Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer

Stares, Mark; Swan, Amanda; Cumming, Kirsten; Ding, Tze-en; Leach, James; Stratton, Cory; Thomson, Findlay; Barrie, Colin; MacLennan, Kirsty; Campbell, Sorcha; Evans, Tamasin; Tufail, Aisha; Harrow, Stephen; Mackean, Melanie; Phillips, I.

doi:10.3389/fnut.2021.734735

Cited by 23 publications

(33 citation statements)

References 48 publications

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“…The key clinical features of cancer cachexia are poor nutritional status, systemic inflammation, and reduced skeletal muscle mass. Clinical measures of these features, that is, serum albumin, NLR, and SMI, are independently associated with poor outcomes [ 16 , 17 , 18 , 19 ]. All these features are included in the CXI and might therefore be desirable to measure cancer cachexia.…”

Section: Introductionmentioning

confidence: 99%

Cachexia Index as a Prognostic Indicator in Patients with Gastric Cancer: A Retrospective Study

Gong

Wan

Zhao

et al. 2022

Cancers

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The current diagnostic criteria for cancer cachexia are inconsistent, and the prognostic value of cachexia in gastric cancer (GC) is controversial. This study aimed to investigate the prognostic value of the cachexia index (CXI) in patients with GC. We calculated the CXI as skeletal muscle index (SMI) × serum albumin/neutrophil-lymphocyte ratio (NLR), and a total of 161 and 163 patients were included in the high and low CXI groups, respectively. Low CXI was significantly associated with a more advanced tumor–node–metastasis (TNM) stage, a higher level of serum C-reactive protein, serum interleukin-6, and NLR, but also a decreased level of serum prealbumin and albumin. In addition, patients in the low CXI group were more likely to have postoperative pulmonary infections (9.8% vs. 3.7%, p = 0.03). Cox proportional analyses indicated that patients with low CXI (HR 0.45, 95% CI 0.29 to 0.69; p < 0.001) or TNM stage III+IV (HR 4.38, 95% CI 2.54 to 7.55; p < 0.001) had a significantly poorer overall survival (OS). Kaplan–Meier survival curves suggested that patients with low CXI had a significantly decreased OS, which was not affected by subgroup analyses of different sex, age, cachexia, body mass index (BMI), and TNM stage. Furthermore, low CXI combined with cachexia, low BMI, or TNM stage III+IV caused the worst OS in each subgroup analysis, respectively. Our study demonstrated that CXI had a good prognostic value in GC. Greater attention should be paid to patients with low CXI, particularly those combined with cachexia, low BMI, or TNM stage III+IV.

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Section: Introductionmentioning

confidence: 99%

Cachexia Index as a Prognostic Indicator in Patients with Gastric Cancer: A Retrospective Study

Gong

Wan

Zhao

et al. 2022

Cancers

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“…Thus, low albumin levels and nutrient indices have been shown to be associated with poorer outcomes in survival time analyses in various malignancies [43][44][45]. In two smaller cohorts, hypoalbuminemia has been shown to be a negative and independent prognostic factor in patients with metastatic or nonmetastatic NSCLC initially treated with chemotherapy or targeted therapies [45,46]. In addition, Rim et al studied 353 elderly cancer patients treated with definitive RT and showed that low albumin levels were associated with a higher rate of poor treatment compliance [47].…”

Section: Discussionmentioning

confidence: 99%

C-Reactive Protein to Albumin Ratio as Prognostic Marker in Locally Advanced Non-Small Cell Lung Cancer Treated with Chemoradiotherapy

et al. 2022

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Despite the implementation of consolidative immune checkpoint inhibition after definitive chemoradiotherapy (CRT), the prognosis for locally advanced non-small-cell lung cancer (NSCLC) remains poor. We assessed the impact of the C-reactive protein (CRP) to albumin ratio (CAR) as an inflammation-based prognostic score in patients with locally advanced NSCLC treated with CRT. We retrospectively identified and analyzed 52 patients with primary unresectable NSCLC (UICC Stage III) treated with definitive/neoadjuvant CRT between 2014 and 2019. CAR was calculated by dividing baseline CRP by baseline albumin levels and correlated with clinicopathologic parameters to evaluate prognostic impact. After dichotomizing patients by the median, univariate and multivariate Cox regression analyses were performed. An increased CAR was associated with advanced T-stage (p = 0.018) and poor performance status (p = 0.004). Patients with pre-therapeutic elevated CAR had significantly lower hemoglobin and higher leukocyte levels (hemoglobin p = 0.001, leukocytes p = 0.018). High baseline CAR was shown to be associated with worse local control (LPFS, p = 0.006), shorter progression-free survival (PFS, p = 0.038) and overall survival (OS, p = 0.022), but not distant metastasis-free survival (DMFS). Multivariate analysis confirmed an impaired outcome in patients with high CAR (LPFS: HR 3.562, 95% CI 1.294–9.802, p = 0.011). CAR is an easily available and independent prognostic marker after CRT in locally advanced NSCLC. CAR may be a useful biomarker for patient stratification to individualize treatment concepts.

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“…It is well known that cancer cachexia is associated with hypoalbuminemia and anorexia, i.e., loss of appetite [ 38 , 39 ]. However, to our knowledge, there are no previous studies on the association between albumin level and appetite in palliative care cancer patients; neither has anyone studied whether there is a difference between men and women in palliative care.…”

Section: Discussionmentioning

confidence: 99%

Appetite in Palliative Cancer Patients and Its Association with Albumin, CRP and Quality of Life in Men and Women—Cross-Sectional Data from the Palliative D-Study

Goodrose-Flores

Bonn

Klasson

et al. 2022

Life

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Albumin is an important biochemical marker in palliative cancer care, used for assessment of nutritional status, disease severity and prognosis. Our primary aim was to investigate sex differences in the association between appetite and albumin levels in palliative cancer patients. We also aimed to study associations between appetite and C-reactive protein (CRP), Quality of Life (QoL), pain and fatigue. In the Palliative D-cohort, consisting of 266 men and 264 women, we found a correlation between appetite and albumin; low appetite, measured with the Edmonton Symptom Assessment System, correlated significantly with low albumin in men: (r = −0.33, p < 0.001), but not in women (r = −0.03, p = 0.65). In a regression analysis adjusted for confounding factors, results were similar. Lower appetite was correlated with higher CRP in men (r = 0.27, p < 0.001), but not in women (r = 0.12, p = 0.05). Appetite was correlated with QoL, fatigue and pain in both men and women; those with a low appetite had a low QoL and high fatigue- and pain-scores (p < 0.001). In conclusion, our results indicated possible sex differences in the associations between appetite and albumin, and between appetite and CRP, in palliative care patients. Understanding these associations could provide additional value for clinical practice.

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Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer

Cited by 23 publications

References 48 publications

Cachexia Index as a Prognostic Indicator in Patients with Gastric Cancer: A Retrospective Study

Cachexia Index as a Prognostic Indicator in Patients with Gastric Cancer: A Retrospective Study

C-Reactive Protein to Albumin Ratio as Prognostic Marker in Locally Advanced Non-Small Cell Lung Cancer Treated with Chemoradiotherapy

Appetite in Palliative Cancer Patients and Its Association with Albumin, CRP and Quality of Life in Men and Women—Cross-Sectional Data from the Palliative D-Study

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