Is Hypoalbuminemia an Independent Prognostic Factor in Patients with Gastric Cancer?

Crumley, Andrew; Stuart, Robert C.; McKernan, Margaret; McMillan, Donald C.

doi:10.1007/s00268-010-0641-y

Cited by 131 publications

(123 citation statements)

References 35 publications

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“…In another study, Crumley et al (2006) indicated that low albumin was a confounding factor in the GPS scoring system. And Crumley also demonstrated that the development of hypo-albuminemia was secondary to an ongoing systemic inflammatory response and poor cancer specific survival was secondary to the systemic inflammatory response in patients with gastric cancer (Crumley et al, 2010). These results, from another perspective, showed that CRP is an effective marker to predict the prognosis for gastric cancer patients.…”

Section: Discussionmentioning

confidence: 89%

“…On the other hand, with the progression of cancer, the tumor itself can also trigger regional inflammatory response and release proinflammatory cytokines, which results in the formation of an inflammatory microenvironment (Balkwill et al, 2001;Coussens et al, 2002;Mantovani et al, 2008). Several studies pointed out that the elevated inflammatory response was associated with poor local immune response to the tumor and contributed to the lymph node spread and metastasis through a series of steps, including recruitment of the regulatory T lymphocytes and chemokine, activation of cytokines interleukin-6 and tumor necrosis factor-alpha, induction of neutrophilia, and secretion of CRP (Ulich et al, 1987;Ulich et al, 1989;Heikkila et al, 2007;Crumley et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Role of C-reactive Protein in Gastric Cancer: A Meta-analysis

Yu²,

Zhang

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: A number of studies have investigated the association between increased pretreatment serum C-reactive protein (CRP) levels and the prognosis of gastric cancer. However, due to the inconsistent results, whether the serum CRP level can be a prognostic factor in primary gastric cancer remains controversial. Methods: We searched Medline, PubMed, Embase and the Cochrane Central Register of Controlled Trials for relevant high-quality reports. A meta-analysis was carried out using the included studies to assess the association between pretreatment serum CRP level and overall survival (OS) in patients with gastric cancer. Correlation analyses were conducted to evaluate the relationship between serum CRP and tumor characteristics such as tumor node metastasis (TNM) stage and recurrence. Results: Twelve reports involving 2,597 patients with gastric cancer were included. Primary meta-analysis indicated a significant association between elevated CRP level and poor OS (HR 1.77, 95% CI 1.56-2.00). Subgroup analyses showed no single factor could alter the primary results when we divided the included studies by "number of patients", "max follow-up period", "TNM stage", "treatment" and "cut-off value". Correlation analyses showed that serum CRP level was significantly related to TNM stage (OR 2.96, 95% CI 2.22-3.93) and tumor recurrence (OR 1.81, 95% CI 1.21-2.71). Conclusions: We demonstrated that increased pretreatment serum CRP level (≥10mg/L) was significantly associated with poor prognosis in gastric cancer patients, either in early or advanced stages.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Prognostic Role of C-reactive Protein in Gastric Cancer: A Meta-analysis

Yu²,

Zhang

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…Many recent studies indicate that elevated CRP is a predictor of poor prognosis in malignant tumors including gastric cancer (Crumley et al, 2010;He et al, 2013;Szkandera et al, 2013;Xia et al, 2013). Serum concentration of CRP in tumor-bearing patients is known to be upregulated by proinflammatory cytokines including interleukin-1, interleukin-6, and tumor necrosis factor (Mahmoud et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…In gastric cancer, hypoalbunemia is reported to be associated with poor survival (Crumley et al, 2010;Jiang et al, 2012). Evidence also suggested that the development of hypoalbuminemia was a consequence of systemic inflammation, and might be secondary to elevation of CRP (Al-Shaiba et al, 2004;Onate-Ocana et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

Neutrophil Count and the Inflammation-based Glasgow Prognostic Score Predict Survival in Patients with Advanced Gastric Cancer Receiving First-line Chemotherapy

