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

Abstract

PurposeTo investigate the prognostic value of preoperative pre-albumin and albumin level in patients with localized upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy.Methods and MaterialsBetween January 2003 and June 2013, we evaluated data on 425 patients with nonmetastatic UTUC (Ta-4N0/+M0) who underwent radical nephroureterectomy at our institution. Low pre-albumin level was defined as <20 mg/dl, while hypoalbuminemia was defined as albumin <35 g/L. The associations of preoperative low pre-albumin level and hypoalbuminemia with clinical and pathologic variables were assessed. Univariable and multivariable analyses using the Cox regression model were performed to determine prognostic factors that were associated with cancer specific survival (CSS) and overall survival (OS). The Harrell concordance index with variables only or combined pre-albumin data were used to evaluate the prognostic accuracy.ResultsCompared with patients with high pre-albumin level, patients with low pre-albumin level were more likely to have older age, higher tumor stage, higher rate of diabetes, regional lymph node metastasis and lymphovascular invasion. Meanwhile, hypoalbuminemia was only associated with diabetes. Multivariate analysis identified decreased preoperative pre-albumin level as an independent prognostic factor for CSS (HR 1.85, 95% CI 1.14-3.00, p=0.013) and OS (HR 1.73, 95% CI 1.12-2.70, p=0.015), but not preoperative hypoalbuminemia. The estimated c-index of the multivariate model for CSS and OS increased from 0.771 and 0.760 without pre-albumin to 0.775 and 0.765 when pre-albumin added.ConclusionsLow preoperative pre-albumin level but not preoperative hypoalbuminemia is a negative independent prognostic factor for survival outcome in patients with UTUC undergoing radical nephroureterectomy.

Serum Levels of Prealbumin and Albumin for Preoperative Risk Stratification

“…Across most surgical specialties, low serum levels of albumin and prealbumin are related to severe complications, such as nosocomial infections, unplanned reoperation, gastrointestinal anastomotic leak, positive oncologic resection margins, advanced tumor stage, postoperative cancer recurrence, prolonged hospital and intensive care unit length of stay, wound complications, renal failure, gastrointestinal dysfunction, postoperative edema, and death (See Table ) …”

Role of Systemic Inflammatory Response Markers in Urothelial Carcinoma

“…Several studies have reported on the association of hypoalbuminemia with poor prognosis in patients with UC ( Table 5) (49,68,72,(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91). The cutoff value of albumin varies from 2 to 4 mg/L, although it is normally around 3.5 mg/L.…”

Preoperative circulating FPR and CCF score are promising biomarkers for predicting clinical outcome of stage II&ndash;III colorectal cancer patients

“… 14 , 15 Moreover, Alb and pre-Alb were observed to be significantly lower in cancer individuals in comparison with the healthy controls. 16 , 17 Hence, we hypothesized that the two new biomarkers, Alb-to-Fib ratio (AFR) and Fib-to-pre-Alb ratio (FPR), might reflect the severity of systemic inflammation and predict the survival of CRC individuals.…”