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Table 1 Serum albumin and survival - gastrointestinal cancer

From: Pretreatment serum albumin as a predictor of cancer survival: A systematic review of the epidemiological literature

First author, year of publication, place Year of data collection Study design, Sample size Cancer type Groups being compared RR (95%Cl), p-value Variables adjusted for
Ishizuka M, 2009, Japan [48] April 2005 to July 2007 Retrospective, 112 Colorectal <3.5 g/dL
>=3.5 g/dL
Univariate: 1.37 (1.10-1.71), 0.004
Multivariate: 2.38 (0.73-7.78), 0.14
Age, sex, tumor site, aspartate transaminase (AST), alanine transaminase (ALT), WBC, neutrophil, CA 19-9, CA 72-4, CRP
Neal CP, 2009, UK [49] January 2000 to December 2005 Retrospective, 174 Colorectal <4 g/dL
>=4 g/dL
Univariate: 1.98 (1.21-3.25) 0.007
Multivariate: 1.68 (1.01-2.79) 0.04
Age, sex, site, stage, CEA, liver mets, chemotherapy, hematological indices, clinical risk score, Carstairs deprivation index
Sun LC, 2009, Taiwan [50] January 1996 to December 2006 Retrospective cohort, 1367 Colorectal <3.5 g/dL
>=3.5 g/dL
Univariate: 1.72(1.38-2.14) < 0.001
Multivariate: 1.45(1.09-1.92) 0.011
Age, sex, site, tumor size, BMI, histology, UICC stage, CEA
Wang CY, 2009, Taiwan [51] November 2002 to July 2007 Prospective, 123 Esophageal >=3.5 g/dL
<3.5 g/dL
Also used as continuous variable
Univariate: p < 0.001
Multivariate:
Categorical = 3.9, (1.9-8.2), <0.001
Continuous = 0.38, (0.25-0.58), <0.001
Age, histology, tumor location, stage, Serum CRP, BMI, WBC count, platelet, bilirubin, hemoglobin, BMI, treatment modality
Choi GH, 2008, South Korea [52] March 1998 to January 2005 Retrospective, 97 Hepatocellular <3.5 g/dL
>=3.5 g/dL
Multivariate: 4.59 (1.79-11.75), 0.001 Sex, cirrhosis, AFP, platelets, tumor size, number of tumors, intrahepatic mets, venous invasion, Child-Pugh class, time to recurrence
Takahashi S, 2008, Japan [53] March 1999 to September 2004 Retrospective cohort, 179 Hepatocellular <3.5 g/dL
>=3.5 g/dL
Univariate: p = 0.001
Multivariate: 3.75(1.64-8.56) 0.002
Age, sex, bilirubin, platelets, AFP, PIVKA-II, tumor size, tumor nodules
Di Fiore FD, 2007, France [2] January 1997 to December 2003 Retrospective, consecutive case series, 105 Non-metastatic esophageal <=3.5 g/dL
>3.5 g/dL
Univariate: p = 0.007
Multivariate: 0.99 (0.50-1.98), 0.99
Age, sex, performance status, weight loss, BMI, hemoglobin, tumor location, tumor length, stage of disease, radiotherapy dose
Ishizuka M, 2007, Japan [3] January 2001 to March 2006 Retrospective, 315 Colorectal <=3.5 g/dL
>3.5 g/dL
Univariate: 0.85 (0.53-1.343), 0.488
Multivariate: 1.98 (0.91-4.29), 0.082
Age, sex, tumor site, CEA, CA19-9, CA72-4, CRP, GPS
Siddiqui A, 2007, USA [6] July 1986 to December
2004
Retrospective, 69 Pancreas >=3.5 g/dL
<3.5 g/dL
Univariate: p < .0001
Multivariate: 2.98 (2.20 to 3.76), <.0001
CA19-9, WBC, laboratory indicators, co-morbidities, age, sex, BMI, stage, treatment
