The association of pretreatment serum albumin with outcomes in bladder cancer: a meta-analysis

Figures & data

Figure 1 Flow diagram of study selection.

Table 1 The main characteristics of the included studies

Study	Country	Tumor type	Case number (LSA/HSA)	Age (years)	Sex (male/female)	Surgical treatment	Follow-up (months)	Survival analysis	Cutoff value of serum albumin (g/dL)
Caras et al^Citation15	USA	BC	1,292/4,282	65	4,228/1,340	RC	1	NR	3.5
Chan et al^Citation16	China	BC	62/55	68 ± 10	99/18	RC	31	CSS, OCS, OS	3.9
Djaladat et al^Citation17	USA	BC	197/1,274	67	1,154/317	RC	12.4	OS	3.5
Garg et al^Citation18	USA	BC	150/947	68	831/266	RC	25.2	NR	4
Hinata et al^Citation19	Japan	BC	NR	68.6	575/155	RC	52	OS	3.5
Johnson et al^Citation20	USA	BC	102/587	73	530/159	RC	1	NR	3.5
Krane et al^Citation21	USA	BC	NR	67.4	55/13	RC	25	OS, CSS	3.5
Ku et al^Citation22	Korea	BC	NR	65.1	362/57	RC	37.7	OS, CSS	3.5
Lambert et al^Citation23	UK	BC	31/156	67.4	153/34	RC	26.2	OS, CSS	3.5
Laurent et al^Citation24	France	BC	95/98	75.2	164/29	RC	9.1	OS	3.5
Lavallee et al^Citation25	Canada	BC	341/1,090	70	1,819/484	RC	NR	NR	NR
Liu et al^Citation26	China	BC	129/167	61.71	250/45	RC	72	CSS	4.0
Morgan et al^Citation27	USA	BC	30/139	78.8	122/47	RC	3	NR	3.7
Mursi et al^Citation28	Egypt	BC	24/7	58.4	22/9	RC	3	NR	3.5
Nakagawa et al^Citation29	Japan	BC	NR	69	248/58	RC	6.8	OS	3.5
Sharma et al^Citation30	USA	BC	NR	70.1	209/65	RC	NR	NR	4.0

Abbreviations: LSA, low serum albumin; HSA, high serum albumin; BC, bladder cancer; CSS, cancer-specific survival; OS, overall survival; RC, radical cystectomy; NR, not reported.

Table 2 The NOS quality assessment of the enrolled studies

Study	Selection				Comparability	Outcome			Total
	Representativeness of the exposed cohort	Selection of the nonexposed cohort	Ascertainment of exposure	Demonstration that outcome of interest was not present at the start of the study	Comparability of cohorts based on the design or analysis	Assessment of outcome	Was follow-up long enough for outcomes to occur?	Adequacy of follow-up of cohorts
Caras et al^Citation15	★	★	★	★	★☆	☆	★	★	7
Chan et al^Citation16	☆	★	★	★	★☆	★	★	☆	6
Djaladat et al^Citation17	★	★	☆	★	★☆	★	★	★	7
Garg et al^Citation18	★	★	☆	★	★☆	★	★	★	7
Hinata et al^Citation19	★	☆	★	★	★☆	★	★	★	7
Johnson et al^Citation20	★	☆	★	★	★☆	★	★	★	7
Krane et al^Citation21	☆	☆	★	★	★☆	★	★	★	6
Ku et al^Citation22	★	★	★	★	★☆	★	★	☆	7
Lambert et al^Citation23	☆	★	★	★	★☆	★	★	★	7
Laurent et al^Citation24	★	★	★	★	★☆	★	☆	★	7
Lavailee et al^Citation25	★	★	☆	★	★☆	★	★	★	7
Liu et al^Citation26	☆	★	★	★	★☆	★	☆	★	6
Morgan et al^Citation27	☆	★	★	★	★☆	★	★	★	7
Mursi et al^Citation28	☆	★	☆	★	★☆	★	☆	★	5
Nakagawa et al^Citation29	★	★	★	★	★☆	★	★	☆	7
Sharma et al^Citation30	☆	★	☆	★	★☆	★	★	★	6
Taguchi et al^Citation31	★	★	☆	★	★☆	★	★	★	7

Notes:

★ Represents one score and

☆ represents no score in corresponding items.

Abbreviation: NOS, Newcastle–Ottawa Scale.

Figure 2 The prognostic significance of low pretreatment serum albumin level on OS in BC.

Note: Weights are from random-effects analysis.
Abbreviations: BC, bladder cancer; HR, hazard ratio; OS, overall survival.

Figure 3 The prognostic significance of low pretreatment serum albumin level on CSS in BC.

Note: Weights are from random-effects analysis.
Abbreviations: BC, bladder cancer; CSS, cancer-specific survival; HR, hazard ratio.

Figure 4 The impact of pretreatment serum albumin on postoperative 30dC.

Note: Weights are from random-effects analysis.
Abbreviations: 30dC, 30-day complication; OR, odds ratio.

Figure 5 The impact of pretreatment serum albumin on postoperative 90dM.

Abbreviations: 90dM, 90-day mortality; OR, odds ratio.

Table 3 Subgroup analysis of preoperative serum albumin and outcomes of BC patients

Variables	Outcome	Studies	Patients	HR (95% CI)	P-value	Model	Heterogeneity I^2	Erogeneity
							%	P-value
Ethnicity
Asian	OS	4	1,655	1.37 (1.11–1.69)	<0.01	Fixed	0.0	0.61
	CSS	3	831	1.32 (0.81–2.14)	0.27	Random	65.2	0.06
Non-Asian	OS	4	1,919	2.35 (1.65–3.34)	<0.01	Random	58.4	0.06
	CSS	2	255	3.21 (0.65–15.80)	0.15	Random	86.2	<0.01
Analysis type
Univariate	CSS	1	117	1.79 (0.73–4.37)	0.20	–	–	–
	90dM	5	7,426	2.42 (1.75–3.33)	<0.01	Fixed	31.5	0.21
	CSS	5	969	1.65 (1.03–2.63)	0.04	Random	89.7	<0.01
Multivariate	90dM	1	1,097	3.03 (1.31–7.02)	0.01	–	–	–
Cutoff value
3.5 g/dL	CSS	2	412	1.12 (0.69–1.82)	0.66	Fixed	42.1	0.19
	30dC	4	7,915	1.74 (1.39–2.17)	<0.01	Fixed	13.4	0.33
	90dM	4	7,257	2.39 (1.54–3.73)	<0.01	Fixed	<0.01	0.12
Others	CSS	3	674	2.22 (1.18–4.17)	0.01	Random	72.7	0.03
	30dC	3	3,674	1.06 (0.61–1.83)	0.85	Random	84.3	<0.01
	90dM	2	1,266	2.66 (1.65–4.28)	<0.01	Fixed	0.0	0.71

Abbreviations: BC, bladder cancer; CSS, cancer-specific survival; 30dC, 30-day complication; 90dM, 90-day mortality; HR, hazard ratio; OS, overall survival.

Figure 6 The results of sensitivity analysis of the pooled HR for OS.

Abbreviations: HR, hazard ratio; OS, overall survival.

Figure 7 The results of sensitivity analysis of the pooled HR for CSS.

Abbreviations: CSS, cancer-specific survival; HR, hazard ratio.

Figure 8 The results of sensitivity analysis of the pooled OR for postoperative 30dC.

Abbreviations: 30dC, 30-day complication; OR, odds ratio.

Figure 9 The results of sensitivity analysis of the pooled OR for postoperative 90dM.

Abbreviations: 90dM, 90-day mortality; OR, odds ratio.

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