Table 1

Serum albumin and survival - gastrointestinal cancer

First author, year of publication, place

Year of data collection

Study design, Sample size

Cancer type

Groups being compared

RR (95%Cl), p-value

Variables adjusted for


Ishizuka M, 2009, Japan [48]

April 2005 to July 2007

Retrospective, 112

Colorectal

<3.5 g/dL

>=3.5 g/dL

Univariate: 1.37 (1.10-1.71), 0.004

Multivariate: 2.38 (0.73-7.78), 0.14

Age, sex, tumor site, aspartate transaminase (AST), alanine transaminase (ALT), WBC, neutrophil, CA 19-9, CA 72-4, CRP


Neal CP, 2009, UK [49]

January 2000 to December 2005

Retrospective, 174

Colorectal

<4 g/dL

>=4 g/dL

Univariate: 1.98 (1.21-3.25) 0.007

Multivariate: 1.68 (1.01-2.79) 0.04

Age, sex, site, stage, CEA, liver mets, chemotherapy, hematological indices, clinical risk score, Carstairs deprivation index


Sun LC, 2009, Taiwan [50]

January 1996 to December 2006

Retrospective cohort, 1367

Colorectal

<3.5 g/dL

>=3.5 g/dL

Univariate: 1.72(1.38-2.14) < 0.001

Multivariate: 1.45(1.09-1.92) 0.011

Age, sex, site, tumor size, BMI, histology, UICC stage, CEA


Wang CY, 2009, Taiwan [51]

November 2002 to July 2007

Prospective, 123

Esophageal

>=3.5 g/dL

<3.5 g/dL

Also used as continuous variable

Univariate: p < 0.001

Multivariate:

Categorical = 3.9, (1.9-8.2), <0.001

Continuous = 0.38, (0.25-0.58), <0.001

Age, histology, tumor location, stage, Serum CRP, BMI, WBC count, platelet, bilirubin, hemoglobin, BMI, treatment modality


Choi GH, 2008, South Korea [52]

March 1998 to January 2005

Retrospective, 97

Hepatocellular

<3.5 g/dL

>=3.5 g/dL

Multivariate: 4.59 (1.79-11.75), 0.001

Sex, cirrhosis, AFP, platelets, tumor size, number of tumors, intrahepatic mets, venous invasion, Child-Pugh class, time to recurrence


Takahashi S, 2008, Japan [53]

March 1999 to September 2004

Retrospective cohort, 179

Hepatocellular

<3.5 g/dL

>=3.5 g/dL

Univariate: p = 0.001

Multivariate: 3.75(1.64-8.56) 0.002

Age, sex, bilirubin, platelets, AFP, PIVKA-II, tumor size, tumor nodules


Di Fiore FD, 2007, France [2]

January 1997 to December 2003

Retrospective, consecutive case series, 105

Non-metastatic esophageal

<=3.5 g/dL

>3.5 g/dL

Univariate: p = 0.007

Multivariate: 0.99 (0.50-1.98), 0.99

Age, sex, performance status, weight loss, BMI, hemoglobin, tumor location, tumor length, stage of disease, radiotherapy dose


Ishizuka M, 2007, Japan [3]

January 2001 to March 2006

Retrospective, 315

Colorectal

<=3.5 g/dL

>3.5 g/dL

Univariate: 0.85 (0.53-1.343), 0.488

Multivariate: 1.98 (0.91-4.29), 0.082

Age, sex, tumor site, CEA, CA19-9, CA72-4, CRP, GPS


Siddiqui A, 2007, USA [6]

July 1986 to December

2004

Retrospective, 69

Pancreas

>=3.5 g/dL

<3.5 g/dL

Univariate: p < .0001

Multivariate: 2.98 (2.20 to 3.76), <.0001

CA19-9, WBC, laboratory indicators, co-morbidities, age, sex, BMI, stage, treatment


Onate-Ocana LF, 2007, Mexico [44]

