Abstract
Background
Early recurrence after surgery for non-small-cell lung cancer (NSCLC) is often observed in spite of pathologically proven early-stage disease. The aim of this study was to identify biomarkers that might be useful in predicting postoperative early recurrence of lung cancer. In this study we evaluated the perioperative nutritional status of the patients by measuring the serum level of prealbumin and analyzed the correlation between this factor and early recurrence.
Methods
Forty-four patients with NSCLC were enrolled in the study. Serum level of prealbumin was measured 5 days before and 7 days after surgery, respectively.
Results
For the patients who developed early recurrence, the perioperative serum prealbumin level was statistically significantly lower than those of the patients who did not develop recurrence (p < 0.05). Furthermore, the patients with low prealbumin level showed statistically significantly poorer outcomes compared with the patients with higher prealbumin level (p < 0.001). On the other hand, there was no correlation between the pathological stage and the serum prealbumin level. Multivariate analysis revealed that low perioperative serum prealbumin level could be an independent prognostic factor of poor outcome (hazard ratio, 10.1; 95 % confidence interval, 2.8–35.5; p = 0.0003).
Conclusions
Low serum prealbumin level in the perioperative period is associated with a poorer prognosis in NSCLC patients and could serve as a marker for identifying patients at high risk, even at an early clinical stage.
Similar content being viewed by others
References
Mountain CF (1997) Revisions in the international system for staging lung cancer. Chest 111:1710–1717
Suzuki K, Nagai K, Yoshida J et al (1999) Conventional clinicopathologic prognostic factors in surgically resected nonsmall cell lung carcinoma. A comparison of prognostic factors for each pathologic TNM stage based on multivariate analyses. Cancer 86:1976–1984
Gu CD, Osaki T, Oyama T et al (2002) Detection of micrometastatic tumor cells in pN0 lymph nodes of patients with completely resected nonsmall cell lung cancer. Impact on recurrence and survival. Ann Surg 235:133–139
Coello MC, Luketich JD, Litle VR et al (2004) Prognostic significance of micrometastasis in non-small-cell lung cancer. Clin Lung Cancer 5:214–225
Ben-Eliyahu S (2003) The promotion of tumor metastasis by surgery and stress: immunological basis and implications for psychoneuroimmunology. Brain Behav Immun 17:S27–S36
Bistrian BR, Blackburn GL, Heddle R (1974) Protein status of general surgical patients. JAMA 230:858–860
Nixon DW, Heymsfield SB, Cohen AE et al (1980) Protein-caloric undernutrition in hospitalized cancer patients. Am J Med 68:683–690
Meakins JL (1989) Host defense mechanisms in surgical patients: effect of surgery and trauma. Acta Chir Scand Suppl 550:43–53
Decker D, Schondorf M, Bidlingmaier F et al (1996) Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to the trauma. Surgery 119:316–325
Chandra RK, Kumari S (1994) Nutrition and immunity: an overview. J Nutr 124:1433S–1435S
Chandra RK (1990) Nutrition is an important determinant of immunity in old age. Proc Clin Biol Res 326:321–334
Lesourd B (1995) Protein undernutrition as the major cause of decreased immune function in the elderly: clinical and functional implications. Nutr Rev 53:S86–S94
Walrand S, Moreau K, Caldefie F et al (2001) Specific and nonspecific immune responses to fasting and refeeding differ in healthy young adult and elderly persons. Am J Clin Nutr 74:670–678
Marcos A, Nova E, Montero A (2003) Changes in the immune system are conditioned by nutrition. Eur J Clin Nutr 57:S66–S69
Dempsey DT, Mullen JL, Buzby GP (1988) The link between nutritional status and clinical outcome: can nutritional intervention modify it? Am J Clin Nutr 47:352–356
Vallejo R, Hord ED, Barna SA et al (2003) Perioperative immunosuppression in cancer patients. J Environ Pathol Toxicol Oncol 22:139–146
Ondrey FG, Hom DB (1994) Effects of nutrition on wound healing. Otolaryngol Head Neck Surg 110:557–559
