# Prognostic and clinical value of serum albumin, cortisol and TNF-a in treatment selection for advanced ovarian cancer patients

## TL;DR

Low serum albumin levels in advanced ovarian cancer patients are linked to worse outcomes and may influence treatment decisions, but survival differences between treatment approaches were not significant.

## Contribution

The study introduces serum albumin as a potential biomarker for treatment planning in advanced ovarian cancer patients.

## Key findings

- Low serum albumin levels correlated with reduced progression-free and overall survival in advanced ovarian cancer patients.
- Patients with low albumin had higher complication rates with primary surgery compared to neoadjuvant chemotherapy followed by surgery.
- C-reactive protein levels were higher in the low albumin group, indicating greater inflammation.

## Abstract

This study aimed to evaluate the prognostic significance of pre-treatment serum albumin levels and assess their association with clinical outcomes and surgical decisions in advanced ovarian cancer (O C) patients. Cortisol and tumour necrosis factor-alpha (TN F-a) were also measured to explore potential but secondary relationships.

A retrospective analysis was conducted on OC patients undergoing surgery at our hospital from June 2022 to June 2024 with complete clinical and pathological data. Patients were categorised into low ALB (< 35 g/L) and normal ALB (>35 g/L) groups based on pre-treatment serum ALB levels. Each group was further divided into primary debulking surgery (PDS) and neoadjuvant chemotherapy, followed by interval debulking surgery (NACT-IDS) subgroups. Clinicopathologic characteristics were analysed.

Pre-treatment serum ALB levels positively correlated with progression-free survival (PFS) (r= 0 .2 9 8 9 , P< 0.05) and overall survival (OS) (r= 0.2702, P< 0.05), with the low ALB group exhibiting significantly lower PFS and OS (P< 0.05). In the low ALB group, significant differences were observed between PDS and NACT-IDS in ascitic fluid level, R0 cytoreduction rate, postoperative complications, and length of stay (P< 0.05), though PFS and OS were comparable (P> 0.05). Similarly, in the normal ALB group, significant differences were noted in FIGO staging, ascitic fluid level, haemoglobin (HGB) levels, intra-operative haemorrhage, blood transfusion volume, R0 cytoreduction rate, and length of stay (P< 0.05), while PFS and OS remained unaffected by treatment type (P> 0.05). Additionally, C-reactive protein (CRP) levels were significantly higher in the low ALB group (6.5± 1.1 mg/L vs 5.2± 1.0 mg/L, P< 0.05), indicating greater inflammation, whereas HGB levels were substantially lower (110.4± 15.8 g/L vs 118.7± 10.5 g/L, P= 0.021), reflecting poorer nutritional status. TNF-a levels showed a non-significant upward trend (P= 0.058), while cortisol levels were similar between groups (P= 0.073).

Selecting NACT-IDS for advanced OC patients with hypoalbuminemia may help reduce the incidence of postoperative complications and improve the likelihood of achieving optimal cytoreduction. While survival outcomes (PFS and OS) did not significantly differ between treatment approaches in this study, the observed surgical benefits suggest that hypoalbuminemia could be considered a supportive factor in treatment planning. However, this indicator should be used cautiously and in conjunction with other clinical parameters until further evidence is available. The roles of TNF-a and cortisol in this context remained inconclusive and warrant further investigation.