The prognostic significance of preoperative serum albumin in urothelial carcinoma: a systematic review and meta-analysis

Abstract

Preoperative serum albumin has been considered to be closely correlated with the prognosis of various cancers, including urothelial carcinoma (UC). However, to date, this conclusion remains controversial. The aim of this meta-analysis is to investigate the prognostic significance of preoperative serum albumin in UC. A literature search was performed in PubMed, Web of Science, Embase, and Cochrane Library up to 4 July 2017. Herein, a total of 15506 patients from 23 studies were enrolled in our meta-analysis. Decreased preoperative serum albumin level predicted poor overall survival (OS) (HR = 1.88, 95% CI: 1.44-2.45, P<0.0001), cancer-specific survival (CSS) (HR = 2.03, 95% CI: 1.42-2.90, P=0.0001), recurrence-free survival (HR = 1.85, 95% CI: 1.15-2.97, P=0.01), 30-day complications (30dCs) after surgery (odds ratio (OR) = 1.93, 95% CI: 1.16-3.20, P=0.01), and 90-day mortality after surgery (OR = 4.24, 95% CI: 2.20-8.16, P<0.001). The subgroup analyses indicated that low preoperative serum albumin level is still positively associated with a worse prognosis of UC based on ethnicity, cut-off value, tumor type, analyses type, and sample size. Our meta-analysis indicated that reduced preoperative serum albumin level was a predictor of poor prognosis of UC.

Keywords: Albumin; meta-analysis; prognosis; urothelial carcinoma.

Figure 1. The study flow of study selection process

Figure 2. Meta-analysis of preoperative serum albumin level and OS (A), CSS (B), and RFS (C) in UC patients

Abbreviations: LSA, low level of preoperative serum albumin; HSA, high level of preoperative serum albumin.

Figure 3. Meta-analysis of preoperative serum albumin level at 30dC (A) and 90dM (B) in UC patients

Figure 4. Sensitivity analyses for OS (A), CSS (B), RFS (C), 30dC (D), 90dM (E), and the Begg’s and Egger’s test results for UC patients’ OS (F)