title: Low preoperative serum albumin in colon cancer: a risk factor for poor outcome.
abstract: OBJECTIVE
  The number of colon cancer patients is increasing worldwide. Malnutrition and comorbidities are frequently associated with these patients. The relationships between the preoperative malnutrition and the outcomes of colon cancer patients are unclear; this study aimed to clarify these issues.
  
  
  METHODS
  A total of 3,849 consecutive colon cancer patients were enrolled in an analysis of short-term outcomes and 2,529 patients were included in an analysis of the long-term outcomes. These patients were divided into the hypoalbuminemic and normal groups according to the definition of hypoalbuminemia (serum albumin < 35 g/L).
  
  
  RESULTS
  Advanced age, female gender, abnormal CEA levels, right colon or large tumors, mucinous adenocarcinoma, poor differentiation, stage II cancer, TNM advancing T stage, old cardiovascular accident, diabetes, and liver cirrhosis were more likely to be associated with hypoalbuminemia. Hypoalbuminemic patients had a higher rate of postoperative mortality and morbidity, including complications related to wounds, lungs, the urinary system, and anastomosis. The 5-year overall survival rates of patients with normal albumin and hypoalbuminemia were 78.0% and 60.0%, respectively (P < 0.0001), and the 5-year relapse-free survival rates were 78.9% and 73.5%, respectively (P = 0.0042). In a multivariate analysis, the albumin level was also significantly correlated with 5-year overall survival (<35 vs. ≥ 35, HR 1.75; 95% CI 1.49-2.08) and 5-year relapse-free survival (<35 vs. ≥ 35, HR 1.28; 95% CI 1.04-1.56).
  
  
  CONCLUSIONS
  Hypoalbuminemia is a predictor of poor surgical outcomes of colon cancer and is a poor prognosis factor for long-term survival of colon cancer after curative operation.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung, Memorial Hospital, Linko, Taiwan.
authors.forename: Cheng-Chou
authors.initials: CC
authors.lastname: Lai
authors.forename: Jeng-Fu
authors.initials: JF
authors.lastname: You
authors.forename: Chien-Yuh
authors.initials: CY
authors.lastname: Yeh
authors.forename: Jinn-Shiun
authors.initials: JS
authors.lastname: Chen
authors.forename: Reiping
authors.initials: R
authors.lastname: Tang
authors.forename: Jeng-Yi
authors.initials: JY
authors.lastname: Wang
authors.forename: Chih-Chien
authors.initials: CC
authors.lastname: Chin
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000097:blood* / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D012709:Serum Albumin