Cancer Treatment Centers of America® at Midwestern Regional Medical Center, Zion, IL, USA.
Nutr J. 2010 Dec 22;9:69. doi: 10.1186/1475-2891-9-69.
There are several methods of assessing nutritional status in cancer of which serum albumin is one of the most commonly used. In recent years, the role of malnutrition as a predictor of survival in cancer has received considerable attention. As a result, it is reasonable to investigate whether serum albumin has utility as a prognostic indicator of cancer survival in cancer. This review summarizes all available epidemiological literature on the association between pretreatment serum albumin levels and survival in different types of cancer.
A systematic search of the literature using the MEDLINE database (January 1995 through June 2010) to identify epidemiologic studies on the relationship between serum albumin and cancer survival. To be included in the review, a study must have: been published in English, reported on data collected in humans with any type of cancer, had serum albumin as one of the or only predicting factor, had survival as one of the outcome measures (primary or secondary) and had any of the following study designs (case-control, cohort, cross-sectional, case-series prospective, retrospective, nested case-control, ecologic, clinical trial, meta-analysis).
Of the 29 studies reviewed on cancers of the gastrointestinal tract, all except three found higher serum albumin levels to be associated with better survival in multivariate analysis. Of the 10 studies reviewed on lung cancer, all excepting one found higher serum albumin levels to be associated with better survival. In 6 studies reviewed on female cancers and multiple cancers each, lower levels of serum albumin were associated with poor survival. Finally, in all 8 studies reviewed on patients with other cancer sites, lower levels of serum albumin were associated with poor survival.
Pretreatment serum albumin levels provide useful prognostic significance in cancer. Accordingly, serum albumin level could be used in clinical trials to better define the baseline risk in cancer patients. A critical gap for demonstrating causality, however, is the absence of clinical trials demonstrating that raising albumin levels by means of intravenous infusion or by hyperalimentation decreases the excess risk of mortality in cancer.
有几种评估癌症患者营养状况的方法，其中血清白蛋白是最常用的方法之一。近年来，营养不良作为癌症患者生存的预测因子的作用受到了广泛关注。因此，研究血清白蛋白是否可作为癌症患者生存的预后指标是合理的。本综述总结了所有关于术前血清白蛋白水平与不同类型癌症患者生存之间相关性的现有流行病学文献。
使用 MEDLINE 数据库（1995 年 1 月至 2010 年 6 月）进行系统文献检索，以确定关于血清白蛋白与癌症生存关系的流行病学研究。要被纳入综述，一项研究必须：发表于英文文献中；报告了收集自任何类型癌症患者的数据；将血清白蛋白作为一个或唯一的预测因素之一；将生存作为一个主要或次要的结果测量指标之一；并具有以下任何一种研究设计（病例对照、队列、横断面、病例系列前瞻性、回顾性、嵌套病例对照、生态学、临床试验、荟萃分析）。
在对胃肠道癌症进行的 29 项研究中，除了三项研究外，其余所有研究均发现，在多变量分析中，较高的血清白蛋白水平与更好的生存相关。在对肺癌进行的 10 项研究中，除了一项研究外，其余所有研究均发现，较高的血清白蛋白水平与更好的生存相关。在对女性癌症和多种癌症进行的 6 项研究中，血清白蛋白水平较低与生存不良相关。最后，在对其他癌症部位的患者进行的所有 8 项研究中，血清白蛋白水平较低与生存不良相关。
术前血清白蛋白水平为癌症提供了有用的预后意义。因此，在临床试验中，可以使用血清白蛋白水平来更好地定义癌症患者的基线风险。然而，证明因果关系的一个关键差距是缺乏临床试验证明通过静脉输注或通过全肠外营养提高白蛋白水平可以降低癌症患者死亡的超额风险。
