Pre-operative serum albumin is associated with post-operative complication rate and overall survival in patients with epithelial ovarian cancer undergoing cytoreductive surgery

• Hypoalbuminemia is a risk factor for severe postoperative complications.
• Hypoalbuminemia is a risk factor for impaired overall survival.
• Albumin levels should be incorporated in pre-operative workup.

ObjectiveHypoalbuminemia has been reported as a risk factor for post-operative complications and unfavorable survival in cancer patients. We aimed to evaluate the predictive value of preoperative serum albumin levels on post-operative complication rate and the impact on overall survival (OS) in patients with epithelial ovarian cancer (EOC) undergoing primary cytoreductive surgery.MethodsThe present retrospective study included 604 consecutive patients with EOC who underwent primary cytoreductive surgery at two tertiary cancer centers specialized in gynecologic oncology. Hypoalbuminemia was defined as a pre-operative serum albumin level ≤ 35 g/L. Post-operative surgical complications were graded according to the Clavien–Dindo-Classification (CDC). Fisher-test was used to investigate the predictive value of hypoalbuminemia on the rate of severe post-operative complications. Survival analyses were calculated using log-rank test and Cox regression models.ResultsThe incidence of pre-operative hypoalbuminemia in the entire cohort was 16.4%. Hypoalbuminemia was a predictive factor for severe post-operative complications (CDC 3–5) (OR 3.65, (CI95% 1.59-–8.39); p = 0.002). Furthermore, median overall survival time of patients with hypoalbuminemia was 24 months compared to 83 months in patients with normal albumin (p < 0.001), respectively. Hypoalbuminemia was independently associated with shortened overall survival (HR 2.2 (95% CI 1.6–3.0); p < 0.001) even after adjusting established prognostic factors such as age, tumor stage, performance status, and post-operative residual disease.ConclusionPre-operative hypoalbuminemia can be used as both an independent predictive factor for severe post-operative complications and as prognostic parameter regarding overall survival in EOC patients. Therefore, albumin levels may be incorporated into future clinical trials as stratification factor.