January 1987 to December 2002

Retrospective, 1023

Gastric

High: >=3.77 g/dL

Medium: 3.3 to 3.73 g/dL

Low: 2.81 to 3.29 g/dL

Very low: <=2.3 g/dL

Medium: 1.2 (0.8-1.7), 0.31

Low: 1.2 (0.8-1.8), 0.31

Very low: 1.8 (1.3-2.6), 0.001

Stage of disease, lymph node dissection, gender, surgical resection


McMillan DC, 2007, UK [54]

January 1997 to June 2004

Retrospective, 316

Colorectal

<=3.5 g/dL

>3.5 g/dL

GPS based on CRP and albumin was associated with survival (p < 0.0001)

Age, Sex, stage, adjuvant therapy


Nagaoka S, 2007, Japan [55]

January 1997 to November 1998

Cohort, 90

Hepatocellular

<3.5 g/dL

>=3.5 g/dL

Univariate: 1.75 (1.13-2.70) 0.011

Multivariate: 2.01 (1.20-3.37) 0.008

Age, sex, hepatitis B virus, bilirubin, prothrombin time, platelet count, CRP, AFP, stage, initial treatment, AST, ALT


Read JA, 2006, Australia [56]

NA

Prospective consecutive case series, 51

Colorectal

<3.5 g/dL

>=3.5 g/dL

Univariate: p = 0.017

Median survival in months

>=3.5 g/dL = 14.3

<3.5 g/dL = 10.3

Gender, age, extent of prior therapy, extent of disease, PS, liver

function CRP, PG-SGA, GPS, type of treatment


Liu SA, 2006, Taiwan [57]

March 1995 to December 2002

Retrospective, 1010

Oral

>=4.15 g/dL

<4.15 g/dL

Multivariate: 1.313, (1.052-1.638), 0.016

Age, sex, complications, BMI, stage, recurrence/metastasis


Boonpipattanapong, T, 2006, Thailand [7]

October 1, 1998 to October 31, 2002

Retrospective cohort, 172

Colorectal

<3.5 g/dL

>=3.5 g/dL

5-year survival

<3.5 g/dL = 48%

>=3.5 g/dL = 59%

CEA, tumor differentiation


Cengiz O, 2006, Turkey and USA [8]

1994-2003

Retrospective, 99

Colorectal

<=3.5 g/dL

>3.5 g/dL

Univariate: <0.0001

Multivariate: 2.791, (1.37-5.67), 0.005

Age, gender, location, differentiation, hemoglobin, cholesterol, TNM stage, venous invasion, CEA, metastasis


Alici S, 2006, Turkey [58]

September 1999 to April 2002

Retrospective, 138

Gastric

<3 g/dL

>=3 g/dL

Univariate:

Median survival in years

<3 g/dL: 1.7

>=3 g/dL: 8.8 p = 0.006

BMI, clinical stage, surgery, type of surgery, gender, age, PS, tumor grade, tumor location, hemoglobin. LDH, type of surgery


Arimura E, 2005, Japan [59]

January 1988 to December 2002

Prospective consecutive case series, 140

Hepatocellular

<=3.5 g/dL

>3.5 g/dL

Univariate: 1.69 (1.01-2.84), 0.04

Multivariate: 1.49 (0.76-2.90), 0.24

LFTs, tumor size, tumor number, local recurrence, distant recurrence, AFP, ICG-R15 (%)


Schindl M, 2005, UK [60]

October 1, 1988, to January

31, 2002

Retrospective, 337

Colorectal

Continuous variable

Univariate: p < 0.001

Multivariate: 0.9 (0.9-1.0) p < 0.001

Dukes stage, site of primary tumor, diameter of the largest liver lesion, serum CEA, ALP, number of lesions, bilobar disease, age


Tateishi R, 2005, Japan [61]

January 1990 to December 1997

Prospective consecutive case series, 403

Hepatocellular

>3.5 g/dL (reference)

2.8-3.5 g/dL

<2.8 g/dL

Univariate:

1.99 (1.52-2.59),0.0001

3.13 (2.01-4.88),0.0001

Multivariate:

