protein-binding drugs , leading to the deficiency of essential elements such as copper , iron , and zinc as well as disturbances of calcium and phosphorus metabolism , thereby exacerbating malnutrition and even cachexia .
However , in addition to the above effects of hypoalbuminaemia , it may also be related to the poor prognosis of the tumour . 2 – 9 The current research on hypoalbuminaemia and tumour prognosis mainly focuses on the relationship between preoperative / non-preoperative albumin levels and tumour prognosis .
Studies on preoperative albumin levels and tumor prognosis have focused on urinary system tumours , gynaecological tumours , non-small cell lung cancer , and colorectal cancer . Studies have shown that the lower the preoperative albumin level or prealbumin level , the higher the risk of poor prognosis . 2 – 9 .
Reasons for this include : ( 1 ) a lower albumin level somewhat reflects the poor nutritional status that is related to survival of cancer patients ; ( 2 ) lower albumin level may be an indicator of liver dysfunction which will undermine the immunity and accelerate tumour progression ; ( 3 ) preoperative albumin level may reflect the pathological characteristics of the disease to a certain extent ; ( 4 ) albumin level and NLR ( ratio of blood neutrophil count to lymphocyte count ), a systemic inflammation marker , have significant negative correlation ( increase of NLR reflects impaired cell immune function ).
The above research findings suggest that for tumour patients with preoperative hypoalbuminaemia , postoperative follow-up should be further stressed in order to detect recurrence in a timely way and give follow-up treatment as soon as possible to extend survival . Among them , a study in colon cancer 5 found that every 0.1g / dl increase in the level of preoperative albumin decreased morbidity and mortality by 7.3 % and 15.6 %, respectively . This correlation only existed in the hypoalbuminaemia subgroup but not in the normal albumin subgroup . Another study among patients with resectable NSCLC found that preoperative serum albumin level was an important prognostic factor for overall survival ( OS ) and recurrence-free survival in patients with normal lung and pulmonary fibrosis , despite no effect on patients with emphysema . 6 This study suggests that the lung status of lung cancer patients also affects the correlation between preoperative serum albumin levels and tumor prognosis .
Studies on the relationship between nonpreoperative albumin levels and tumour prognosis mainly focus on haematological malignancies , gastroenterological tumors , gynaecological tumours , breast cancer , nasopharyngeal cancer , and renal cancer . Multiple studies have shown that serum albumin levels before treatment is the independent prognostic factor for disease-free survival and progression-free survival ( PFS ). 10 – 19 Among them , studies on metastatic renal cell carcinoma have shown that serum albumin levels before and after treatment with tyrosine kinase inhibitors are prognostic factors affecting patients ’ PFS and OS . 12 Meanwhile they found that hypoalbuminaemia after treatment was associated with NLR higher than the NLR level in the normal albumin group after treatment , indicating that a low level of serum albumin after treatment was associated with systemic inflammation . Thus , it is believed that by integrating serum albumin level after treatment into the basic MSKCC risk model , accuracy of the model in predicting overall survival and progression-free survival will be increased . A study of haematological malignancies showed that the occurrence of severe hypoalbuminaemia within 90 days of haematopoietic stem cell transplantation for acute myelogenous leukaemia and myelodysplastic syndrome could predict mortality after relapse and OS . 13 A retrospective cohort study of colorectal cancer showed that serum albumin level was an important prognostic factor for patients with colorectal cancer . 14 Its prognostic value was even higher than TNM staging and other known clinical prognostic factors . It can be easily used in prognostic models as well as in prognostic stratification in therapeutic randomised clinical trials .
Conclusions In summary , it is currently believed that development of hypoalbuminaemia before and after treatment in a variety of solid tumour and haematological malignancies is an independent prognostic factor for the tumour . The main causes of hypoalbuminaemia includes malnutrition , inflammation status and tumour burden of the patient . The introduction of albumin levels into the current prognostic model for tumour patients will help to formulate individualised treatment plans . Studies showed that correcting malnutritionassociated hypoalbuminaemia through nutritional intervention can help improve tumour prognosis , while correcting non-malnutrition-associated hypoalbuminaemia by exogenous human albumin infusion might improve prognosis of tumour patients . Further studies are still needed .
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