Is Serum Albumin an Independent Predictor of Survival in Ovarian Cancer?

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AbstractBackground:The medical literature shows several examples of an inverse relationship between serum albumin and mortality in patients with advanced cancer. Because malnutrition can be a frequent manifestation in ovarian cancer, we investigated the prognostic role of serum albumin in patients with ovarian cancer treated in an integrative cancer treatment setting.Materials and Methods:We evaluated 213 histologically confirmed case series of ovarian cancer patients treated at Cancer Treatment Centers of America® between January 2001 and May 2006. Serum albumin was divided into 2 categories of ≥ 3.6 g/dL and ≤ 3.5 g/dL. The Kaplan-Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of serum albumin independent of other prognostic factors.Results:Of 213 patients, 41 were newly diagnosed at our hospital, and 172 had received previous treatment elsewhere. Thirty had stage I disease at diagnosis, 17 stage II, 128 stage III, and 24 stage IV. A total of 135 patients had a serum albumin score of ≥ 3.6 g/dL, and 78 patients had a score of ≤ 3.5 g/dL. Patients with ≥ 3.6 g/dL scores had a median survival of 23.3 months (95% CI, 16.5–30.1 months), whereas those with ≤ 3.5 g/dL scores had a median survival of 7.3 months (95% CI, 4.8–9.8 months); P < .001. Multivariate Cox modeling found that every 1 gm/dL increase in serum albumin was associated with a relative risk of 0.39 (95% CI, 0.29–0.53; P < .001).Conclusion:Univariate and multivariate survival analysis found that low levels of serum albumin adversely affected survival by a statistically significant level across all stages of ovarian cancer independent of stage at diagnosis, serum cancer antigen–125, and previous treatment history.

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