Preoperative serum albumin as a prognostic factor in patients with upper urinary tract urothelial carcinoma

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Purpose: The study evaluated whether preoperative measures of the C-reactive protein--based systemic inflammatory response may predict cancer survival independent of tumor stage in patients with upper urinary tract urothelial carcinoma (UTUC). Materials and Methods:Between September 1999 and October 2010, 181 patients submitted to radical nephroureterectomy were available for evaluation. Multivariate survival analyses were performed using Cox's proportional hazards model and the coefficient for each factor was divided by the highest coefficient, multiplied by 4, and rounded to the nearest integer.Results: Multivariate analyses showed that tumor location, pathologic T stage, lymphovascular invasion, margin status, and albumin level were independent contributors. The bootstrap-corrected C statistics of the model were 0.813 for disease-specific survival and 0.755 for overall survival, respectively. For time to disease-specific and overall mortality for patients, integrated area under the curve values were 0.792 and 0.739, respectively. When patients were clustered into three groups according to their model--predicted survival, the 5-year disease-specific survival in the low-, intermediate-and high-risk group was 95.4%, 76.2%, and 36.9%, respectively (p<0.001), and were 87.8%, 54.4%, and 31.8%, respectively, for overall survival (p<0.001). Decision curve analysis revealed that the use of model was associated with net benefit gains relative to the treat-all strategy. Conclusions: Pretreatment albumin is a simple biomarker based on routinely available well-standardized measures, and is not an expensive and time-consuming process. Hypoalbuminemia is an independent marker of poor prognosis in patients with upper urinary tract urothelial carcinoma.

The prognostic value of C-reactive protein/albumin ratio in human malignancies: an updated meta-analysis

“…As a major plasma protein, HA has been used for prognostic assessment in patients with different conditions, including hemodialysis patients, multiple myeloma patients and patients undergoing replacement albumin therapy 46. In addition, pretreatment serum protein is used as a prognostic marker in many human malignancies, including urinary carcinoma,47,48 head and neck cancer,49 lung cancer,50 gynecological cancer51,52 and gastrointestinal cancers 53,54…”

Pretreatment Serum Albumin Level is an Independent Prognostic Factor in Patients with Stage IIIB Non-Small Cell Lung Cancer: A Study of the Turkish Descriptive Oncological Researches Group

“…Previous studies have shown that serum albumin level may have an adverse prognostic impact on certain cancer types and different cancer stages and that hypoalbuminemia is associated with poor prognosis (Gupta et al, 2009;Gupta and Lis, 2010;Ku et al, 2014;Zhang et al, 2014) In addition, the studies including patients with lung cancer have demonstrated that serum albumin level may play an important role in the scoring systems in metastatic patients (Espinosa et al, 1995;Maestu et al, 1997;Lai et al, 1998;Forrest et al, 2005;Win et al, 2008). The possible relationship between cancer and inflammation has been also widely studied in clinical trials (Lai et al, 1998).…”

Preoperative serum pre-albumin as an independent prognostic indicator in patients with localized upper tract urothelial carcinoma after radical nephroureterectomy

“…Few studies have been conducted to determine the influence of perioperative nutritional status in the prognosis of UTUC patients [10, 24]. Kang et al demonstrated that preoperative underweight (BMI<21.6 kg/m 2 ) could significantly increase the rate of cancer-specific motility and overall mortality in UTUC patiets after RUN [24].…”

“…Kang et al demonstrated that preoperative underweight (BMI<21.6 kg/m 2 ) could significantly increase the rate of cancer-specific motility and overall mortality in UTUC patiets after RUN [24]. Ku et al reported that preoperative hypoalbuminemia (albumin<3.5 g/dL) is an independent prognostic factor of CSS and OS in UTUC patients [10]. …”

“…Therefore, it is crucial to identify risk factors, which would allow for the assessment of individual risk profiles. The nutritional status of patients with cancer is an important parameter affecting survival outcomes [9, 10]. …”