Objective: To evaluate the clinical significance of preoperative serum albumin level and its association with survival in colon cancer patients.
Methods: Clinicopathological data of 621 consecutive patients with colon cancer admitted in Henan Cancer Hospital between January 2000 and December 2008 were retrospectively analyzed. These patients were divided into hypoalbuminemic and normal groups according to the definition of hypoalbuminemia (serum albumin < 35 g/L). Clinicopathological features were compared between two groups. The association of preoperative serum albumin level and the prognosis was analyzed by Kaplan-Meier and Log-rank test. Multivariate Cox model was used to evaluate the survival.
Results: Sixty-seven(10.8%) patients were defined as preoperative hypoalbuminemia and were mostly found in those with right hemicolon cancer. Preoperative serum albumin level was associated with depth of tumor (χ(2)=35.609, P=0.000), lymph node metastasis (χ(2)=8.110, P=0.004), distant metastasis (χ(2)=9.064, P=0.003), advanced TNM T staging (χ(2)=23.070, P=0.000), and not associated with age, gender, tumor gross type, histological type, and degree of tumor differentiation (all P>0.05). 5-year survival rate of hypoalbuminemia group and normal group was 55.2% and 66.1% respectively (P=0.032). Univariate analysis revealed age (P=0.000), tumor gross type (P=0.014), degree of tumor differentiation (P=0.014), depth of tumor (P=0.000), lymph node metastasis (P=0.001), distant metastasis (P=0.000), advanced TNM T staging (P=0.000), operative method (P=0.000) and preoperative serum albumin level (P=0.032) were associated with survival. Cox multivariate analysis revealed the albumin level was the independent prognostic factor of the 5-year overall survival (HR:0.694, 95% CI: 0.492-0.980, P=0.038). The patients with higher albumin level had better survival outcome.
Conclusions: Preoperative serum albumin level is an independent prognostic factor for colon cancer. Colon cancer patients with hypoalbuminemia have worse clinicopathological manifestation and poorer overall survival.