Predictive value of serum albumin levels on cancer survival: a prospective cohort study

Abstract

Background: Serum albumin levels and cancer mortality are closely related, yet large-sample studies encompassing a broad spectrum of cancer types are lacking.

Methods: This study encompassed patients diagnosed with cancer across the continuous 10 cycles of NHANES surveys from 1999 to 2018. The study population was stratified into two groups based on median albumin levels (≤ 4.2g/dL and > 4.2 g/dL) or cancer aggressiveness (well-survived cancers and poorly-survived cancers). Survival rates were estimated using the Kaplan-Meier method. The Cox proportional hazards model was employed to evaluate the association between serum albumin levels and cancer mortality. Restricted cubic spline (RCS) analysis was conducted to assess the nonlinear relationship between serum albumin levels and the risk of cancer mortality.

Results: Kaplan-Meier curves demonstrated that patients with albumin levels ≤ 4.2 g/dL exhibited lower survival rates compared to those with levels > 4.2 g/dL, irrespective of cancer aggressiveness. Following adjustment for confounders, decreased albumin levels were associated with an elevated risk of cancer mortality across all groups [all cancers, HR (95%CI) = 2.03(1.73, 2.37); well survived cancers, HR (95%CI) = 1.78(1.38, 2.32); and poorly survived cancers, HR (95%CI) = 1.99(1.64, 2.42)]. RCS analyses revealed a stable nonlinear negative association between albumin levels and cancer mortality in all groups, regardless of confounder adjustment.

Conclusion: Low serum albumin levels predict higher cancer mortality. Furthermore, a nonlinear negative association was observed between serum albumin levels and the risk of cancer mortality.

Keywords: National Health and Nutrition Examination Survey (NHANES); albumin levels; cancer mortality; cardiovascular disease (CVD); restricted cubic spline (RCS).

Figure 1

Distribution of albumin (A) and cancer types (B).

Figure 2

Survival differences between the low albumin group and the high albumin group. (A) All cancers. (B) Well survived cancers (Thyroid, Breast, Prostate and Non-melanoma Skin). (C) Poorly survived cancers (Other cancers except “B”).

Figure 3

Nonlinear association between serum albumin levels and cancer mortality. Crude model: adjusted for none. Adjusted model: adjusted for age, sex, ethnicity, BMI, smoking, drinking, hypertension, diabetes mellitus, anemia, CVD. (A, B) All cancers. (C, D) Well survived cancers. (E, F) Poorly survived cancers.

Figure 4

Survival differences between the low albumin group and the high albumin group. (A) Cervix. (B) Uterus. (C) Bladder. (D) Ovary. (E) Lymphoma. (F) Kidney.