Onate-Ocana LF, 2007, Mexico [44] January 1987 to December 2002 Retrospective, 1023 Gastric High: >=3.77 g/dL
Medium: 3.3 to 3.73 g/dL
Low: 2.81 to 3.29 g/dL
Very low: <=2.3 g/dL
Medium: 1.2 (0.8-1.7), 0.31
Low: 1.2 (0.8-1.8), 0.31
Very low: 1.8 (1.3-2.6), 0.001
Stage of disease, lymph node dissection, gender, surgical resection
McMillan DC, 2007, UK [54] January 1997 to June 2004 Retrospective, 316 Colorectal <=3.5 g/dL
>3.5 g/dL
GPS based on CRP and albumin was associated with survival (p < 0.0001) Age, Sex, stage, adjuvant therapy
Nagaoka S, 2007, Japan [55] January 1997 to November 1998 Cohort, 90 Hepatocellular <3.5 g/dL
>=3.5 g/dL
Univariate: 1.75 (1.13-2.70) 0.011
Multivariate: 2.01 (1.20-3.37) 0.008
Age, sex, hepatitis B virus, bilirubin, prothrombin time, platelet count, CRP, AFP, stage, initial treatment, AST, ALT
Read JA, 2006, Australia [56] NA Prospective consecutive case series, 51 Colorectal <3.5 g/dL
>=3.5 g/dL
Univariate: p = 0.017
Median survival in months
>=3.5 g/dL = 14.3
<3.5 g/dL = 10.3
Gender, age, extent of prior therapy, extent of disease, PS, liver
function CRP, PG-SGA, GPS, type of treatment
Liu SA, 2006, Taiwan [57] March 1995 to December 2002 Retrospective, 1010 Oral >=4.15 g/dL
<4.15 g/dL
Multivariate: 1.313, (1.052-1.638), 0.016 Age, sex, complications, BMI, stage, recurrence/metastasis
Boonpipattanapong, T, 2006, Thailand [7] October 1, 1998 to October 31, 2002 Retrospective cohort, 172 Colorectal <3.5 g/dL
>=3.5 g/dL
5-year survival
<3.5 g/dL = 48%
>=3.5 g/dL = 59%
CEA, tumor differentiation
Cengiz O, 2006, Turkey and USA [8] 1994-2003 Retrospective, 99 Colorectal <=3.5 g/dL
>3.5 g/dL
Univariate: <0.0001
Multivariate: 2.791, (1.37-5.67), 0.005
Age, gender, location, differentiation, hemoglobin, cholesterol, TNM stage, venous invasion, CEA, metastasis
Alici S, 2006, Turkey [58] September 1999 to April 2002 Retrospective, 138 Gastric <3 g/dL
>=3 g/dL
Univariate:
Median survival in years
<3 g/dL: 1.7
>=3 g/dL: 8.8 p = 0.006
BMI, clinical stage, surgery, type of surgery, gender, age, PS, tumor grade, tumor location, hemoglobin. LDH, type of surgery
Arimura E, 2005, Japan [59] January 1988 to December 2002 Prospective consecutive case series, 140 Hepatocellular <=3.5 g/dL
>3.5 g/dL
Univariate: 1.69 (1.01-2.84), 0.04
Multivariate: 1.49 (0.76-2.90), 0.24
LFTs, tumor size, tumor number, local recurrence, distant recurrence, AFP, ICG-R15 (%)
Schindl M, 2005, UK [60] October 1, 1988, to January
31, 2002
Retrospective, 337 Colorectal Continuous variable Univariate: p < 0.001
Multivariate: 0.9 (0.9-1.0) p < 0.001
Dukes stage, site of primary tumor, diameter of the largest liver lesion, serum CEA, ALP, number of lesions, bilobar disease, age
Tateishi R, 2005, Japan [61] January 1990 to December 1997 Prospective consecutive case series, 403 Hepatocellular >3.5 g/dL (reference)
2.8-3.5 g/dL
<2.8 g/dL
Univariate:
1.99 (1.52-2.59),0.0001
3.13 (2.01-4.88),0.0001
Multivariate:
1.74 (1.31-2.30) 0.00014
2.45 (1.55-3.88) 0.00013
