Serum albumin level as a potential marker for deciding chemotherapy or best supportive care in elderly, advanced non-small cell lung cancer patients with poor performance status

Abstract

Background: There have been few data on the chemotherapy in elderly advanced non-small cell lung cancer (NSCLC) patients with poor performance status (PS), and usefulness of chemotherapy for such patients remains unclear. The objective of this study was to identify factors that predicted the survival benefit of chemotherapy.

Methods: All consecutive elderly patients (≥75 years) with advanced NSCLC, Eastern Cooperative Oncology Group PS ≥2, EGFR mutation wild type/unknown, and newly diagnosed from January 2009 to December 2012 at a tertiary hospital were retrospectively reviewed.

Results: We enrolled 59 patients, and 31 patients received at least one chemotherapy regimen (chemotherapy group). However, 28 patients received best supportive care (BSC) alone (BSC group). The proportion of PS 2 and serum albumin levels was significantly higher in the chemotherapy group than in the BSC group. In the chemotherapy group, log-rank testing did not show statistically significant differences in overall survival (OS) between the single-agent therapy group and carboplatin-based doublet therapy group; however, the OS of patients receiving chemotherapy for only 1 cycle (early termination) was significantly shorter than patients receiving chemotherapy for ≥2 cycles. Hypoalbuminemia was not only a risk factor for the early termination of chemotherapy but also an independent prognostic factor in the chemotherapy group. A receiver operating characteristic curve analysis showed that the best cut-off value was 3.40 g/dL. In patients with serum albumin levels ≥3.40 g/dL, OS was significantly better in the chemotherapy group than in the BSC group (p = 0.0156), however, patients with serum albumin levels <3.40 g/dL exhibited poor prognosis regardless of the presence or absence of chemotherapy.

Conclusion: In the elderly NSCLC patients with poor PS, serum albumin levels may help identify certain patient populations more likely to receive a survival benefit of systemic chemotherapy.

Keywords: Albumin; Elderly; Hypoalbuminemia; Non-small cell lung cancer; Performance status.

Fig. 1

A comparison of survival curves between chemotherapy and BSC groups. A comparison of survival curves is shown. The overall survival (OS) was better in the chemotherapy group than in the BSC group

Fig. 2

Log-rank testing in the chemotherapy group. Log-rank testing did not show statistically significant differences in median overall survival (OS) between single-agent therapy and carboplatin-based doublet therapy groups (a). To note, the OS of patients who received chemotherapy for only 1 cycle was significantly shorter than those of patients who received chemotherapy for ≥2 cycles (b)

Fig. 3

Comparison of survival curves based on serum albumin levels. In the patients with serum albumin levels ≥3.40 g/dL, overall survival (OS) was significantly better in the chemotherapy group than that in the BSC group (a); in patients with serum albumin levels <3.40 g/dL, the OS did not differ between chemotherapy and BSC groups (b)