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Serum albumin and survival in glioblastoma multiforme

  • Clinical Study – Patient Study
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Abstract

Serum albumin is an established predictor of survival in numerous cancers but its prognostic value in central nervous system tumours has not been established. Here we have examined prognostic factors in 685 patients with histologically proven glioblastoma multiforme (GBM), the majority of which (n = 549) had pre-operative serum albumin assayed. Mean serum albumin was 34.7 g/l (SD 5.2). Post-operative survival was significantly less for patients with hypoalbuminaemia (<30 g/l, n = 82) than for patients with normal albumin level (median 2.3 vs. 5.6 months, P < 0.001 Log-rank test). Furthermore, patients with lower normal albumin (30–40 g/l, n = 371) had significantly shorter survival compared against patients with albumin in the upper normal range (40–50 g/l, n = 96; median 5.1 vs. 8.8 months, P < 0.001). Multivariate Cox regression showed the independent predictors of survival were age, debulking surgery, chemoradiotherapy, and serum albumin (Hazard Ratio 0.97 per g/l, P < 0.005). This study suggests pre-operative serum albumin level is a significant predictor of survival in patients with GBM. Further studies are needed to examine the relationship between albumin and other known prognostic factors, and to determine if pre-operative serum albumin is a clinically useful predictor of survival.

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References

  1. Gorlia T, Van den Bent MJ, Hegi ME, Mirimanoff RO, Weller M, Cairncross JG, Eisenhauer E, Belanger K, Brandes AA, Allgeier A, Lacombe D, Stupp R (2008) Nomograms for predicting survival of patients with newly diagnosed glioblastoma: prognostic factor analysis of EORTC and NCIC trial 26981–22981/CE.3. Lancet Oncol 9(1):29–38

    Article  PubMed  Google Scholar 

  2. Neugut AI, Fink DJ, Radin D (1989) Serum cholesterol and primary brain tumours: a case–control study. Int J Epidemiol 18(4):798–801

    Article  PubMed  CAS  Google Scholar 

  3. Schwartzbaum JA, Lal P, Evanoff W, Mamrak S, Yates A, Barnett GH, Goodman J, Fisher JL (1999) Presurgical serum albumin levels predict survival time from glioblastoma multiforme. J Neurooncol 43(1):35–41

    Article  PubMed  CAS  Google Scholar 

  4. Goldwasser P, Feldman J (1997) Association of serum albumin and mortality risk. J Clin Epidemiol 50(6):693–703

    Article  PubMed  CAS  Google Scholar 

  5. Djousse L, Rothman KJ, Cupples LA, Levy D, Ellison RC (2002) Serum albumin and risk of myocardial infarction and all-cause mortality in the Framingham Offspring Study. Circulation 106(23):2919–2924

    Article  PubMed  CAS  Google Scholar 

  6. Horwich TB, Kalantar-Zadeh K, MacLellan RW, Fonarow GC (2008) Albumin levels predict survival in patients with systolic heart failure. Am Heart J 155(5):883–889

    Article  PubMed  CAS  Google Scholar 

  7. Yukl RL, Bar-Or D, Harris L, Shapiro H, Winkler JV (2003) Low albumin level in the emergency department: a potential independent predictor of delayed mortality in blunt trauma. J Emerg Med 25(1):1–6

    Article  PubMed  Google Scholar 

  8. Gunen H, Hacievliyagil SS, Kosar F, Mutlu LC, Gulbas G, Pehlivan E, Sahin I, Kizkin O (2005) Factors affecting survival of hospitalised patients with COPD. Eur Respir J 26(2):234–241

    Article  PubMed  CAS  Google Scholar 

  9. Jones CH, Newstead CG, Wills EJ, Davison AM (1997) Serum albumin and survival in CAPD patients: the implications of concentration trends over time. Nephrol Dial Transplant 12(3):554–558

    Article  PubMed  CAS  Google Scholar 

  10. Feldman JG, Gange SJ, Bacchetti P, Cohen M, Young M, Squires KE, Williams C, Goldwasser P, Anastos K (2003) Serum albumin is a powerful predictor of survival among HIV-1-infected women. J Acquir Immune Defic Syndr 33(1):66–73

    Article  PubMed  CAS  Google Scholar 

  11. Espinosa E, Feliu J, Zamora P, Gonzalez Baron M, Sanchez JJ, Ordon ez A, Espinosa J (1995) Serum albumin and other prognostic factors related to response and survival in patients with advanced non-small cell lung cancer. Lung Cancer 12(1–2):67–76

    Article  PubMed  CAS  Google Scholar 

  12. Lis CG, Grutsch JF, Vashi PG, Lammersfeld CA (2003) Is serum albumin an independent predictor of survival in patients with breast cancer? J Parenter Enteral Nutr 27(1):10–15

    Article  CAS  Google Scholar 

  13. Lien YC, Hsieh CC, Wu YC, Hsu HS, Hsu WH, Wang LS, Huang MH, Huang BS (2004) Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia. J Gastrointest Surg 8(8):1041–1048

