Low serum albumin levels and high neutrophil counts are predictive of a poorer prognosis in patients with metastatic breast cancer

Abstract

Breast cancer is a severe disease with high incidence and mortality rates in menopausal women. Previous studies have shown that nutritional status and inflammation play a significant role in the development of breast cancer. However, whether serum albumin (ALB) and neutrophils (NE) accelerate the progression of this disease remains unclear.In the present study, a total of 94 cases of newly diagnosed metastatic breast cancer were assessed. For analysis, 26 risk factors including ALB and NE were assessed. Multivariate Cox proportional hazards regression analysis was then used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for continuous and categorical covariates. Compared with the control group, patients with disease progression, low levels of ALB, higher NE, counts, and higher neutrophil to lymphocyte ratio counts were associated with worse overall survival (OS). When these risk factors were fitted into a multivariate regression model, progression [P<0.001, HR=3.03 (1.62-5.66)], NE counts ≥3.370x10 9 [P=0. 004,] and ALB levels <43.275 g/l [P=0.008, HR=0.47 (0.27-0.82)] remained statistically significant factors for a worse OS. These independently associated risk factors were used to form an OS estimation nomogram. The constructed nomogram demonstrated good accuracy in estimating risk, with a bootstrap-corrected C index of 0.686. We further collected data on 30 patients for external validation and found the nomogram had an accuracy of 83.3%. In conclusion, low serum ALB levels and increased NE counts were predictive of a poorer prognosis in patients with metastatic breast cancer. Nomograms based on the multivariate analysis showed a good predictive ability for estimating the risk of OS.

Low albumin status accompanies multi-layered immunosuppressive phenotypes in metastatic breast cancer patients

“…Low albumin status is a prevalent phenotype in various diseases 9, 10, 11, 12 . Indeed, this is one of the most unfavorable symptoms, suggestive of low nutrition status, observed in patients with advanced cancers 9, 10, 11, 12 . In breast cancers, low albumin status is a prognostic factor 9, 10, 11, 12 .…”

“…Indeed, this is one of the most unfavorable symptoms, suggestive of low nutrition status, observed in patients with advanced cancers 9, 10, 11, 12 . In breast cancers, low albumin status is a prognostic factor 9, 10, 11, 12 . Despite its prevalence, what low albumin status tells us in detail in patients has been largely unexplored.…”

“…This is largely due to our insufficient understanding of the comprehensive picture of host pathophysiology in cancers. For example, it is known that blood albumin levels are low in patients with advanced cancers, which generally indicate poor nutritional condition and associate with poor prognosis 9, 10, 11, 12 . However, it remains incompletely understood what kind of pathophysiology is associated with albumin down-regulation in advanced cancer patients in detail.…”

The role of nutrition-based index in predicting survival of breast cancer patients: A systematic review and meta-analysis

“…The reduction in albumin production in cancer has been supported by an in-vivo investigation, wherein mice with tumors exhibited hypoalbuminemia, mostly attributed to a decline in the abundance of liver albumin mRNA [ 36 , 37 ]. The reduction in albumin synthesis will lead to an elevation in TNF-induced micro-vessel permeability, resulting in a decline in serum albumin concentrations [ 35 , 38 ]. Additionally, a prior investigation has indicated that malnutrition among cancer patients can contribute to a reduction in the synthesis rate of serum albumin, hastening its breakdown and thus leading to hypoproteinemia [ 38 ].…”

The role and metabolic adaptations of neutrophils in premetastatic niches

“…Several studies have demonstrated that more neutrophil infiltration of tumors is associated with worse clinical prognosis [ 2 – 4 ]. However, the exact role of neutrophils in the formation of pre-metastatic niche remains unknown.…”