title: Pre-operative hypoalbuminaemia predicts poor overall survival in rectal cancer: a retrospective cohort analysis.
abstract: BACKGROUND
  Serum albumin is a marker of nutrition and inflammation. It has recently emerged as a predictor of outcome after surgery for rectal cancer. Our aim was to evaluate if pre-operative serum albumin would predict survival after resection for rectal cancer.
  
  
  METHODS
  226 Patients with rectal cancer of all stages undergoing resection with curative intent were studied. Kaplan-Meier curves analysed survival based on a pre-operative albumin level of <35 g/L vs. >35 g/L. We sought for significant associations of survival with age, sex, stage, tumour site, use of neoadjuvant chemoradiation, microscopic positive resection margins, differentiation, angio, peri-neural, and lymphovascular invasion using individual variable analysis. Multifactorial analysis was performed using type III analysis with Weibull hazard model and Cox-proportional hazard model. Significance was assigned to a P value <0.05.
  
  
  RESULTS
  Of 226 patients (median age- 59 years; range 19 - 88, Male - 54%), forty five (20%) had an albumin level < 35 g/L and was associated with a poor overall survival (P = 0.02). Mean survival in months for <35 g/L vs. >35 g/L was 64.7 (SE - 9.3) vs. 95.8 (SE - 7.0) and 5 year overall survival rates were 49% and 69%. Individual variable analysis revealed age, circumferential margin, stage, perineural, lympho-vascular and angio invasion to be also significant. With multifactorial analysis hypoalbuminaemia (HR = 0.58; 95% CI: 0.35 - 0.95, P = 0.03), advanced stage (HR = 2.0; 95% CI: 1.26 - 3.23, P < 0.01) and positive circumferential margin (HR = 2.2; 95% CI: 1.26 - 3.89, P < 0.01) remained significant.
  
  
  CONCLUSIONS
  Preoperative hypoalbuminaemia is an independent risk factor for poor overall survival in rectal cancer. Advanced tumour stage and circumferential margin positivity were the other associations with poor survival.
authors.affiliation: Department of Surgery, North Colombo Teaching Hospital, Ragama, Sri Lanka.
authors.forename: Pramodh C
authors.initials: PC
authors.lastname: Chandrasinghe
authors.affiliation: Department of Surgery, North Colombo Teaching Hospital, Ragama, Sri Lanka.
authors.forename: Dileepa S
authors.initials: DS
authors.lastname: Ediriweera
authors.affiliation: Department of Surgery, North Colombo Teaching Hospital, Ragama, Sri Lanka.
authors.forename: Sumudu K
authors.initials: SK
authors.lastname: Kumarage
authors.affiliation: Department of Surgery, North Colombo Teaching Hospital, Ragama, Sri Lanka.
authors.forename: Kemal I
authors.initials: KI
authors.lastname: Deen