Preoperative hypoalbuminemia and survival among patients selected for primary cytoreduction in advanced ovarian cancer: A Memorial Sloan Kettering Cancer Center Team Ovary study

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OBJECTIVE: To examine if preoperative serum albumin (SA) level is associated with worse survival following primary debulking surgery (PDS) for epithelial ovarian cancer (EOC). METHODS: In this retrospective study, we identified patients with stage III-IV EOC who underwent PDS at our institution from 1/1/2015-8/31/2022. Patients were assigned to the low albumin (LA; SA < 3.5 g/dL) or normal albumin (NA; SA ≥ 3.5 g/dL) group. Exclusion criteria included age ≥ 80 years, age 75-79 years with poor physical status or high likelihood of complex surgery, secondary malignancy, and missing preoperative SA level. Median and 5-year progression-free (PFS) and overall survival (OS) rates were calculated using Kaplan-Meier method. Log-rank test was used for categorical variables and Wald test for continuous variables. RESULTS: Overall, 636 patients were identified, 65 (10%) in the LA and 571 (90%) in the NA group. Median follow-up was 73 months (95% CI: 68-76). Comparing the LA versus NA group, 5-year PFS rate was 18.3% (95% CI: 9.2%-29.9%) vs 26.5% (95% CI: 22.6%-30.5%), respectively (P = 0.107); 5-year OS rate was 56.1% (95% CI: 41.5%-68.4%) vs 66.1% (95% CI: 61.6%-70.3%), respectively (P = 0.053). Complete gross resection (CGR) was achieved in 66% of patients with LA compared to 78% with NA (P = 0.029). On multivariate analysis of OS, age, histology, BRCA status, and CGR were statistically significant prognostic factors, but preoperative SA was not. CONCLUSIONS: Five-year survival rates were similar between patients with and without hypoalbuminemia. Relying on preoperative SA level alone, patients may be selected for neoadjuvant chemotherapy who would have equivalent survival outcomes with PDS.

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