Serum albumin as a significant prognostic factor in patients with malignant pleural mesothelioma

Our plain-English summary of Serum albumin as a significant prognostic factor in patients with malignant pleural mesothelioma, by Z.H. Yao, G.Y. Tian, S.X. Yang, et al (Tumour Biology, 2014).

The study

• Authors: Z.H. Yao, G.Y. Tian, S.X. Yang, Y.Y. Wan, Y.M. Kang, Q.H. Liu, F. Yao, D.J. Lin
• Journal: Tumour Biology
• Published: 2014;35(7):6839-45
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Our aim was to evaluate the prognostic role of the pretreatment serum albumin level in patients with malignant pleural mesothelioma (MPM) receiving platinum-based systemic chemotherapy. From 1995 to 2013, a total of 97 patients receiving platinum-based systemic chemotherapy for newly diagnosed MPM were enrolled. All clinical information and laboratory results were retrospectively collected from the medical records. The Kaplan-Meier method was used to calculate survival. The Cox proportional hazards model was used to identify significant independent prognostic factors for predicting survival. In total, 34 of the 97 patients (35.1 %) had hypoalbuminaemia (albumin ≤ 35 g/l). The 1-year overall survival rate was 44.1 % for patients with hypoalbuminaemia and 72.0 % for patients with a normal albumin level. Multivariate analysis indicated that pretreatment albumin was an independent prognostic factor in MPM. Patients with hypoalbuminaemia had a greater risk of death than those with a normal albumin level [hazard ratio (HR) 1.778; 95 % confidence interval (CI) 1.504-2.998; P = 0.031]. When albumin was entered as a continuous variable in the Cox regression model, the HR of death was significantly decreased by 9.8 % (95 % CI 0.851-0.956) for each 1-g/l increment. The pretreatment serum albumin level is a simple, inexpensive and easily measurable marker with prognostic significance in MPM patients treated with platinum-based systemic chemotherapy.

In plain English

This retrospective study asked whether pretreatment levels of albumin, a blood protein, were linked to survival in malignant pleural mesothelioma. The authors reviewed the medical records of 97 patients treated with platinum-based chemotherapy at three hospitals in Shandong Province, China, between 1995 and 2013. The study did not examine asbestos exposure. Low albumin (35 g/l or less) was found in 34 of the 97 patients (35.1 %). Median survival was 10 months with low albumin and 15 months with normal albumin. One-year survival was 44.1 % and 72.0 % respectively. In a multivariate analysis, low albumin carried a hazard ratio for death of 1.778 versus normal albumin. The text gives its 95 % confidence interval as 1.504 to 2.998; the results table gives 1.054 to 2.998. Each 1 g/l rise in albumin was linked to a 9.8 % lower hazard of death (hazard ratio 0.902, 95 % confidence interval 0.851 to 0.956). Older age and non-epithelioid tumour type were also linked with worse survival. The authors concluded that pretreatment albumin was an independent prognostic indicator. They noted the study was retrospective and small.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective study of patient medical records (survival analysis using Kaplan-Meier and Cox regression)
• Who was studied: 110 consecutive patients with malignant pleural mesothelioma (MPM) were treated with systemic chemotherapy from 1995 to 2013 at three hospitals in Shandong Province, China (Shandong Provincial Hospital, Shandong Provincial Chest Hospital, Qilu Hospital). Of these, 97 met the criteria and were analysed. All 97 received platinum-based chemotherapy. There were 48 men and 49 women, with a median age of 58 years.
• Exposure: The study did not examine asbestos exposure. The factor studied was pretreatment serum albumin: 35 g/l or less was classed as hypoalbuminaemia (low albumin), and above 35 g/l as normal.
• Main results:
  • 34 of the 97 patients (35.1 %) had low albumin, and 63 (64.9 %) had normal albumin.
  • Median overall survival was 10 months for patients with low albumin and 15 months for patients with normal albumin (logrank P=0.008).
  • 1-year overall survival was 44.1 % for patients with low albumin and 72.0 % for patients with normal albumin.
  • In the multivariate analysis, patients with low albumin had a hazard ratio for death of 1.778 compared with normal albumin, P=0.031. The text gives the 95 % CI as 1.504 to 2.998, while Table 3 gives 1.054 to 2.998.
  • With albumin treated as a continuous measure, the hazard of death fell by 9.8 % for each 1 g/l increase (HR 0.902, 95 % CI 0.851 to 0.956, P less than 0.001).
  • Older age at diagnosis (P=0.036) and non-epithelioid tumour type (P less than 0.001) were also independent adverse prognostic factors.
  • Low albumin was associated with older age (P=0.017). It was not significantly associated with sex, smoking, weight loss, performance status, tumour type, stage, chemotherapy or hospital.
• The authors' conclusion: The authors concluded that pretreatment serum albumin is an independent prognostic indicator of overall survival in MPM treated with platinum-based chemotherapy, and that it is a simple, inexpensive marker.
• Limitations the authors state:
  • The study was retrospective and had a small number of patients. The authors stated that a larger prospective study is needed to validate the results.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Chemotherapy, Overall Survival, Multivariate Analysis, Hazard Ratio, confidence interval.

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