Prognostic significance of the postoperative level and recovery rate of serum albumin in patients with curatively resected pancreatic ductal adenocarcinoma

Nakano,Yutaka; Kitago,Minoru; Shinoda,Masahiro; Yagi,Hiroshi; Abe,Yuta; Takano,Kiminori; Oshima,Go; Takeuch,Ayano; Endo,Yutaka; Kitagawa,Yuko

doi:10.3892/mco.2019.1883

Prognostic significance of the postoperative level and recovery rate of serum albumin in patients with curatively resected pancreatic ductal adenocarcinoma

Authors:
- Yutaka Nakano
- Minoru Kitago
- Masahiro Shinoda
- Hiroshi Yagi
- Yuta Abe
- Kiminori Takano
- Go Oshima
- Ayano Takeuch
- Yutaka Endo
- Yuko Kitagawa
View Affiliations

Affiliations: Department of Surgery, Keio University School of Medicine, Tokyo 160‑8582, Japan, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo 160‑8582, Japan
Published online on: June 19, 2019 https://doi.org/10.3892/mco.2019.1883
Pages: 270-278

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of the present study was to investigate the clinicopathological features and prognostic factors associated with pre‑ and postoperative serum albumin levels in patients with curatively resected pancreatic ductal adenocarcinoma (PDAC). To achieve this, the data of patients who underwent pancreatectomy for PDAC between January 1995 and March 2016 were retrospectively reviewed, and the pre‑ and postoperative serum albumin levels at postoperative months (POMs) 3, 6, and 12 were evaluated. The serum albumin recovery rate was also investigated. A total of 196 patients were enrolled in the present study. In the multivariate Cox regression analysis, lymph node metastasis [hazard ratio (HR): 1.65; P=0.022], serum albumin level at POM 12 (≥3.9 g/dl; HR: 0.60; P=0.017), and serum albumin recovery rate at POM 12 (≥1.00; HR: 0.60; P=0.017) were independent prognostic factors for disease‑free survival. Lymph node metastasis (HR: 1.79; P=0.013) and serum albumin level at POM 12 (≥3.9 g/dl) (HR: 0.60; P=0.033) were independent prognostic factors for overall survival. These results indicated that the postoperative level and recovery rate of serum albumin are potential biomarkers for predicting the prognosis of patients with curatively resected PDAC. However, further studies are required in order to investigate the survival benefit of increasing postoperative serum albumin levels in these patients.