Age, sex, treatment modality, tumor factors, including size, number of nodules, lobar distribution, and presence of extrahepatic metastasis, clinical manifestations, including ascites and hepatic encephalopathy, bilirubin, prothrombin activity, AST, ALT, platelet count, AFP, positivity for viral markers (hepatitis B surface antigen and anti-hepatitis C antibody), alcohol
Xu HX, 2005, China [62] August 1997 to September 2003 Prospective consecutive case series, 137 Hepatocellular <3.5 g/dL
>=3.5 g/dL
Multivariate: 0.48 (0.28-0.83), 0.008 Age, gender, cirrhosis, Child's class, AFP, ALT, bilirubin, prothrombin time, tumor nodules, tumor size, treatment method, recurrence
Lien YC, 2004, Taiwan [63] 1987 to 1997 Retrospective, 314 Gastric cardia >3.5 g/dL
<=3.5 g/dL
Univariate: 5 year survival rate
>3.5 g/dL: 38.4%
<=3.5 g/dL: 19.1%, p = <0.001
Age, sex, extent of resection, diet at presentation, depth of penetration, nodal involvement
Elahi MM, 2004, UK [64] 1988 to 1996 Retrospective, 165 Colorectal
Gastric
<3.5 g/dL
>=3.5 g/dL
Median survival in months
<3.5 g/dL: 1.7(0.6-2.8),
>=3.5 g/dL: 6.9 (4.7-9.0) p = <0.001
Age, sex, GPS, tumor type, CRP
Chen MF, 2003, Taiwan [65] 1986 to 1998 Retrospective, 254 Hepatocellular <=3.5 g/dL
>3.5 g/dL
Univariate:
Median survival in months
<=3.5 g/dL: 6.18
>3.5 g/dL: 12.3, p = 0.0037
Multivariate:
Disease-free survival
2.17 (1.21-3.90)
Overall survival 1.65 (1.005-2.73)
Age, sex, Hepatitis B antigen, Hepatitis C antibody, AFP, BUN, creatinine, ALP, AST, bilirubin, prothrombin time, extent of resection, blood loss, blood transfusion, tumor size, no of tumors, resection margin, operating time
Koike Y, 2003, Japan [66] 1987 to 1999 Retrospective consecutive case series, 952 Hepatocellular NA Univariate analysis indicated that the serum albumin level was associated with survival Child classification, number of tumor foci, portal venous invasion-targeted irradiation, and percutaneous tumor ablation of the parenchymal main tumor
Dixon MR, 2003, USA [67] 1991-1999 Retrospective cohort, 105 Colorectal Continuous variable Univariate (Median Albumin) (IQR):
Short survival <120 days : 2.5 (2.2-3.0)
Long survival >120 days : 3.1 (2.6-3.5), 0.002
Age, ALP, AST, total bilirubin, CEA, ALT, prothrombin time, mean corpuscular volume,
fibrinogen, hematocrit, creatinine
Heys SD, 1998, UK [45] 1972 to 1985 Retrospective case series, 431 Colorectal Continuous variable Univariate: <0.00005
Multivariate: 0.95 (0.93-0.98) < 0.0001
Duke's stage, age and tumor differentiation
Stuart KE, 1996, USA [68] 1986-1995 Retrospective, 314 Hepatocellular Albumin cutoffs not provided Univariate:
Median survival in months
Low albumin: 4
High Albumin: 15, p < 0.001
Multivariate: p < 0.001
Age, gender, cirrhosis, alcohol abuse, bilirubin, PVO and AFP
Onate-Ocana LF, 2007, Mexico [69] NA Retrospective cohort, 793 Gastric <=3.5 g/dL
>3.5 g/dL
Multivariate: 1.26 (1.03-1.5), <0.03 TNM stage, operative morbidity, type of lymphadenectomy, gastrectomy performed