Elevated serum creatinine and low albumin are associated with poor outcomes in patients with liposarcoma

Abstract

Low serum albumin levels and impaired kidney function have been associated with decreased survival in patients with a variety of cancer types. In a retrospective cohort study, we analyzed 84 patients with liposarcoma treated at from May 1994 to October 2011. Uni-and multivariable Cox proportional hazard models and competing risk analyses were performed to evaluate the association between putative biomarkers with disease-specific and overall survival. The median age of the study population was 51.7 (range 19.6-83.8) years. In multivariable analysis adjusted for AJCC tumor stage, serum creatinine was highly associated with diseasespecific survival (Subdistribution Hazard ratio (SHR) per 1 mg/dl increase ¼ 2.94; 95%CI 1.39-6.23; p ¼ 0.005). High albumin was associated with improved overall and disease-specific survival (Hazard Ratio (HR) per 10 units increase ¼ 0.50; 95%CI 0.26-0.95; p ¼ 0.033 and SHR ¼ 0.64; 95%CI 0.42-1.00; p ¼ 0.049). The serum albumin-creatinine-ratio emerged to be associated with both overall and disease-specific survival after adjusting for AJCC tumor stage (HR ¼ 0.95; 95%CI 0.92-0.99; p ¼ 0.011 and SHR ¼ 0.96; 95%CI 0.93-0.99; p ¼ 0.08). Our study provides evidence for a tumor-stage-independent association between higher creatinine and lower albumin with worse disease-specific survival. Low albumin and a high albumin-creatinine-ratio independently predict poor overall survival. Our work identified novel prognostic biomarkers for prognosis of patients with liposarcoma. ß

Serum creatinine and albumin predict sarcoma‐specific survival in patients with myofibroblastic and fibroblastic sarcomas

“…Patients with STS recurrence who have been referred to our tertiary center for salvage therapy ( n = 27) were also excluded. Considering the data by Funovics et al, who showed that re‐resection of inadequately resected STS within 3 months after index surgery does not appear to compromise oncologic outcomes, we set a cut‐off of 12 weeks for patients admitted to our hospital for re‐resection . Twenty patients had to be excluded due to longer referral times.…”

“…Albumin (g/L) was measured using a bromocresol green colorimetric assay, and creatinine (mg/dl) with the Jaffe method . The albumin‐creatinine ratio (ACR) was calculated by dividing albumin (g/L)/creatinine (mg/dl) …”

“…Albumin and creatinine as surrogate for nutrition, patient's performance status and kidney function in cancer patients are associated with survival although the pathological relations are not clearly understood yet . Recent data from liposarcoma patients identified elevated serum creatinine, low albumin, and a decreased albumin‐creatinine ratio (ACR) as negative prognostic factor with worse disease specific survival …”

C‐reactive protein: An independent predictor for dedifferentiated chondrosarcoma

“…Over the last years, the involvement of systemic inflammation in cancer progression and metastasis has been postulated. Cancer cells may interact directly and indirectly with host inflammatory cells 6, 9, 15. Especially the C‐reactive protein (an acute phase protein synthesized by the liver) as a marker of systemic inflammatory response has been found to be associated with decreased survival rates in different malignancies 5, 7, 8, 16, 17…”

“…In recent studies, the concept of the involvement of systemic inflammation in cancer progression and metastasis has been postulated 5, 6. Specifically, elevated pre‐operative CRP as marker of systemic inflammatory response has been found to be associated with decreased overall survival in osteosarcoma, chordoma, and soft tissue sarcoma 5, 7, 8, 9…”