Hypoalbuminemia in colorectal cancer prognosis: Nutritional marker or inflammatory surrogate?

Table 1 Pretreatment serum albumin and colorectal cancer

Ref.	Design	Objective	Sample size	Findings	Comments
Heys et al[7]	Retrospective cohort study	ALB's prognostic value in localized and metastatic CRC	431 patients	On multivariate analysis, reduced OS with lower ALB	First report of ALB's prognostic value in CRC
Boonpipattanapong et al[26]	Retrospective cohort study	Preoperative CEA and ALB's prognostic value in CRC following curative surgery	384 patients	Combination of CEA ≥ 5 ng/dL and ALB ≤ 3.5 g/dL predicts lower 5-yr OS. No statistically significant association of either alone with survival	Linking a tumor marker (CEA) to a host marker (ALB) can have a prognostic significance
Lai et al[35]	Retrospective cohort study	Preoperative ALB's value in predicting postoperative outcomes in CRC	3849 patients	Short-term: More complications related to wounds, anastomosis, lungs and urinary system in low ALB group	No difference in short-term postoperative GI and cardiovascular complications
				Long-term: Lower 5-yr OS (60% vs 78%) and 5-yr RFS (73.5% vs 78.9%) in low compared to normal ALB group
Cengiz et al[36]	Retrospective cohort study	Pretreatment ALB and cholesterol's prognostic value in CRC following curative surgery	99 patients	2.8 RR of death in low compared to normal ALB group. No survival effect for cholesterol on multivariate analysis	No difference in CRC recurrence between low and normal ALB groups
Chandrasinghe et al[37]	Retrospective cohort study	Pretreatment ALB's prognostic value in rectal cancer following curative surgery	226 patients	Lower 5-yr OS (47% vs 69%) and RFS (69.7% vs 83%) in low compared to normal ALB group. No differences in 30-d postoperative mortality/complications	First report on ALB's long-term prognostic value in rectal cancer
Gupta et al[38]	Systematic review	Relationship between pretreatment ALB and cancer survival	59 studies in total; 29 on GI cancers including 12 on CRC	26 of 29 studies on GI cancers had higher OS with higher ALB on multivariate analysis	Inter-study differences in definition of low ALB (continuous variable vs cut-off points)

ALB: Serum albumin; CRC: Colorectal cancer; OS: Overall survival; RR: Relative risk; CEA: Serum carcinoembryonic antigen; RFS: Recurrence-free survival; GI: Gastrointestinal.