Introduction/Background To investigate the impact of serum albumin (both at diagnosis and pre-operatively) on survival in patients undergoing cytoreductive surgery for AOC and whether any change in albumin achieved following Neoadjuvant chemotherapy (NACT) affects overall survival (OS).
Pre-operative albumin is known to be a marker of survival in AOC. However, little is known of the outcomes of hypoalbuminaemic patients after neo-adjuvant chemotherapy (NACT).
Methodology Outcomes of 441 patients who underwent cytoreduction for AOC between 16/08/2007–03/02/2014) at the Pan-Birmingham Gynaecological Cancer Centre (PBGCC) were reviewed. Albumin was recorded both at diagnosis and immediately pre-operatively. If hypoalbuminaemic at diagnosis, they were further analysed according to whether they received primary debulking (PDS) or interval debulking (IDS) with normalisation of albumin or IDS without normalisation of albumin.
Results 308 patients had a diagnosis albumin level available for analysis and 400 patients had an immediate pre-operative albumin available for analysis. For patients with a diagnosis albumin ≤35 g/L and ≥36 g/L median OS was 31.5 (95% CI 23.5–39.5) and 50.4 (95% CI 38.9–61.9) months respectively (P=0.003). On multivariate analysis (MVA) adjusting for cytoreductive outcome, stage and grade, diagnosis albumin remained statistically significant (p=0.04, Hazard ratio 1.38, 95% CI 1.01–1.89). Preoperative albumin showed a significant difference between low and normal albumin levels (p=0.003) which was not confirmed on MVA.
53% of patients hypoalbuminaemic at diagnosis achieved complete cytoreduction, of which Median OS in those undergoing PDS was 19.7 months (95% CI 11.5–27.9) months, those undergoing IDS but remained hypoalbuminaemic 27.9 Months (n=1) and those undergoing IDS with normalisation of Albumin 42.9 months (95% CI 31.5–54.3) (p>0.05).
Conclusion Hypoalbuminaemia at diagnosis is a poor prognostic factor in AOC. Normalisation of serum albumin after NACT in our exploratory analysis suggests a survival benefit which needs further investigation.
Disclosure Nothing to disclose.
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