic rates, the acute phase response and cytokines in pancreatic cancer. Br J Surg. 1995;82:682.

Barber MD, Ross JA, Fearon KC. Changes in nutritional, functional, and inflammatory markers in advanced pancreatic cancer. Nutr Cancer. 1999;35:106-10.

McMillan DC, Watson WS, O’Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 2001;39:210-3.

Aung KCY, Feng L, Yap KB, Sitoh YY, Leong IYO, Pin TN. Serum albumin and hemoglobin are associated with physical function in community-living older persons in Singapore. The journal of nutrition, health & aging. 2011;15(10):877-82.

Kopple JD, Zhu X, Lew NL, Lowrie EG. Body weight-for-height relationships predict mortality in maintenance hemodialysis patients. Kidney Int. 1999;56(3):1136-48

McMillan DC , Watson WS, O'Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 2001;39(2):210-3.

Jong RJ, Hermans J, Molenaar J, Briaire JJ, Cessie SL. Prediction of survival in patients with head and neck cancer. Head Neck. 2001;23:718-24.

Sayed SS, Sharma S, Rane P. Can Metastatic Lymph Node Ratio (LNR) Predict Survival in Oral Cavity Cancer Patients? Journal of Surgical Oncology. 2013;108:256-63.