A High Preoperative Blood Urea Nitrogen to Serum Albumin Ratio Does Not Predict Worse Outcomes Following the Robotic-Assisted Pulmonary Lobectomy for Lung Cancer

Allison O Dumitriu Carcoana; Kristie M Labib; Cole R Fiedler; Jenna C Marek; Lauren C Ladehoff; William J West 3rd; Jose A Malavet; William N Doyle Jr; Carla C Moodie; Joseph R Garrett; Jenna R Tew; Jobelle Joyce Anne R Baldonado; Jacques P Fontaine; Eric Toloza

doi:10.7759/cureus.50468

A High Preoperative Blood Urea Nitrogen to Serum Albumin Ratio Does Not Predict Worse Outcomes Following the Robotic-Assisted Pulmonary Lobectomy for Lung Cancer

Cureus. 2023 Dec 13;15(12):e50468. doi: 10.7759/cureus.50468. eCollection 2023 Dec.

Authors

Allison O Dumitriu Carcoana¹, Kristie M Labib¹, Cole R Fiedler¹, Jenna C Marek¹, Lauren C Ladehoff¹, William J West 3rd¹, Jose A Malavet¹, William N Doyle Jr¹, Carla C Moodie², Joseph R Garrett², Jenna R Tew², Jobelle Joyce Anne R Baldonado^{2

3}, Jacques P Fontaine^{2

3}, Eric Toloza^{2

3}

Affiliations

¹ Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA.
² Thoracic Oncology, Moffitt Cancer Center, Tampa, USA.
³ Surgery and Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, USA.

Abstract

Background: The blood urea nitrogen to serum albumin ratio (BAR) is an emerging prognostic parameter of interest. The utility of BAR as a prognostic factor has not been analyzed in lung cancer patients undergoing pulmonary lobectomy. We evaluated the ability of High BAR to predict worse outcomes after robotic-assisted pulmonary lobectomy (RAPL) for lung cancer.

Methods: We retrospectively analyzed 400 patients who underwent RAPL from September 2010 to March 2022 by one surgeon. Patients were stratified by Low BAR (<6.25 mg/g) and High BAR (≥6.25 mg/g). Patients' demographics, tumor characteristics, comorbidities, surgical complications, outcomes, and survival were collected and compared by High and Low BAR groups. The primary outcome of interest was 30-day mortality.

Results: Receiver operator curves (ROC) confirmed that 6.25 was an optimal threshold for estimating mortality based on Low and High BAR. There were no differences in surgical complications or outcomes between the Low and High BAR groups. The ability of BAR to predict 30-day mortality was evaluated with the area under the curve (AUC) analysis, which showed that higher BAR could not predict mortality (AUC=0.655; 95% CI, 0.435-0.875; p=0.166). Similarly, survival analysis revealed no difference in five-year overall survival between the Low and High BAR groups (p=0.079).

Conclusion: High BAR did not predict worse outcomes after RAPL for lung cancer in our study. Further studies are needed to better determine the prognostic ability of BAR in lower-risk populations.

Keywords: blood urea nitrogen; lung cancer; outcomes; pulmonary lobectomy; robotic surgery; serum albumin.

Grants and funding

Funding/Financial Support: This research was supported in part by individual 2022 Summer Scholarly Awards to W.J.W.III, C.R.F., and K.M.L. from the Scholarly Concentrations Program of the Office of Research, Innovation & Scholarly Endeavors (RISE) Program at the University of South Florida (USF) Health Morsani College of Medicine in Tampa, FL, USA. This study was also supported in part by the 2022 Summer Immersion Awards to W.N.D.Jr. and L.C.L. from the Scholarly Excellence, Leadership Experiences, and Collaborative Training (SELECT) Program and the RISE Program of the Lehigh Valley Health Network in Allentown, PA, USA, and of the USF Health Morsani College of Medicine.