Nazha B, Moussaly E, Zaarour M, Weerasinghe C, Azab B. Hypoalbuminemia in colorectal cancer prognosis: Nutritional marker or inflammatory surrogate? World J Gastrointest Surg 2015; 7(12): 370-377 [PMID: 26730282 DOI: 10.4240/wjgs.v7.i12.370]
Corresponding Author of This Article
Bassel Nazha, MD, MPH, Resident Physician, Department of Medicine, North Shore-LIJ Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, United States. bnazha@nshs.edu
Research Domain of This Article
Oncology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Dec 27, 2015; 7(12): 370-377 Published online Dec 27, 2015. doi: 10.4240/wjgs.v7.i12.370
Hypoalbuminemia in colorectal cancer prognosis: Nutritional marker or inflammatory surrogate?
Bassel Nazha, Elias Moussaly, Mazen Zaarour, Chanudi Weerasinghe, Basem Azab
Bassel Nazha, Elias Moussaly, Mazen Zaarour, Chanudi Weerasinghe, Department of Medicine, North Shore-LIJ Staten Island University Hospital, Staten Island, NY 10305, United States
Basem Azab, Department of General Surgery, Arnot Medical Center, Elmira, NY 14905, United States
Author contributions: All authors contributed to the literature review and manuscript writing; the final version of the manuscript was approved by all authors.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bassel Nazha, MD, MPH, Resident Physician, Department of Medicine, North Shore-LIJ Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, United States. bnazha@nshs.edu
Telephone: +1-718-2266205 Fax: +1-718-2268695
Received: July 9, 2015 Peer-review started: July 14, 2015 First decision: September 22, 2015 Revised: October 12, 2015 Accepted: November 10, 2015 Article in press: November 11, 2015 Published online: December 27, 2015 Processing time: 167 Days and 12.9 Hours
Core Tip
Core tip: Early studies had shown a prognostic value of hypoalbuminemia in colorectal cancer. The relationship between albumin levels and survival was more consistent when the former was coupled to C-reactive protein, a classic inflammatory marker, in the modified Glasgow prognostic score (mGPS). This relationship also appeared to be independent of nutrition on multivariate analyses. The superiority of mGPS in predicting survival supports inflammation as the major culprit of poorer outcomes. A number of studies showing an association of lower albumin-to-globulin ratios with poorer survival are also in favor of a tilt towards proinflammatory states as the cause of morbidity and mortality. Cancer cachexia is a downstream consequence of the systemic inflammation brought in by colorectal cancer. In this view, albumin is a negative acute phase reactant rather than a nutritional marker. Interventions aimed to halt cancer cachexia should therefore target inflammation.
