Pretreatment serum albumin as a predictor of cancer survival: A systematic review of the epidemiological literature

Abstract

BackgroundThere are several methods of assessing nutritional status in cancer of which serum albumin is one of the most commonly used. In recent years, the role of malnutrition as a predictor of survival in cancer has received considerable attention. As a result, it is reasonable to investigate whether serum albumin has utility as a prognostic indicator of cancer survival in cancer. This review summarizes all available epidemiological literature on the association between pretreatment serum albumin levels and survival in different types of cancer.MethodsA systematic search of the literature using the MEDLINE database (January 1995 through June 2010) to identify epidemiologic studies on the relationship between serum albumin and cancer survival. To be included in the review, a study must have: been published in English, reported on data collected in humans with any type of cancer, had serum albumin as one of the or only predicting factor, had survival as one of the outcome measures (primary or secondary) and had any of the following study designs (case-control, cohort, cross-sectional, case-series prospective, retrospective, nested case-control, ecologic, clinical trial, meta-analysis).ResultsOf the 29 studies reviewed on cancers of the gastrointestinal tract, all except three found higher serum albumin levels to be associated with better survival in multivariate analysis. Of the 10 studies reviewed on lung cancer, all excepting one found higher serum albumin levels to be associated with better survival. In 6 studies reviewed on female cancers and multiple cancers each, lower levels of serum albumin were associated with poor survival. Finally, in all 8 studies reviewed on patients with other cancer sites, lower levels of serum albumin were associated with poor survival.ConclusionsPretreatment serum albumin levels provide useful prognostic significance in cancer. Accordingly, serum albumin level could be used in clinical trials to better define the baseline risk in cancer patients. A critical gap for demonstrating causality, however, is the absence of clinical trials demonstrating that raising albumin levels by means of intravenous infusion or by hyperalimentation decreases the excess risk of mortality in cancer.

Albumin-globulin Ratio for Prediction of Long-term Mortality in Lung Adenocarcinoma Patients

“…Hypoalbuminemia has a strong predictive value on mortality and morbidity regardless of its cause (Gatta et al, 2012). Up to now, hypoalbuminemia has been reported as an independent negative prognostic factor for survival in several cancers including lung (Gupta et al, 2010), gastric (Onate-Ocana et al, 2007), colorectal and breast (Gupta et al, 2010). Also low serum albumin level was shown to be an important prognostic factor for tumor recurrence and correlate with poor survival in NSCLC patients (Jin et al, 2013;Yildirim et al, 2013).…”

Pretreatment Serum Albumin Level is an Independent Prognostic Factor in Patients with Stage IIIB Non-Small Cell Lung Cancer: A Study of the Turkish Descriptive Oncological Researches Group

“…Several studies showed an inverse relationship between the body mass index and albumin synthesis, which is also an indicator of cancer cachexia (Fearon et al, 1998;Gupta and Lis, 2010). Gastrointestinal cancers and lung cancer are the most common cancer types presenting malnutrition and cancer-induced weight loss in all stages of the disease (Dewys et al, 1980;O'Gorman et al, 1998;von Meyenfeldt, 2005).…”

“…Previous studies have shown that serum albumin level may have an adverse prognostic impact on certain cancer types and different cancer stages and that hypoalbuminemia is associated with poor prognosis (Gupta et al, 2009;Gupta and Lis, 2010;Ku et al, 2014;Zhang et al, 2014) In addition, the studies including patients with lung cancer have demonstrated that serum albumin level may play an important role in the scoring systems in metastatic patients (Espinosa et al, 1995;Maestu et al, 1997;Lai et al, 1998;Forrest et al, 2005;Win et al, 2008). The possible relationship between cancer and inflammation has been also widely studied in clinical trials (Lai et al, 1998).…”

Reliability of nutritional assessment in patients with gastrointestinal tumors

“…The accuracy and reproducibility of anthropo- Serum albumin has also been described as an independent survival prognostic factor in many tumors, displaying an inverse relation to complications and length of postoperative hospitalization or intensive care, mortality, and resumption of oral intake 26,27 .…”

“…But they also have been used to assess overall nutritional status, severity, progression and prognosis of the disease 26 , assuming that plasma levels indeed reflect the rate of synthesis 27-29. However, other factors such as liver function, inflammation markers and endocrine stress result in increased levels of cortisol, which also affects albumin regulation 27 .…”