1.74 (1.31-2.30) 0.00014

2.45 (1.55-3.88) 0.00013

Age, sex, treatment modality, tumor factors, including size, number of nodules, lobar distribution, and presence of extrahepatic metastasis, clinical manifestations, including ascites and hepatic encephalopathy, bilirubin, prothrombin activity, AST, ALT, platelet count, AFP, positivity for viral markers (hepatitis B surface antigen and anti-hepatitis C antibody), alcohol


Xu HX, 2005, China [62]

August 1997 to September 2003

Prospective consecutive case series, 137

Hepatocellular

<3.5 g/dL

>=3.5 g/dL

Multivariate: 0.48 (0.28-0.83), 0.008

Age, gender, cirrhosis, Child's class, AFP, ALT, bilirubin, prothrombin time, tumor nodules, tumor size, treatment method, recurrence


Lien YC, 2004, Taiwan [63]

1987 to 1997

Retrospective, 314

Gastric cardia

>3.5 g/dL

<=3.5 g/dL

Univariate: 5 year survival rate

>3.5 g/dL: 38.4%

<=3.5 g/dL: 19.1%, p = <0.001

Age, sex, extent of resection, diet at presentation, depth of penetration, nodal involvement


Elahi MM, 2004, UK [64]

1988 to 1996

Retrospective, 165

Colorectal

Gastric

<3.5 g/dL

>=3.5 g/dL

Median survival in months

<3.5 g/dL: 1.7(0.6-2.8),

>=3.5 g/dL: 6.9 (4.7-9.0) p = <0.001

Age, sex, GPS, tumor type, CRP


Chen MF, 2003, Taiwan [65]

1986 to 1998

Retrospective, 254

Hepatocellular

<=3.5 g/dL

>3.5 g/dL

Univariate:

Median survival in months

<=3.5 g/dL: 6.18

>3.5 g/dL: 12.3, p = 0.0037

Multivariate:

Disease-free survival

2.17 (1.21-3.90)

Overall survival 1.65 (1.005-2.73)

Age, sex, Hepatitis B antigen, Hepatitis C antibody, AFP, BUN, creatinine, ALP, AST, bilirubin, prothrombin time, extent of resection, blood loss, blood transfusion, tumor size, no of tumors, resection margin, operating time


Koike Y, 2003, Japan [66]

1987 to 1999

Retrospective consecutive case series, 952

Hepatocellular

NA

Univariate analysis indicated that the serum albumin level was associated with survival

Child classification, number of tumor foci, portal venous invasion-targeted irradiation, and percutaneous tumor ablation of the parenchymal main tumor


Dixon MR, 2003, USA [67]

1991-1999

Retrospective cohort, 105

Colorectal

Continuous variable

Univariate (Median Albumin) (IQR):

Short survival <120 days : 2.5 (2.2-3.0)

Long survival >120 days : 3.1 (2.6-3.5), 0.002

Age, ALP, AST, total bilirubin, CEA, ALT, prothrombin time, mean corpuscular volume,

fibrinogen, hematocrit, creatinine


Heys SD, 1998, UK [45]

1972 to 1985

Retrospective case series, 431

Colorectal

Continuous variable

Univariate: <0.00005

Multivariate: 0.95 (0.93-0.98) < 0.0001

Duke's stage, age and tumor differentiation


Stuart KE, 1996, USA [68]

1986-1995

Retrospective, 314

Hepatocellular

Albumin cutoffs not provided

Univariate:

Median survival in months

Low albumin: 4

High Albumin: 15, p < 0.001

Multivariate: p < 0.001

Age, gender, cirrhosis, alcohol abuse, bilirubin, PVO and AFP


Onate-Ocana LF, 2007, Mexico [69]

NA

Retrospective cohort, 793

Gastric

<=3.5 g/dL

>3.5 g/dL

Multivariate: 1.26 (1.03-1.5), <0.03

TNM stage, operative morbidity, type of lymphadenectomy, gastrectomy performed


Gupta and Lis Nutrition Journal 2010 9:69   doi:10.1186/1475-2891-9-69

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