Hypoalbuminemia in children with cancer treated with chemotherapy
Thomas Williams McLean1, Ryan Michael Stewart1, Thomas Patrick Curley1
1Departments of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Insights
Hypoalbuminemia, low serum albumin, is common in pediatric cancer patients. Severe cases correlate with worse outcomes in certain cancer types, impacting relapse-free survival (RFS) and overall survival (OS).
Area of Science:
- Pediatric Oncology
- Clinical Chemistry
- Cancer Research
Background:
- Hypoalbuminemia is a known indicator in adult cancer patients.
- Its prevalence and prognostic value in pediatric cancer are not well-established.
- Understanding these factors is crucial for managing childhood cancers.
Purpose of the Study:
- To determine the frequency of hypoalbuminemia before chemotherapy initiation in pediatric cancer patients.
- To investigate the association between hypoalbuminemia and relapse-free survival (RFS) and overall survival (OS).
Main Methods:
- Retrospective review of 659 pediatric oncology patients diagnosed between 1998 and 2012.
- Serum albumin levels were assessed prior to chemotherapy.
- Kaplan-Meier method and Cox regression were used for survival analysis.
Main Results:
- Nearly half (45.8%) of pediatric cancer patients presented with hypoalbuminemia before chemotherapy.
- No significant difference in 5-year RFS or OS was observed between patients with and without hypoalbuminemia.
- Severe hypoalbuminemia was linked to poorer RFS and OS in hematologic/lymphatic malignancies and poorer RFS in metastatic Ewing sarcoma.
Conclusions:
- Hypoalbuminemia is a frequent finding in pediatric oncology patients.
- Severe hypoalbuminemia is associated with inferior survival outcomes in specific pediatric cancer subgroups.
Background:
Hypoalbuminemia is a well-recognized finding associated with cancer, but its prevalence and prognostic significance have not been well studied in children with cancer.
Objective:
To determine the prevalence of hypoalbuminemia prior to starting chemotherapy in children with cancer and its association with relapse-free survival (RFS) and overall survival (OS).
Design/Method:
We performed a single institution, IRB-approved, retrospective review of pediatric oncology patients diagnosed between 1998 and 2012. Five-year survival was estimated using the Kaplan-Meier method; groups were compared using Cox regression.
Results:
We identified 659 pediatric patients with a first diagnosis of cancer and a serum albumin level prior to starting chemotherapy. Mean age was 8.6 years (SD = 5.8); 62% were male and 92% were non-Hispanic. Hypoalbuminemia prior to starting chemotherapy was present at least once in 302 (45.8%). The five-year RFS and OS of those with hypoalbuminemia and without hypoalbuminemia were not significantly different. However, patients with severe hypoalbuminemia (defined as a value 10% or more below the lower limit of normal) had inferior RFS and OS for patients with hematologic/lymphatic malignancies, and inferior RFS for patients with metstatic Ewing sarcoma.
Conclusion:
Hypoalbuminemia prior to starting chemotherapy in pediatric oncology patients is common (nearly half in this cohort). Severe hypoalbuminemia was associated with inferior 5-year RFS in some subgroups.
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