SpringerLink
Log in

Is Hypoalbuminemia an Independent Prognostic Factor in Patients with Gastric Cancer?

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Studies have indicated that hypoalbuminemia is associated with decreased survival of patients with gastric cancer. However, the prognostic value of albumin may be secondary to an ongoing systemic inflammatory response. The aim of the study was to assess the relation between hypoalbuminemia, the systemic inflammatory response, and survival in patients with gastric cancer.

Methods

Patients diagnosed with gastric carcinoma attending the upper gastrointestinal surgical unit in the Royal Infirmary, Glasgow between April 1997 and December 2005 and who had a pretreatment measurement of albumin and C-reactive protein (CRP) were studied.

Results

Most of the patients had stage III/IV disease and received palliative treatment. The minimum follow-up was 15 months. During follow-up, 157 (72%) patients died of their cancer. On univariate analysis, stage (p < 0.001), treatment (p < 0.001), albumin level (p < 0.001), and CRP level (p < 0.001) were significant predictors of survival. On multivariate analysis, stage (p < 0.001), treatment (p < 0.001), and CRP level (p < 0.001) remained significant predictors of survival. Albumin was no longer an independent predictor of survival.

Conclusions

Low albumin concentrations are associated with poorer survival in patients with gastric cancer. However, the strength of this relation with survival is dependent on the presence of a systemic inflammatory response, as evidenced by an elevated CRP level. Therefore, it appears that the relation between hypoalbuminemia and poor survival is secondary to that of the systemic inflammatory response.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cancer Research UK Information Resource Centre (2004) CancerStats. http://info.cancerresearchuk.org/cancerstats

  2. Allgayer H, Heiss MM, Schildberg FW (1997) Prognostic factors in gastric cancer. Br J Surg 84:1651–1664

    Article  CAS  PubMed  Google Scholar 

  3. Pyrhonen S, Kuitunen T, Nyandoto P et al (1995) Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer 71:587–591

    CAS  PubMed  Google Scholar 

  4. Ross P, Nicolson M, Cunningham D et al (2002) Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) with epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer. J Clin Oncol 20:1996–2004

    Article  CAS  PubMed  Google Scholar 

  5. Lien YC, Hsieh CC, Wu YC et al (2004) Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia. J Gastrointest Surg 8:1041–1048

    Article  PubMed  Google Scholar 

  6. Onate-Ocana LF, Aiello-Crocifoglio V, Gallardo-Rincon D et al (2007) Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Ann Surg Oncol 14:381–389

    Article  PubMed  Google Scholar 

  7. Alici S, Kaya S, Izmirli M et al (2006) Analysis of survival factors in patients with advanced-stage gastric adenocarcinoma. Med Sci Monit 12:CR221–CR229

    PubMed  Google Scholar 

  8. Lee J, Lim T, Uhm JE et al (2007) Prognostic model to predict survival following first-line chemotherapy in patients with metastatic gastric adenocarcinoma. Ann Oncol 18:886–891

    Article  CAS  PubMed  Google Scholar 

  9. Onate-Ocana LF, Becker M, Carrillo JF et al (2008) Selection of best candidates for multiorgan resection among patients with T4 gastric carcinoma. J Surg Oncol 98:336–342

    Article  PubMed  Google Scholar 

  10. McMillan DC, Crozier JE, Canna K et al (2007) Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Colorectal Dis 22:881–886

    Article  PubMed  Google Scholar 

  11. Al Murri AM, Bartlett JM, Canney PA et al (2006) Evaluation of an inflammation-based prognostic score (GPS) in patients with metastatic breast cancer. Br J Cancer 94:227–230

    Article  CAS  PubMed  Google Scholar 

  12. Forrest LM, McMillan DC, McArdle CS et al (2003) Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer 89:1028–1030

    Article  CAS  PubMed  Google Scholar 

  13. Glen P, Jamieson NB, McMillan DC et al (2006) Evaluation of an inflammation-based prognostic score in patients with inoperable pancreatic cancer. Pancreatology 6:450–453

    Article  PubMed  Google Scholar 

  14. McMillan DC, Watson WS, O’Gorman P et al (2001) Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer 39:210–213

    Article  CAS  PubMed  Google Scholar 

  15. Siewert JR, Stein HJ (1998) Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 85:1457–1459

    Article  CAS  PubMed  Google Scholar 

  16. Maltoni M, Caraceni A, Brunelli C et al (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations: a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 23:6240–6248

    Article  PubMed  Google Scholar 

  17. Ellegard LH, Bosaeus IG (2008) Biochemical indices to evaluate nutritional support for malignant disease. Clin Chim Acta 390:23–27

    Article  CAS  PubMed  Google Scholar 

  18. McMillan DC (2008) An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc 67:257–262

    Article  PubMed  Google Scholar 

  19. Morley JE, Thomas DR, Wilson MM (2006) Cachexia: pathophysiology and clinical relevance. Am J Clin Nutr 83:735–743

    CAS  PubMed  Google Scholar 

  20. Fearon KC, Voss AC, Hustead DS (2006) Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr 83:1345–1350

    CAS  PubMed  Google Scholar 

  21. Ashizawa T, Okada R, Suzuki Y et al (2005) Clinical significance of interleukin-6 (IL-6) in the spread of gastric cancer: role of IL-6 as a prognostic factor. Gastric Cancer 8:124–131

    Article  CAS  PubMed  Google Scholar 

  22. Liao WC, Lin JT, Wu CY et al (2008) Serum interleukin-6 level but not genotype predicts survival after resection in stages II and III gastric carcinoma. Clin Cancer Res 14:428–434

    Article  CAS  PubMed  Google Scholar 

  23. Ikeguchi M, Hatada T, Yamamoto M et al (2009) Serum interleukin-6 and -10 levels in patients with gastric cancer. Gastric Cancer 12:95–100

    Article  CAS  PubMed  Google Scholar 

  24. Kim DK, Oh SY, Kwon HC et al (2009) Clinical significances of preoperative serum interleukin-6 and C-reactive protein level in operable gastric cancer. BMC Cancer 9:155

    Article  PubMed  Google Scholar 

  25. Xu CY, Shen JG, Shen JY et al (2009) Ulcer size as a novel indicator marker is correlated with prognosis of ulcerative gastric cancer. Dig Surg 26:312–316

    Article  CAS  PubMed  Google Scholar 

  26. Deans DA, Wigmore SJ, de Beaux AC et al (2007) Clinical prognostic scoring system to aid decision-making in gastro-oesophageal cancer. Br J Surg 94:1501–1508

    Article  CAS  PubMed  Google Scholar 

  27. Crumley AB, Stuart RC, McKernan M et al (2010) Comparison of pre-treatment clinical prognostic factors in patients with gastro-oesophageal cancer and proposal of a new staging system. J Gastrointest Surg 14:781–787

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Department of Surgery, Royal Infirmary, Glasgow, G31 2ER, UK

    Andrew B. C. Crumley, Robert C. Stuart, Margaret McKernan & Donald C. McMillan

Authors
  1. Andrew B. C. Crumley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert C. Stuart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Margaret McKernan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donald C. McMillan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew B. C. Crumley.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Crumley, A.B.C., Stuart, R.C., McKernan, M. et al. Is Hypoalbuminemia an Independent Prognostic Factor in Patients with Gastric Cancer?. World J Surg 34, 2393–2398 (2010). https://doi.org/10.1007/s00268-010-0641-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-010-0641-y

Keywords

Search

Navigation