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

Digant Gupta; Carolyn A. Lammersfeld; Pankaj G. Vashi; Sadie Dahlk; James F. Grutsch; Christopher G. Lis


Clin Ovarian Cancer. 2009;2(1):52-56. 

In This Article

Abstract and Introduction


Background: 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.


The overall age-adjusted incidence rate for all ovarian cancer cases as reported by the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute is 16.23 cases per 100,000 women standardized to the 2000 United States standard population.[1] Ovarian cancer is the fifth leading cause of cancer deaths in women, the leading cause of death from gynecologic malignancy, and the second most commonly diagnosed gynecologic malignancy in the United States.[2,3] Most patients are diagnosed with regional and distant disease, which have poor 5-year survival rates of 69% and 29%, respectively.[2]

Various clinical, biochemical, and histologic prognostic factors for ovarian cancer have been identified. Age, stage, grade, and cytology are important prognostic factors in high-risk early-stage epithelial ovarian cancer.[4,5] Performance status, tumor histology, and residual tumor volume are independent predictors of prognosis in patients with stage III epithelial ovarian cancer.[4] Additionally, the presence or absence of ascites and diameter of the largest residual tumor nodule are statistically important predictors of survival in ovarian cancer.[6] Furthermore, change of body weight during primary chemotherapy has also been reported as a strong prognostic factor.[7] Recently, nutritional status has been hypothesized to be of prognostic value in patients with ovarian cancer.[8]

Malnutrition in cancer patients is a significant problem because of a variety of mechanisms involving the tumor, the host response to the tumor, and anticancer therapies,[9] especially among those patients diagnosed with ovarian cancer.[10] Malnutrition has been associated with a number of clinical consequences, including reduced quality of life, decreased response to treatment, increased risk of chemotherapy-induced toxicity, and a reduction in survival of cancer patients,[11,12] ovarian cancer being no exception.[13] The prevalence of malnutrition in patients with ovarian cancer has been reported to an extent of 67%.[14] In ovarian cancer, poor nutritional status and cachexia are believed to be caused by the metabolic effects of the enlarging tumor masses and bowel obstruction.[15] As malnutrition can affect the treatment and outcomes of patients with ovarian cancer, timely intervention to assess and improve nutritional status in such patients is of utmost importance.

There are various methods of assessing nutritional status in cancer, and each has its own advantages and disadvantages. Among the most commonly used tools to measure nutritional status are subjective global assessment (SGA),[16,17] bioelectrical impedance analysis (BIA),[18] and laboratory measurements of serum albumin,[19] prealbumin, and transferrin.[20,21] Others include anthropometric parameters[21,22,23] such as weight loss, arm muscle circumference, skin-fold thickness,[24] and presence of edema and ascites.[25] In assessing nutritional status of gynecologic patients, subjective assessment differs from objective/laboratory measurement,[26] with laboratory methods such as serum albumin being considered an independent parameter of nutritional status.

Serum albumin is a commonly used parameter to assess nutritional status in various life-threatening illnesses such as cardiovascular diseases and cancers.[27] Serum albumin has been described as an independent prognosticator of survival in lung cancer,[28] pancreatic cancer,[29] gastric cancer,[30] colorectal cancer,[31,32,33] and breast cancer.[34] Low serum albumin has also been shown to be an independent indicator for prognosis in cancer patients with unknown primaries.[35] However, there is no evidence in the literature to suggest the role of serum albumin as a prognosticator in ovarian cancer. We therefore investigated the role of serum albumin as an independent predictor of survival in ovarian cancer.


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