title: Is hypoalbuminemia an independent prognostic factor in patients with gastric cancer?
abstract: BACKGROUND
  Studies have indicated that hypoalbuminemia is associated with decreased survival of patients with gastric cancer. However, the prognostic value of albumin may be secondary to an ongoing systemic inflammatory response. The aim of the study was to assess the relation between hypoalbuminemia, the systemic inflammatory response, and survival in patients with gastric cancer.
  
  
  METHODS
  Patients diagnosed with gastric carcinoma attending the upper gastrointestinal surgical unit in the Royal Infirmary, Glasgow between April 1997 and December 2005 and who had a pretreatment measurement of albumin and C-reactive protein (CRP) were studied.
  
  
  RESULTS
  Most of the patients had stage III/IV disease and received palliative treatment. The minimum follow-up was 15 months. During follow-up, 157 (72%) patients died of their cancer. On univariate analysis, stage (p < 0.001), treatment (p < 0.001), albumin level (p < 0.001), and CRP level (p < 0.001) were significant predictors of survival. On multivariate analysis, stage (p < 0.001), treatment (p < 0.001), and CRP level (p < 0.001) remained significant predictors of survival. Albumin was no longer an independent predictor of survival.
  
  
  CONCLUSIONS
  Low albumin concentrations are associated with poorer survival in patients with gastric cancer. However, the strength of this relation with survival is dependent on the presence of a systemic inflammatory response, as evidenced by an elevated CRP level. Therefore, it appears that the relation between hypoalbuminemia and poor survival is secondary to that of the systemic inflammatory response.
authors.affiliation: University Department of Surgery, Royal Infirmary, Glasgow, G31 2ER, UK. abccrumley@doctors.org.uk
authors.forename: Andrew B C
authors.initials: AB
authors.lastname: Crumley
authors.forename: Robert C
authors.initials: RC
authors.lastname: Stuart
authors.forename: Margaret
authors.initials: M
authors.lastname: McKernan
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000368:Aged; D000418:Albumins / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013274:Stomach Neoplasms / Q000097:blood* / Q000401:mortality*; D016019:Survival Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000401:mortality*
chemical_list: D000418:Albumins; D002097:C-Reactive Protein