Serum Albumin as a Predictor of Survival after Interval Debulking Surgery for Advanced Ovarian Cancer (AOC): A Retrospective Study

Abstract

Objective

To investigate the impact of serum albumin (at diagnosis and pre-operatively) on survival in patients undergoing cytoreductive surgery for advanced ovarian cancer(AOC) and whether improvement in albumin achieved following neoadjuvant chemotherapy (NACT) affects overall survival (OS).

Methods

Outcomes of 441 patients who underwent cytoreduction for AOC were reviewed. Albumin was recorded at diagnosis and pre-operatively. Further analysis was performed if patients were hypoalbuminaemic at diagnosis.Analysis was stratified according to whether the patientreceived primary debulking surgery (PDS) or interval debulking surgery (IDS) and if their albumin was corrected.

Results

308 patients had a serum albumin level at diagnosis and 400 patients had a pre-operative albumin available for analysis. For patients with an albumin at diagnosis ≤ 35g/L and ≥36 g/L, median OS was 31.5 (95% CI 23.5–39.5) and 50.4 (95% CI 38.9–61.9) months respectively (P = 0.003). Followingmultivariate analysis (MVA), albumin at diagnosis remained statistically significant as an independent marker for survival, even after adjusting for cytoreductive outcome, stage and grade(p = 0.04, Hazard ratio 1.38, 95% CI 1.01–1.89).

Hypoalbuminaemic patients at diagnosis achieved complete cytoreduction in 53% of cases.For PDS patients, median OS was 19.7 months (95% CI 11.5–27.9). For IDS patients, median OS was 27.9 months (n = 1).IDS patients with a corrected albumin had a median OS of 42.9 months (95% CI 31.5–54.3) (p > 0.05).

Conclusion

Hypoalbuminaemia at diagnosis is a poor prognostic factor in AOC. Normalization of serum albumin after NACT is a potential predictor of survival.

KEYWORDS:

• Advanced ovarian cancer
• neo-adjuvant chemotherapy
• albumin
• primary debulking surgery
• interval debulking surgery

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Author contribution statement

Dairui Dai: Conceptualization, Methodology, Formal analysis, Writing – original draft preparation, Visualization, Project administration.

Janos Balega: Conceptualization, Resources, Investigation, Data curation, Writing – Review & Editing, Project administration.

Sudha Sundar: Writing – Review & Editing, Supervision.

Sean Kehoe: Investigation, Data curation.

Ahmed Elattar: Investigation, Data curation, Writing – Review & Editing.

Andrew Phillips: Conceptualization, Methodology, Formal analysis, Investigation, Writing – Review & Editing, Visualization, Project administration, Supervision.

Kavita Singh: Conceptualization, Investigation, Writing – Review & Editing, Supervision.

Disclosure statement

Sean Kehoe has received fees for lecturing for Astra Zeneca and Roche.

Janos Balega has received personal fees from Astra Zeneca and Roche.

All other authors have no disclosures of interests.