title: Low pre-operative levels of serum albumin predict lymph node metastases and ultimately correlate with a biochemical recurrence of prostate cancer in radical prostatectomy patients.
abstract: BACKGROUND
  To date, only few studies focusing on the issue of host general and immune activity have been performed in localized prostate cancer (PCa). The aim of this study was to elucidate potent non tumor-related biomarkers that express aggressiveness of PCa treated by radical prostatectomy (RP).
  
  
  METHODS
  Data from 179 patients who underwent RP were analyzed. The correlations between various kinds of non tumor-related factors in addition to tumor-related factors and biochemical recurrence (BCR) were analyzed. The correlations between pre-, intra- and post-operative factors were also analyzed.
  
  
  RESULTS
  Thirty-two cases (17.9%) had a BCR. The factors found to be significantly predictive of BCR using a Cox-proportional hazard model were the pre-operative serum prostate specific antigen (PSA) level and the existence of pathological lymph node metastasis (LNM). A low pre-operative serum albumin level (<4.0 g/dl) was significantly correlated with BCR univariately. Logistic regression analysis revealed that a low pre-operative serum albumin level, an American Society of Anesthesiologists (ASA) score above class 2, and a Gleason score above 8 in the biopsy specimens were significantly predictive of pathological LNM.
  
  
  CONCLUSIONS
  Tumor-related characteristics are more important for predicting BCR. However, our results suggest that low pre-operative serum albumin level may indicate extensive disease of clinically localized PCa and may ultimately be correlated with BCR. Although multiple reasons may account for the significance of the serum albumin level, it is noteworthy that delayed diagnostic and therapeutic procedures in comorbid patients with low serum albumin levels may lead to PCa progression.
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sejima
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Iwamoto
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Masago
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Morizane
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Yao
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Isoyama
authors.affiliation: Department of Urology, Sanin Rosai Hospital, Yonago, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kadowaki
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takenaka
keywords: prostate–specific antigen; prostatic cancer; radical prostatectomy; recurrence; serum albumin