Daly JM, Redmond HP, Gallagher H (1992) Perioperative nutrition in cancer patients. JPEN J Parenter Enteral Nutr 16:100S–105S
Nishi M, Hiramatsu Y, Hioki K et al (1988) Risk factors in relation to postoperative complications in patients undergoing esophagectomy or gastrectomy for cancer. Ann Surg 207:148–154
Campos AC, Meguid MM (1992) A critical appraisal of the usefulness of perioperative nutritional support. Am J Clin Nutr 55:117–130
Braga M, Gianotti L, Radaelli G et al (1999) Perioperative immunonutrition in patients undergoing cancer surgery. Arch Surg 134:428–433
Fearon KC, Luff R (2003) The nutritional management of surgical patients: enhanced recovery after surgery. Proc Nutr Soc 62:807–811
Bozzetti F, Gianotti L, Braga M et al (2007) Postoperative complications in gastrointestinal cancer patients: the joint role of the nutritional status and the nutritional support. Clin Nutr 26:698–709
Chandra RK (1997) Nutrition and the immune system: an introduction. Am J Clin Nutr 66:460S–463S
Bashir Y, Graham TR, Torrance A et al (1990) Nutritional state of patients with lung cancer undergoing thoracotomy. Thorax 45:183–186
Fredrix EW, Staal-van den Brekel AJ, Wouters EF (1997) Energy balance in nonsmall cell lung carcinoma patients before and after surgical resection of their tumors. Cancer 79:717–723
Bianchi RC, de Souza JN, Giaciani Cde A et al (2006) Prognostic factors for complications following pulmonary resection: pre-albumin analysis, time on mechanical ventilation, and other factors. J Bras Pneumol 32:489–494
Tewari N, Martin-Ucar AE, Black E et al (2007) Nutritional status affects long term survival after lobectomy for lung cancer. Lung Cancer 57:389–394
Jagoe RT, Goodship TH, Gibson GJ (2001) Nutritional status of patients undergoing lung cancer operations. Ann Thorac Surg 71:929–935
Beck FK, Rosenthal TC (2002) Prealbumin: a marker for nutritional evaluation. Am Fam Physician 65:1575–1578
Devoto G, Gallo F, Marchello C et al (2006) Prealbumin serum concentrations as a useful tool in the assessment of malnutrition in hospitalized patients. Clin Chem 52:2281–2285
Crumley ABC, Stuart RC, McKernan M et al (2010) Is hypoalbuminemia an independent prognostic factor in patients with gastric cancer? World J Surg 34:2393–2398. doi:10.1007/s00268-010-0641-y
Ishizuka M, Nagata H, Takagi K et al (2007) Inflammation-based prognostic score is a novel predictor of postoperative outcome in patients with colorectal cancer. Ann Surg 246:1047–1051
Ramsey S, Lamb GWA, Aitchison M et al (2007) Evaluation of an inflammation-based prognostic score in patients with metastatic renal cancer. Cancer 109:205–212
Braga M, Gianotti L, Vignali A et al (2002) Preoperative oral arginine and n-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer. Surgery 132:805–814
Giger U, Büchler M, Farhadi J et al (2007) Preoperative immunonutrition suppresses perioperative inflammatory response in patients with major abdominal surgery—a randomized controlled pilot study. Ann Surg Oncol 14:2798–2806
Xu J, Zhong Y, Jing D et al (2006) Preoperative enteral immunonutrition improves postoperative outcome in patients with gastrointestinal cancer. World J Surg 30:1284–1289. doi:10.1007/s00268-005-0756-8
Plank LD, McCall JL, Gane EJ et al (2005) Pre- and postoperative immunonutrition in patients undergoing liver transplantation: a pilot study of safety and efficacy. Clin Nutr 24:288–296
Gunerhan Y, Koksal N, Sahin UY et al (2009) Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters. World J Gastroenterol 15:467–472
Buijs N, van Bokhorst-de van der Schueren MA, Langius JA et al (2010) Perioperative arginine-supplemented nutrition in malnourished patients with head and neck cancer improves long-term survival. Am J Clin Nutr 92:1151–1156
Conflict of interest
The authors have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kawai, H., Ota, H. Low Perioperative Serum Prealbumin Predicts Early Recurrence after Curative Pulmonary Resection for Non-Small-Cell Lung Cancer. World J Surg 36, 2853–2857 (2012). https://doi.org/10.1007/s00268-012-1766-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-012-1766-y