Li¹,

Lü²,

Yang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Purpose: To explore the value of systemic inflammatory markers as independent prognostic factors and the extent these markers improve prognostic classification for patients with inoperable advanced or metastatic gastric cancer (GC) receiving palliative chemotherapy. Methods: We studied the prognostic value of systemic inflammatory factors such as circulating white blood cell count and its components as well as that combined to form inflammation-based prognostic scores (Glasgow Prognostic Score (GPS), Neutrophil-Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR), Prognostic Index (PI) and Prognostic Nutritional Index (PNI)) in 384 patients with inoperable advanced or metastatic gastric cancer (GC) receiving first-line chemotherapy. Univariate and multivariate analyses were performed to examine the impact of inflammatory markers on overall survival (OS). Results: Univariate analysis revealed that an elevated white blood cell, neutrophil and/or platelet count, a decreased lymphocyte count, a low serum albumin concentration, and high CRP concentration, as well as elevated NLR/PLR , GPS, PI, PNI were significant predictors of shorter OS. Multivariate analysis demonstrated that only elevated neutrophil count (HR 3.696, p=0.003) and higher GPS (HR 1.621, p=0.01) were independent predictors of poor OS. Conclusion: This study demonstrated elevated pretreatment neutrophil count and high GPS to be independent predictors of shorter OS in inoperable advanced or metastatic GC patients treated with first-line chemotherapy. Upon validation of these data in independent studies, stratification of patients using these markers in future clinical trials is recommended.

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“…Decreased prealbumin level is known to be an independent risk factor in cancer patients and its use is recommended in terminal cancer patients [19]. Similarly, hypo-albuminemia is a typical index of malnutrition and has been associated with poor prognosis in patients with advanced cancers [20].…”

Section: Discussionmentioning

confidence: 99%

Can Prealbumin, Albumin and CRP Levels be used to Predict Prognosis in Patients with Gastric Cancer

Üreyen¹

2016

J Surg Surgical Res

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Background: The impact of systemic inflammatory response on carcinogenesis and tumor progression has recently gained much attention. Biochemical markers such as albumin, pre-albumin and C-reactive protein (CRP) are currently used to predict prognosis in several cancer types, and the usefulness of these biomarkers in gastric cancer has become an emerging topic of research. The present study aims to assess the correlation between tumor stage and the levels of pre-albumin, albumin and CRP in patients who underwent surgery for gastric cancer.Methods: Albumin, pre-albumin and CRP levels of the patients who underwent surgery for gastric cancer in our division, were prospectively recorded and retrospectively evaluated. Age, gender, duration of hospital stay, TNM stage, and preoperative albumin, pre-albumin and CRP levels were recorded. Albumin levels lower than 3.5 mg/dL and pre-albumin levels lower than 20 mg/dL were considered to be below the normal range. CRP levels higher than 5 mg/L were considered to be elevated. Patients with another focus of inflammation were excluded from the study.Results: A total number of 41 patients, 32 (78%) men and 9 (22%) women, were included in the study. Albumin levels were significantly associated with the age (p=0.010). There was no significant correlation between disease stage, gender, presence of metastatic lymph nodes and albumin levels (p>0.05). There was a significant correlation between the TNM stage and pre-albumin levels (P=0.014). No significant correlation was demonstrated between pre-albumin levels and the other parameters (P>0.05). The independent variables were not found to be significantly different between the groups with normal and elevated CRP levels (p>0,05) Conclusions:The present study showed that the patients with lymph node metastasis and advanced stage gastric cancer more frequently have decreased levels of albumin and pre-albumin, and elevated levels of CRP. Decreased pre-albumin level was found to be associated with the TNM stage. The albumin levels were found to be decreasing by age. Although we failed to demonstrate a statistically correlation with albumin and CRP, preoperative albumin, pre-albumin and CRP levels may be useful to predict prognosis of patients with gastric cancer.

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Is Hypoalbuminemia an Independent Prognostic Factor in Patients with Gastric Cancer?

Cited by 131 publications

References 35 publications

Prognostic Role of C-reactive Protein in Gastric Cancer: A Meta-analysis

Prognostic Role of C-reactive Protein in Gastric Cancer: A Meta-analysis

Neutrophil Count and the Inflammation-based Glasgow Prognostic Score Predict Survival in Patients with Advanced Gastric Cancer Receiving First-line Chemotherapy

Can Prealbumin, Albumin and CRP Levels be used to Predict Prognosis in Patients with Gastric Cancer

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