    Article  PubMed  Google Scholar 

  14. Dixon MR, Haukoos JS, Udani SM, Naghi JJ, Arnell TD, Kumar RR, Stamos MJ (2003) Carcinoembryonic antigen and albumin predict survival in patients with advanced colon and rectal cancer. Arch Surg 138(9):962–966

    Article  PubMed  Google Scholar 

  15. Seve P, Ray-Coquard I, Trillet-Lenoir V, Sawyer M, Hanson J, Broussolle C, Negrier S, Dumontet C, Mackey JR (2006) Low serum albumin levels and liver metastasis are powerful prognostic markers for survival in patients with carcinomas of unknown primary site. Cancer 107(11):2698–2705

    Article  PubMed  CAS  Google Scholar 

  16. Proctor MJ, Talwar D, Balmar SM, O’Reilly DS, Foulis AK, Horgan PG, Morrison DS, McMillan DC (2010) The relationship between the presence and site of cancer, an inflammation-based prognostic score and biochemical parameters. Initial results of the Glasgow Inflammation Outcome Study. Br J Cancer 103(6):870–876

    Article  PubMed  CAS  Google Scholar 

  17. Shenkin A (2006) Serum prealbumin: is it a marker of nutritional status or of risk of malnutrition? Clin Chem 52(12):2177–2179

    Article  PubMed  CAS  Google Scholar 

  18. Barbosa-Silva MCG (2008) Subjective and objective nutritional assessment methods: what do they really assess? Curr Opin Clin Nutr Metab Care 11(3):248–254

    Article  PubMed  Google Scholar 

  19. Chojkier M (2005) Inhibition of albumin synthesis in chronic diseases: molecular mechanisms. J Clin Gastroenterol 39(4):S143–S146

    Article  PubMed  CAS  Google Scholar 

  20. Reynes G, Vila V, Martin M, Parada A, Fleitas T, Reganon E, Martinez-Sales V. (2010) Circulating markers of angiogenesis, inflammation, and coagulation in patients with glioblastoma. J Neurooncol. Epub ahead of print. doi: 10.1007/s11060-010-0290-x

  21. Rolhion C, Penault-Llorca F, Kemeny J-L, Lemaire J-J, Jullien C, Labit-Bouvier C, Finat-Duclos F, Verrelle P (2001) Interleukin-6 overexpression as a marker of malignancy in human gliomas. J Neurosurg 94(1):97–101

    Article  PubMed  CAS  Google Scholar 

  22. Chang CY, Li MC, Liao SL, Huang YL, Shen CC, Pan HC (2005) Prognostic and clinical implication of IL-6 expression in glioblastoma multiforme. J Clin Neurosci 12(8):930–933

    Article  PubMed  CAS  Google Scholar 

  23. Weiss JF, Morantz RA, Bradley WP, Chretien PB (1979) Serum acute-phase proteins and immunoglobulins in patients with gliomas. Cancer Res 39(2 Part 1):542–544

    PubMed  CAS  Google Scholar 

  24. Matsuura H, Nakazawa S (1985) Prognostic significance of serum alpha 1-acid glycoprotein in patients with glioblastoma multiforme: a preliminary communication. J Neurol Neurosurg Psychiatry 48(8):835–837

    Article  PubMed  CAS  Google Scholar 

  25. Brockmann MA, Giese A, Mueller K, Kaba FJ, Lohr F, Weiss C, Gottschalk S, Nolte I, Leppert J, Tuettenberg J, Groden C (2007) Preoperative thrombocytosis predicts poor survival in patients with glioblastoma. Neuro Oncol 9(3):335–342

    Article  PubMed  Google Scholar 

  26. Loeffler S, Fayard B, Weis J, Weissenberger J (2005) Interleukin-6 induces transcriptional activation of vascular endothelial growth factor (VEGF) in astrocytes in vivo and regulates VEGF promoter activity in glioblastoma cells via direct interaction between STAT3 and Sp1. Int J Cancer 115(2):202–213

    Article  PubMed  CAS  Google Scholar 

  27. de Groot JF, Fuller G, Kumar AJ, Piao Y, Eterovic K, Ji Y, Conrad CA (2010) Tumor invasion after treatment of glioblastoma with bevacizumab: radiographic and pathologic correlation in humans and mice. Neuro Oncol 12(3):233–242

    PubMed  Google Scholar 

  28. Curran WJ Jr, Scott CB, Horton J, Nelson JS, Weinstein AS, Fischbach AJ, Chang CH, Rotman M, Asbell SO, Krisch RE, Nelson DF (1993) Recursive partitioning analysis of prognostic factors in three radiation therapy oncology group malignant glioma trials. J Natl Cancer Inst 85(9):704–710

    Article  PubMed  Google Scholar 

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Correspondence to Mathew R. Guilfoyle.

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Borg, N., Guilfoyle, M.R., Greenberg, D.C. et al. Serum albumin and survival in glioblastoma multiforme. J Neurooncol 105, 77–81 (2011). https://doi.org/10.1007/s11060-011-0562-0

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  • DOI: https://doi.org/10.1007/s11060-011-0562-0

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