Prognostic Value of Change in Albumin and Body Mass Index during and after Definitive Radiotherapy in Patients with Locally Advanced Cervical Cancer

Abstract

<h3>Purpose/Objective(s)</h3> Definitive radiotherapy (RT) is the standard treatment in patients with locally advanced cervical cancer (LACC). Many studies have shown that in addition to the intrinsic characteristics of the tumor, there are many other factors can also affect the prognosis, such as baseline nutritional and inflammation status. However, which of these factors, or their alterations during radiotherapy, has a greater impact on prognosis is unclear on survival is unknown. Therefore, the purpose of this study was to observe changes in these factors during RT and to evaluate the prognostic impact of these factors and their changes in clinical practice. <h3>Materials/Methods</h3> A total of 229 patients were involved in this retrospective study. All patients received definitive RT at a single institution. Clinical pathological characteristics and eight inflammatory and nutritional factors (albumin, weight, Body Mass Index (BMI), neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, etc.) of patients were collected at pre-, during and post-radiation. Changes in those parameters at different radiotherapy periods were evaluated, and the association between those parameters and their changes with progression-free survival (PFS) and overall survival (OS) were assessed at 3 years. <h3>Results</h3> The median follow-up periods were 42.3 months for all patients. During RT, almost all the parameters reduced significantly, and after RT, albumin levels returned to pre-treatment levels, but the body weight was further significantly reduced compare with that during RT (p < 0.001). In univariate analysis, neither baseline nutritional nor inflammatory factor levels were shown to be associated with prognosis, whereas changes in albumin and body weight during RT were associated with prognosis. In multivariate analysis, non-SCC (HR 2.747 for PFS, <i>p</i> =0.016; HR 2.983 for OS, p=0.016), a decrease >0.2kg/m² in BMI during and post RT (HR 2.595 for PFS, <i>p</i> <0.001; HR 2.579 for OS, <i>p</i> =0.002), and albumin <35g/L (defined as hypoalbuminemia) during RT (HR 2.208 for PFS, <i>p</i> =0.004; HR 2.069 for OS, <i>p</i> =0.021), were independent predictors of poor prognosis for both PFS and OS, ranking with gradually decreased hazard ratios. Hypoalbuminemia during RT was more common in patients with older age, lower baseline hemoglobin and albumin levels, BMI <25kg/m², concurrent chemotherapy with weekly cisplatin and higher incidence of diarrhea during treatment. However, the decrease in BMI during and post RT showed no significant association with patients' baseline characteristics. <h3>Conclusion</h3> Changes in albumin and BMI during or after RT showed more prognostic value than their baseline levels or other hematological and inflammatory parameters in LACC. Therefore, prevention of hypoalbuminemia during RT and maintenance of BMI in the middle and later stages of RT are the management priorities in the clinical practice of LACC.