Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction-a retrospective study

Ming-Hsien Tsai; Hui-Ching Chuang; Yu-Tsai Lin; Hui Lu; Wei-Chih Chen; Fu-Min Fang; Chih-Yen Chien

doi:10.7717/peerj.4490

Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction-a retrospective study

PeerJ. 2018 Mar 12:6:e4490. doi: 10.7717/peerj.4490. eCollection 2018.

Authors

Ming-Hsien Tsai¹, Hui-Ching Chuang^{1

2}, Yu-Tsai Lin^{1

2}, Hui Lu¹, Wei-Chih Chen^{1

2}, Fu-Min Fang^{2

3}, Chih-Yen Chien^{1

2}

Affiliations

¹ Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
² Head and Neck Oncologic Group, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
³ Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Abstract

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.

Keywords: Hospital stay; Hypoalbuminemia; Nutritional status; Prognostic factor; Reconstruction; Survival; Wound infection.

Grants and funding

This work was supported by grants nos. CORPG8F1481, CMRPG8A0961, CMRPG8D1421-3, CMRPG8C0071, CMRPG8B0971-3, CMRPG8C0071, and CMRP100-0689B, CMRPG8E1472 from Kaohsiung Chang Gung Memorial Hospital. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.