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

PeerJ

article

Ming-Hsien Tsai¹  Hui-Ching Chuang¹  Yu-Tsai Lin¹  Hui Lu¹  Wei-Chih Chen¹  Fu-Min Fang²  Chih-Yen Chien¹ 

[1] Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine;Head and Neck Oncologic Group, Kaohsiung Chang Gung Memorial Hospital;Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine

关键词: Hypoalbuminemia;    Nutritional status;    Reconstruction;    Wound infection;    Hospital stay;    Prognostic factor;    Survival;   

DOI  :  10.7717/peerj.4490

学科分类：社会科学、人文和艺术（综合）

来源: Inra

【 摘 要 】

BackgroundPoor 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.MethodsA 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).ResultsPostoperative 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).ConclusionsPostoperative 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.

【 授权许可】

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