View Figures

View References

1	Egawa S, Toma H, Ohigashi H, Okusaka T, Nakano A, Hatori T, Maguchi H, Yanagisawa A and Tanaka M: Japan pancreatic cancer registry; 30th year anniversary: Japan pancreas society. Pancreas. 41:985–992. 2012. View Article : Google Scholar : PubMed/NCBI
2	Jemal A, Siegel R, Xu J and Ward E: Cancer statistics, 2010. CA Cancer J Clin. 60:277–300. 2010. View Article : Google Scholar : PubMed/NCBI
3	Verma V, Li J and Lin C: Neoadjuvant therapy for pancreatic cancer: Systematic review of postoperative morbidity, mortality, and complications. Am J Clin Oncol. 39:302–313. 2016. View Article : Google Scholar : PubMed/NCBI
4	Uesaka K, Boku N, Fukutomi A, Okamura Y, Konishi M, Matsumoto I, Kaneoka Y, Shimizu Y, Nakamori S, Sakamoto H, et al: Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: A phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet. 388:248–257. 2016. View Article : Google Scholar : PubMed/NCBI
5	Farrugia A: Albumin usage in clinical medicine: Tradition or therapeutic? Transfus Med Rev. 24:53–63. 2010. View Article : Google Scholar : PubMed/NCBI
6	Gabay C and Kushner I: Acute-phase proteins and other systemic responses to inflammation. N Eng J Med. 340:448–454. 1999. View Article : Google Scholar
7	Namendys-Silva SA, Gonzalez-Herrera MO, Texcocano-Becerra J and Herrera-Gomez A: Hypoalbuminemia in critically ill patients with cancer: Incidence and mortality. Am J Hosp Palliat Care. 28:253–257. 2011. View Article : Google Scholar : PubMed/NCBI
8	Fuhrman MP: The albumin-nutrition connection: Separating myth from fact. Nutrition. 18:199–200. 2002. View Article : Google Scholar : PubMed/NCBI
9	Visser M, Kritchevsky SB, Newman AB, Goodpaster BH, Tylavsky FA, Nevitt MC and Harris TB: Lower serum albumin concentration and change in muscle mass: The health, aging and body composition study. Am J Clin Nutr. 82:531–537. 2005. View Article : Google Scholar : PubMed/NCBI
10	Haruki K, Shiba H, Shirai Y, Horiuchi T, Iwase R, Fujiwara Y, Furukawa K, Misawa T and Yanaga K: The C-reactive protein to albumin ratio predicts long-term outcomes in patients with pancreatic cancer after pancreatic resection. World J Surg. 40:2254–2260. 2016. View Article : Google Scholar : PubMed/NCBI
11	Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S and Nakao A: Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 98:268–274. 2011. View Article : Google Scholar : PubMed/NCBI
12	Imaoka H, Mizuno N, Hara K, Hijioka M, Tajika M, Tanaka T, Ishihara M, Yogi T, Tsutsumi H, Fujiyoshi T, et al: Evaluation of modified glasgow prognostic score for pancreatic cancer: A retrospective cohort study. Pancreas. 45:211–217. 2016. View Article : Google Scholar : PubMed/NCBI
13	Nakano Y, Kitago M, Matsuda S, Nakamura Y, Fujita Y, Imai S, Shinoda M, Yagi H, Abe Y, Hibi T, et al: KRAS mutations in cell-free DNA from preoperative and postoperative sera as a pancreatic cancer marker: A retrospective study. Br J Cancer. 118:662–669. 2018. View Article : Google Scholar : PubMed/NCBI
14	Nakano Y, Kitago M, Shinoda M, Abe Y, Yagi H, Hibi T, Takeuchi A, Aiura K, Itano O and Kitagawa Y: Clinical predictive factors of long-term survival after curative resection of pancreatic cancer: A retrospective study. Br J Cancer. 6:2278–2281. 2018.
15	Fujii-Nishimura Y, Nishiyama R, Kitago M, Masugi Y, Ueno A, Aiura K, Kawachi S, Kawaida M, Abe Y, Shinoda M, et al: Two cases of pathological complete response to neoadjuvant chemoradiation therapy in pancreatic cancer. Keio J Med. 64:26–31. 2015. View Article : Google Scholar : PubMed/NCBI
16	Japan Pancreas Society: Classification of pancreatic carcinoma. 2nd English ed. Tokyo. Kanehara2009.
17	Takahashi S, Aiura K, Saitoh J, Hayatsu S, Kitajima M and Ogata Y: Treatment strategy for pancreatic head cancer: Pylorus-preserving pancreatoduodenectomy, intraoperative radiotherapy and portal catheterization. Digestion. 60 (Suppl):S130–S134. 1999. View Article : Google Scholar
