Is Serum Albumin an Independent Predictor of Survival in Ovarian Cancer?

BackgroundThe medical literature shows several examples of an inverse relationship between serum albumin and mortality in patients with advanced cancer. Because malnutrition can be a frequent manifestation in ovarian cancer, we investigated the prognostic role of serum albumin in patients with ovarian cancer treated in an integrative cancer treatment setting.Materials and MethodsWe evaluated 213 histologically confirmed case series of ovarian cancer patients treated at Cancer Treatment Centers of America® between January 2001 and May 2006. Serum albumin was divided into 2 categories of ≥ 3.6 g/dL and ≤ 3.5 g/dL. The Kaplan-Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of serum albumin independent of other prognostic factors.ResultsOf 213 patients, 41 were newly diagnosed at our hospital, and 172 had received previous treatment elsewhere. Thirty had stage I disease at diagnosis, 17 stage II, 128 stage III, and 24 stage IV. A total of 135 patients had a serum albumin score of ≥ 3.6 g/dL, and 78 patients had a score of ≤ 3.5 g/dL. Patients with ≥ 3.6 g/dL scores had a median survival of 23.3 months (95% CI, 16.5–30.1 months), whereas those with ≤ 3.5 g/dL scores had a median survival of 7.3 months (95% CI, 4.8–9.8 months); P < .001. Multivariate Cox modeling found that every 1 gm/dL increase in serum albumin was associated with a relative risk of 0.39 (95% CI, 0.29–0.53; P < .001).ConclusionUnivariate and multivariate survival analysis found that low levels of serum albumin adversely affected survival by a statistically significant level across all stages of ovarian cancer independent of stage at diagnosis, serum cancer antigen-125, and previous treatment history.