Serum Albumin Levels Linked With Survival After Pancreatic Cancer Resection

A new study in PLOS One shows that higher preoperative levels of serum albumin were significantly associated with greater overall survival among patients undergoing resection of pancreatic adenocarcinoma.

“This benefit does not appear to be related to quality indicators for perioperative outcomes including blood loss, margin status, or 30-day re-hospitalization,” wrote researchers led by Andrew E. Hendifar, MD, MPH, of Cedars-Sinai Medical Center. “There was an association between lower serum albumin and transfusion rate and length of hospital stay of questionable clinical significance.”

The study also found that a significant decrease in serum albumin levels was associated with a decrease in disease-free survival.

According to the study, previous research has linked obesity with the development of pancreatic adenocarcinoma, as well as negative outcomes among patients with the disease. The cause for the link between obesity and pancreatic adenocarcinoma is still unknown.

In this study, Hendifar and colleagues evaluated if body mass index (BMI) and serum albumin had an effect on perioperative outcomes and survival among patients with resected pancreatic adenocarcinoma. They evaluated records from 1,545 patients with pancreatic adenocarcinoma at a single institution between 2007 and 2013. Of this group, 106 patients had undergone upfront surgery for their disease with curative intent.

Preoperative BMI or serum albumin was not available for all patients in the study. At baseline, the majority of patients had a BMI between 19 and 29 (n = 77). The median preoperative BMI was 24.1, with a median change of –1.6. Preoperative serum albumin was less than 3.5 in 57 patients and 3.5 or greater in 40 patients. The median preoperative serum albumin level was 3.3 and the median change was –0.4.

Very few perioperative outcomes could be linked with pretreatment serum albumin or BMI. However, the researchers did find that a patient’s length of hospital stay was associated with a low BMI (P = .023), change in BMI (P = .003), and low serum albumin (P = .004). In addition, postoperative transfusion rate was associated with serum albumin (P = .021).

The median survival of patients was 14 months and the median time to disease recurrence was 11 months.

When the researchers conducted a multivariate analysis, they found that change in serum albumin (P = .03) and node positivity (P = .008) were both significantly associated with a decreased disease-free survival. Level of preoperative serum albumin (P = .023), node positivity (P = .026), and poor differentiation (P = .045) were all significantly associated with a worse overall survival.

Lower levels of preoperative serum albumin were associated with both worse disease-free and overall survival among patients who underwent resection of pancreatic adenocarcinoma.

“One would assume that a patient with poor nutrition status would have increased hospitalization rates or increased perioperative morbidity. However, our data suggests that decreased albumin is a poor prognostic factor independent of perioperative morbidity especially in excess of 0.6 g/dL,” the researchers wrote. “This may potentially reflect more aggressive cancer biology.”