Elsevier

Lung Cancer

Volume 111, September 2017, Pages 88-95
Lung Cancer

Original research articles
Clinical significance of preoperative serum albumin level for prognosis in surgically resected patients with non-small cell lung cancer: Comparative study of normal lung, emphysema, and pulmonary fibrosis

https://doi.org/10.1016/j.lungcan.2017.07.003Get rights and content

Highlights

Abstract

Objectives

This study was performed to clarify whether preoperative serum albumin level is related to the prognosis of non-small cell lung cancer patients undergoing surgical resection, and the relationships between serum albumin level and clinicopathological characteristics of lung cancer patients with emphysema or pulmonary fibrosis.

Materials and methods

We retrospectively evaluated 556 patients that underwent surgical resection for non-small cell lung cancer. The correlation between preoperative serum albumin level and survival was evaluated. Patients were divided into three groups according to the findings on chest high-resolution computed tomography (normal lung, emphysema, and pulmonary fibrosis), and the relationships between serum albumin level and clinicopathological characteristics, including prognosis, were evaluated.

Results

The cut-off value of serum albumin level was set at 4.2 g/dL. Patients with low albumin levels (albumin <4.2) had significantly poorer prognosis than those with high albumin levels (albumin ≥4.2) with regard to both overall survival and recurrence-free survival. Serum albumin levels in the emphysema group (n = 48) and pulmonary fibrosis group (n = 45) were significantly lower than that in the normal lung group (n = 463) (p = 0.009 and <0.001, respectively). Low serum albumin level was a risk factor in normal lung and pulmonary fibrosis groups, but not in the emphysema group.

Conclusion

Preoperative serum albumin level was an important prognostic factor for overall survival and recurrence-free survival in patients with resected non-small cell lung cancer. Divided into normal lung, emphysema, and pulmonary fibrosis groups, serum albumin level showed no influence only in patients in the emphysema group.

Introduction

Lung cancer is one of the most prevalent malignant cancers worldwide. Recently, the prognosis of lung cancer after surgical resection was reported to be related to preoperative nutritional status, i.e., prognostic nutritional index (PNI) and neutrophil/lymphocyte ratio (NLR) [1], [2], [3], [4], [5]. PNI is calculated from the serum albumin and lymphocyte cell count using a simple formula first advocated in Japan in 1984 [6]. NLR is calculated from the total neutrophil and total lymphocyte cell counts, and it was suggested to influence prognosis in various types of cancer, including lung cancer. Shoji et al. reported that preoperative PNI was a simple predictor of recurrence in stage I non-small cell lung cancer (NSCLC) patients [1]. Shimizu et al. reported that low PNI and high NLR were significantly associated with poor survival among patients that had undergone complete resection for NSCLC [2]. Thus, the prognosis of lung cancer is likely related to preoperative nutritional status. However, there have been no reports regarding whether preoperative serum albumin level, which reflects nutritional status, is simply related to prognosis of NSCLC after surgical resection.

On the other hand, patients with chronic obstructive pulmonary disease (COPD) show malnutrition and weight loss due to systemic inflammation caused by increased plasma levels of various proinflammatory cytokines, particularly TNF-α [7]. Patients with chronic inflammatory pulmonary diseases, such as emphysema or pulmonary fibrosis, could be malnourished. However, there have been few reports regarding the relationships between nutritional status and prognosis in patients with lung cancer who have emphysema and fibrosis in their lungs.

This study was performed to determine whether preoperative serum albumin level is related to prognosis in NSCLC patients undergoing surgical resection, and to clarify the relationships between serum albumin level and clinicoradiographic characteristics of NSCLC patients with emphysema or pulmonary fibrosis.

Section snippets

Patient population and study design

We retrospectively evaluated 717 consecutive cases of NSCLC treated with surgical resection at Shinshu University Hospital between January 2006 and December 2012. Using a database, we investigated the characteristics of patients, including age, sex, smoking history, serum carcinoembryonic antigen (CEA), body mass index (BMI), primary tumor standard uptake value max (SUV-max) on fluorodeoxyglucose positron emission tomography (FDG-PET), pathological stage, histological subtype, and tumor grade.

Flow chart of patient selection and exclusion

Fig. 1 shows a flow chart of patient selection and exclusion. Among the 717 patients with NSCLC, 161 patients were excluded from this study due to wedge resection, preoperative chemotherapy and/or radiotherapy, and insufficient data. The remaining 556 patients were reviewed and diagnosed by HRCT in this study. Four hundred sixty-three patients (83.3%) with NSCLC had neither emphysema nor fibrosis (LC + normal group), 48 patients (8.6%) with NSCLC had only emphysema (LC + emphysema group), and 45

Discussion

This study showed that preoperative serum albumin level was an important prognostic factor in NSCLC patients with surgical resection. In addition, NSCLC patients with pulmonary fibrosis and low serum albumin level had poor RFS, while low serum albumin level was not a prognostic risk factor in patients with emphysema.

There have been no previous reports regarding the relationships between only serum albumin level and prognosis of lung cancer, although the relationships between PNI, NLR, or

Conclusions

This study showed that preoperative serum albumin level is an independent prognostic factor in NSCLC patients undergoing surgical resection. In addition, NSCLC patients with emphysema and fibrosis in the lungs are in a state of malnutrition compared to those with normal lungs because of their low serum albumin level. Therefore, preoperative low serum albumin level is an independent prognostic factor in LC + normal and LC + fibrosis patients, but not in LC + emphysema patients. This is the first study

Conflicts of interest

The authors declare that there are no conflicts of interest.

References (26)

  • T. Onodera et al.

    Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients

    Nihon Geka Gakkai Zasshi

    (1984)
  • A.G. Agusti et al.

    Systemic effects of chronic obstructive pulmonary disease

    Eur. Respir. J.

    (2003)
  • K. Migita et al.

    The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage

    Ann. Surg. Oncol.

    (2013)
  • Cited by (78)

    View all citing articles on Scopus
    View full text