Almasaudi Arwa S, Dolan Ross D, Edwards Christine A, McMillan Donald C
Department of Clinical Nutrition, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life of Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK.
Cancers (Basel). 2020 Jul 21;12(7):1986. doi: 10.3390/cancers12071986.
It has long been recognized that albumin has prognostic value in patients with cancer. However, although the Global Leadership Initiative on Malnutrition GLIM criteria (based on five diagnostic criteria, three phenotypic criteria and two etiologic criteria) recognize inflammation as an important etiologic factor in malnutrition, there are limited data regarding the association between albumin, nutritional risk, body composition and systemic inflammation, and whether albumin is associated with mortality independent of these parameters. The aim of this study was to examine the relationship between albumin, nutritional risk, body composition, systemic inflammation, and outcomes in patients with colorectal cancer (CRC). A retrospective cohort study ( = 795) was carried out in which patients were divided into normal and hypoalbuminaemic groups (albumin < 35 g/L) in the presence and absence of a systemic inflammatory response C-reactive protein (CRP > 10 and <10 mg/L, respectively). Post-operative complications, severity of complications and mortality were considered as outcome measures. Categorical variables were analyzed using Chi-square test χ or linear-by-linear association. Survival data were analyzed using univariate and multivariate Cox regression. In the presence of a systemic inflammatory response, hypoalbuminemia was directly associated with Malnutrition Universal Screening Tool MUST ( < 0.001) and inversely associated with Body Mass Index BMI ( < 0.001), subcutaneous adiposity ( < 0.01), visceral obesity ( < 0.01), skeletal muscle index ( < 0.001) and skeletal muscle density ( < 0.001). There was no significant association between hypoalbuminemia and either the presence of complications or their severity. In the absence of a systemic inflammatory response ( = 589), hypoalbuminemia was directly associated with MUST ( < 0.05) and inversely associated with BMI ( < 0.01), subcutaneous adiposity ( < 0.05), visceral adiposity ( < 0.05), skeletal muscle index ( < 0.01) and skeletal muscle density ( < 0.001). Hypoalbuminemia was, independently of inflammatory markers, associated with poorer cancer-specific and overall survival (both < 0.001). The results suggest that hypoalbuminemia in patients with CRC reflects both increased nutritional risk and greater systemic inflammatory response and was independently associated with poorer survival in patients with CRC.
长期以来，人们已经认识到白蛋白对癌症患者具有预后价值。然而，尽管全球营养不良领导倡议（GLIM）标准（基于五项诊断标准、三项表型标准和两项病因标准）将炎症视为营养不良的一个重要病因，但关于白蛋白、营养风险、身体成分与全身炎症之间的关联，以及白蛋白是否独立于这些参数与死亡率相关的数据有限。本研究的目的是探讨白蛋白、营养风险、身体成分、全身炎症与结直肠癌（CRC）患者预后之间的关系。进行了一项回顾性队列研究（n = 795），根据全身炎症反应（C反应蛋白，CRP分别> 10和< 10 mg/L）的有无，将患者分为正常白蛋白组和低白蛋白血症组（白蛋白 < 35 g/L）。术后并发症、并发症严重程度和死亡率被视为观察指标。分类变量采用卡方检验χ²或线性-by-线性关联分析。生存数据采用单因素和多因素Cox回归分析。在存在全身炎症反应的情况下，低白蛋白血症与营养不良通用筛查工具（MUST）直接相关（P < 0.001），与体重指数（BMI，P < 0.001）、皮下脂肪含量（P < 0.01）、内脏肥胖（P < 0.01）、骨骼肌指数（P < 0.001）和骨骼肌密度（P < 0.001）呈负相关。低白蛋白血症与并发症的发生或严重程度之间无显著关联。在不存在全身炎症反应的情况下（n = 589），低白蛋白血症与MUST直接相关（P < 0.05），与BMI（P < 0.01）、皮下脂肪含量（P < 0.05）、内脏脂肪含量（P < 0.05）、骨骼肌指数（P < 0.01）和骨骼肌密度（P < 0.001）呈负相关。独立于炎症标志物，低白蛋白血症与较差的癌症特异性生存率和总生存率相关（均P < 0.001）。结果表明，CRC患者的低白蛋白血症既反映了营养风险增加，也反映了全身炎症反应增强，并且与CRC患者较差的生存率独立相关。
