Publication:

Pretreatment serum albumin: a prognostic indicator of survival inoral cancer

Background Malnutrition has been recognized as a poor prognostic indicator for cancer. In recent years, the role of serum albumin as a predictor of survival in cancer has received considerable attention. Therefore, the present study was carried out to investigate whether the pretreatment serum albumin can predict the prognosis of patients with oral cancer.

Methods Medical records of 433 pathologically proven oral cancer patients diagnosed and treated from 01st January 2006 to 31st December 2008 were retrospectively analyzed. We used Receiver operating characteristic curve analysis to establish most appropriate cut-off for serum albumin, Kaplan-Meier method for survival analysis and the Cox proportional hazard models to investigate the prognosticators.

Results The overall 5 year’s survival of the cohort was found to be 54.4%.  On univariate analysis, serum albumin of ≤4.34 g/dl was associated with poor overall survival (OS) (p=0.029). Multivariate Cox proportional hazard analysis revealed that lower serum albumin (<4.35g/dl) was a significant independent predictors for worse OS (HR=1.350, 95% CI = 1.013 - 1.817; P< 0.038). Lymph nodal involvement was also found to be independent indicator for poor OS. Furthermore, serum albumin was found to be positively correlated with both body weight (r=0.142, p=0.003) and heamoglobin (r=0.304, p=0.000).

Conclusion Pretreatment serum albumin levels are of useful prognostic significance in oral cancer patients. Thus, this easily accessible variable may not only serve as a potent marker to predict the outcomes, but more importantly as an indicator for initiating aggressive nutrition intervention in oral cancer patients.