Abstract P4-11-35: The association of serum albumin and glycated hemoglobin with all cause mortality in patients with breast cancer
Authors: Minocha Vinay N , Pal Kavita , Zaiden Robert 
Published: May 2015

Background: There has been increasing data within the oncology literature to support an inverse relationship between serum albumin levels and survival with breast cancer. Various studies have also indicated that diabetes is associated with a higher mortality in patients with breast cancer. Given the need to develop objective ways to identify patients with a poorer than expected outcome, the aim of this study is to determine whether serum albumin and glycated hemoglobin at diagnosis bears any relationship with all cause mortality in patients with all stages of breast cancer.

Methods: We performed a retrospective study of patients diagnosed with breast cancer of all stages at University of Florida Health Center, Jacksonville between August 2007 and October 2013. The data for this study was obtained from a combination of the hospital tumor registry and the electronic medical record. We collected data including age, sex, stage of cancer, histological type, tumour size and grade, lymph node status, estrogen (ER), progesterone (PR) and HER2/Neu receptor status. We collected baseline serum albumin levels and glycated hemoglobin (HbA1C) values recorded within 3 months of diagnosis of breast cancer. Wilcoxon’s rank sum test was used to test whether cancer stage differed between survival outcomes. Spearman correlation was used to assess the relationship between cancer stage and serum albumin and HbA1C at time of diagnosis. Logistic regression was used to model the impact of HbA1c, serum albumin and age at time of diagnosis on the probability of survival.

Results: The number of patients with breast cancer included in our study was 294. Of these patients, 219 patients had serum albumin values available at diagnosis and 69 patients had glycated hemoglobin values at diagnosis. The correlation between serum albumin and stage is statistically significant (P &lt; 0.0001).

Correlation between HbA1C, Serum albumin, and StageSpearman Correlation Coefficients\ P-Value\ Number of ObservationsSerum AlbuminStage -0.378 &lt;0.0001 217HbA1C0.004 0.9731 69

The negative correlation means that higher levels of serum albumin are associated with lower stages. Serum albumin at diagnosis had a significant effect on the probability of survival (p=0.0005). For every unit increase in serum albumin, the odds of survival increase (OR=4.938, 95% CI: 2.023, 12.050). Alternatively, for each unit decrease the odds of dying increase by about five fold. Hypoalbuminemia has a significant effect on survival (p=0.0020). When serum albumin is &gt;3.5, the odds of death decrease (OR=0.176 95% CI: 0.058, 0.528). Neither HbA1c nor age had a significant effect on survival (P=0.7635, 0.0858 respectively).

Odds Ratios for probability of survival  95% CI  ORLower LimitUpper Limitp-valueSerum Albumin4.9382.02312.0500.0005HbA1C1.0920.6141.9420.7635Age0.9740.9461.0040.0858

Conclusion: In the present study, a low serum albumin level at the time of diagnosis, either as a continuous or categoric variable, was significantly associated with poorer survival in patients with breast cancer. Furthermore, a lower serum albumin is associated with a higher stage of breast cancer. In contrast, glycated hemoglobin (HbA1C) at the time of diagnosis did not have a significant effect on survival.

Citation Format: Vinay N Minocha, Kavita Pal, Robert Zaiden. The association of serum albumin and glycated hemoglobin with all cause mortality in patients with breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-11-35.