Prognostic value of serum albumin recovery in pediatric cancer patients: insights into cancer-cachexia and survival outcomes

Hypoalbuminemia and cancer cachexia predict poor survival in adult cancers, with limited studies in pediatrics. Also, the serial recovery kinetics of serum albumin and its effect on cancer outcomes are unknown. This study investigated trends and determinants of serum-albumin at various time points of therapy and their influence on 3-year survival of pediatric cancers. It included cancer patients below 18yrs. Baseline systemic symptoms, stage/risk-group, nutritional status and serum-albumin at baseline, 3-months, 6-months and 12-months were recorded from hospital database along with outcomes like relapse/death and toxicity. Among 402 patients, hemato-lymphoid cancers (57.71%)were more common. Prevalence of hypoalbuminemia at baseline, 3 m, and 6 m was 46.52%, 26.45% and 22.0%, respectively. Patients with hypoalbuminemia at baseline (HR = 2.1; <i>p</i> = 0.000), 3 m (HR = 2.28; <i>p</i> = 0.000), or 6 m (HR = 2.02; <i>p</i> = 0.001) had lower overall-survival (OS) in univariate analysis, while on multivariate analysis, only risk group (HR = 1.74; <i>p</i> = 0.009) and 6 m albumin (HR = 3.33; <i>p</i> = 0.001) independently predicted OS. For event-free-survival (EFS) risk-group (HR = 1.59; <i>p</i> = 0.018) and 6 m-albumin (HR = 2.91; <i>p</i> = 0.001) were the only independent predictors. Out of various predictors of serum albumin, systemic-symptoms (OR = 8.01, <i>p</i> = 0.008) and baseline-malnutrition (OR = 2.08; <i>p</i> = 0.004) independently predicted baseline-hypoalbuminemia. Organomegaly measured as liver/spleen size(r=-0.39) and systemic inflammation measured as serum-globulin (r=-0.37) had negative correlation with baseline-albumin. In contrast, 6-month albumin was dependent only on baseline systemic symptoms (OR = 5.28; <i>p</i> = 0.007) and independent of baseline malnutrition (OR = 1.72; <i>p</i> = 0.091). We conclude that while baseline albumin is influenced by multiple factors, such as malnutrition, systemic symptoms, inflammatory state (hypergammaglobulinemia), and disease bulk (organomegaly), 6-month albumin is independent of baseline malnutrition and serves as a better predictor of the cancer-inflammation-cachexia-cascade and ultimate survival.