Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction—a retrospective study
Background Poor nutritional status among patients with advanced stage head and neck squamous cell carcinoma (HNSCC) is common. Albumin is a common indicator of nutritional status and has been shown to be a predictor of oncological outcomes and perioperative morbidity. This study aims to determine th...
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PeerJ Inc.
2018-03-01
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| author | Ming-Hsien Tsai Hui-Ching Chuang Yu-Tsai Lin Hui Lu Wei-Chih Chen Fu-Min Fang Chih-Yen Chien |
| author_facet | Ming-Hsien Tsai Hui-Ching Chuang Yu-Tsai Lin Hui Lu Wei-Chih Chen Fu-Min Fang Chih-Yen Chien |
| author_sort | Ming-Hsien Tsai |
| collection | DOAJ |
| description | Background Poor nutritional status among patients with advanced stage head and neck squamous cell carcinoma (HNSCC) is common. Albumin is a common indicator of nutritional status and has been shown to be a predictor of oncological outcomes and perioperative morbidity. This study aims to determine the prognostic value of the serum albumin level among patients with advanced HNSCC undergoing surgery with simultaneous free flap reconstruction. Methods A total of 233 patients with advanced head and neck cancer undergoing tumor resection and immediate microvascular free flap reconstruction in a tertiary referral center were enrolled retrospectively between January 2009 and December 2011. Statistical analyses including Pearson’s chi-squared test were used to determine whether there was a significant difference between each selected clinical factors and postoperative major wound infection. Multiple regression analysis was performed to reveal the relationship between postoperative major wound infection and clinical factors. Kaplan–Meier curves and multivariate Cox regression were applied to analyse survival outcome for overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS). Results Postoperative serum albumin level (p < 0.001) and tumor location were both significantly associated with postoperative major wound infection (p = 0.018) in univariate analysis. Multiple regression analysis showed a higher risk of postoperative major wound infection among patients with postoperative hypoalbuminemia than in their counterparts (odds ratio [OR] 9.811, 95% CI [2.288–42.065], p = 0.002). Patients with a tumor located over the hypopharynx experienced increased risk of postoperative major wound infection (OR 2.591, 95% CI [1.095–6.129], p = 0.030). With respect to oncological outcomes, preoperative serum albumin level is a significant independent prognostic factor for overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS). Conclusions Postoperative hypoalbuminemia is a useful indicator for the development of postoperative complications. In addition, preoperative hypoalbuminemia is a negative prognostic factor for patients who have undergone tumor excision and free flap reconstruction for the advanced stage of HNSCC. |
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| language | English |
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| spelling | doaj.art-1e6a58755b52484e99002a312ae145da2023-12-03T11:06:25ZengPeerJ Inc.PeerJ2167-83592018-03-016e449010.7717/peerj.4490Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction—a retrospective studyMing-Hsien Tsai0Hui-Ching Chuang1Yu-Tsai Lin2Hui Lu3Wei-Chih Chen4Fu-Min Fang5Chih-Yen Chien6Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanHead and Neck Oncologic Group, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanBackground Poor nutritional status among patients with advanced stage head and neck squamous cell carcinoma (HNSCC) is common. Albumin is a common indicator of nutritional status and has been shown to be a predictor of oncological outcomes and perioperative morbidity. This study aims to determine the prognostic value of the serum albumin level among patients with advanced HNSCC undergoing surgery with simultaneous free flap reconstruction. Methods A total of 233 patients with advanced head and neck cancer undergoing tumor resection and immediate microvascular free flap reconstruction in a tertiary referral center were enrolled retrospectively between January 2009 and December 2011. Statistical analyses including Pearson’s chi-squared test were used to determine whether there was a significant difference between each selected clinical factors and postoperative major wound infection. Multiple regression analysis was performed to reveal the relationship between postoperative major wound infection and clinical factors. Kaplan–Meier curves and multivariate Cox regression were applied to analyse survival outcome for overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS). Results Postoperative serum albumin level (p < 0.001) and tumor location were both significantly associated with postoperative major wound infection (p = 0.018) in univariate analysis. Multiple regression analysis showed a higher risk of postoperative major wound infection among patients with postoperative hypoalbuminemia than in their counterparts (odds ratio [OR] 9.811, 95% CI [2.288–42.065], p = 0.002). Patients with a tumor located over the hypopharynx experienced increased risk of postoperative major wound infection (OR 2.591, 95% CI [1.095–6.129], p = 0.030). With respect to oncological outcomes, preoperative serum albumin level is a significant independent prognostic factor for overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS). Conclusions Postoperative hypoalbuminemia is a useful indicator for the development of postoperative complications. In addition, preoperative hypoalbuminemia is a negative prognostic factor for patients who have undergone tumor excision and free flap reconstruction for the advanced stage of HNSCC.https://peerj.com/articles/4490.pdfHypoalbuminemiaNutritional statusReconstructionWound infectionHospital stayPrognostic factor |
| spellingShingle | Ming-Hsien Tsai Hui-Ching Chuang Yu-Tsai Lin Hui Lu Wei-Chih Chen Fu-Min Fang Chih-Yen Chien Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction—a retrospective study PeerJ Hypoalbuminemia Nutritional status Reconstruction Wound infection Hospital stay Prognostic factor |
| title | Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction—a retrospective study |
| title_full | Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction—a retrospective study |
| title_fullStr | Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction—a retrospective study |
| title_full_unstemmed | Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction—a retrospective study |
| title_short | Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction—a retrospective study |
| title_sort | clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction a retrospective study |
| topic | Hypoalbuminemia Nutritional status Reconstruction Wound infection Hospital stay Prognostic factor |
| url | https://peerj.com/articles/4490.pdf |
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