18	Aiura K, Takahashi S, Matsui J, Ueda M and Kitagawa Y: Beneficial effects of 5-Fluorouracil and heparin-based portal infusion chemotherapy combined with mitomycin C and cisplatin after curative resection of pancreatic cancer. Pancreatology. 10:250–258. 2017. View Article : Google Scholar
19	McMillan DC, Watson WS, O'Gorman P, Tom Preston, Scott HR and McArdle CS: Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 39:210–213. 2001. View Article : Google Scholar : PubMed/NCBI
20	Schmid I, Schmitt M, Streiter M, Meilbeck R, Haas RJ and Stachel DK: Effects of soluble TNF receptor II (sTNF-RII), IL-1 receptor antagonist (IL-1ra), tumor load and hypermetabolism on malnutrition in children with acute leukemia. Eur J Med Res. 10:457–461. 2005.PubMed/NCBI
21	Matsuda S, Niihara M, Tsubosa Y, Sato H, Takebayashi K, Kawamorita K, Mori K, Tsushima T, Yasui H, Takeuchi H and Kitagawa Y: Clinical significance of postoperative recovery of serum albumin levels in patients with esophageal cancer who underwent transthoracic esophagectomy. Surg Today. 46:1138–1145. 2016. View Article : Google Scholar : PubMed/NCBI
22	Ravasco P, Monteiro-Grillo I, Vidal PM and Camilo ME: Dietary counseling improves patient outcomes: A prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol. 23:1431–1438. 2005. View Article : Google Scholar : PubMed/NCBI
23	Roxburgh CSD, Crozier JEM, Maxwell F, Foulis AK, Brown J, McKee RF, Anderson JH, Horgan PG and McMillan DC: Comparison of tumour based (Petersen Index) and inflammation-based (Glasgow Prognostic Score) scoring systems in patients undergoing curative resection for colon cancer. Br J Cancer. 100:701–706. 2009. View Article : Google Scholar : PubMed/NCBI
24	McMillan DC, Crozier JE, Canna K, Angerson WJ and McArdle CS: Evaluation of an inflammation based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Colorectal Dis. 22:881–886. 2007. View Article : Google Scholar : PubMed/NCBI
25	Gilliland TM, Villafane-Ferriol N, Shah KP, Shah RM, Tran Cao HS, Massarweh NN, Silberfein EJ, Choi EA, Hsu C and McElhany CA: Nutritional and metabolic derangements in pancreatic cancer and pancreatic resection. Nutrients. 9:E2432017. View Article : Google Scholar : PubMed/NCBI
26	Shu XL, Kang K, Gu LJ and Zhang YS: Effect of early enteral nutrition on patients with digestive tract surgery: A meta-analysis of randomized controlled trials. Exp Ther Med. 12:2136–2144. 2016. View Article : Google Scholar : PubMed/NCBI
27	Okada S, Yamazaki S, Kaiga T, Funada T, Kochi M and Takayama T: Impact of nutritional status in the era of FOLFOX/FIRI-based chemotherapy. World J Surg Oncol. 15:162–169. 2017. View Article : Google Scholar : PubMed/NCBI
28	Conroy T, Hammel P, Hebbar M, Ben Abdelghani M, Wei AC, Raoul JL, Chone L, Francois E, Artru A, Biagi JJ, et al: Folfirinox or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 379:2395–2406. 2018. View Article : Google Scholar : PubMed/NCBI
29	Fleck A, Raines G, Hawker F, Trotter J, Wallace PI, Ledingham IM and Calman KC: Increased vascular permeability: A major cause of hypoalbuminaemia in disease and injury. Lancet. 1:781–784. 1985. View Article : Google Scholar : PubMed/NCBI
30	Hubner M, Mantziari S, Demartines N, Pralong F, Coti-Bertrand P and Schafer M: Postoperative albumin drop is a marker for surgical stress and a predictor for clinical outcome: A pilot study. Gastroenterol Res Pract. 87431872016.PubMed/NCBI
31	Gao Q, Mok HP, Wang WP, Xiao F and Chen LQ: Effect of perioperative glucocorticoid administration on postoperative complications following esophagectomy: A meta-analysis. Oncol Lett. 7:349–356. 2014. View Article : Google Scholar : PubMed/NCBI
32	Takata A, Takiguchi S, Miyazaki Y, Miyata H, Takahashi T, Kurokawa Y, Yamasaki M, Nakajima K, Mori M, Kanagawa K and Doki Y: Randomized phase II study of the anti-inflammatory effect of ghrelin during the postoperative period of esophagectomy. Ann Surg. 262:230–236. 2015. View Article : Google Scholar : PubMed/NCBI