The Use of Serum Albumin for Further Classification of Stage III Non–Oat Cell Lung Cancer and Its Therapeutic Implications

The use of the preadmission serum albumin level for predicting survival was evaluated in 81 patients with Stage III disease, 59 with unresectable and 22 with resectable primary tumors. A serum albumin of less than 3.4 gm/dl in a patient with unresectable Stage III disease indicates a poor prognosis with an accuracy that supersedes that obtained from a clinical assessment of the anatomical extent of disease. Seventeen of the 22 patients with resectable Stage III disease had a preadmission level of albumin of 3.4 gm/dl or greater. The median survival was 20.5 months, which was statistically longer than 9.9 months for 12 patients with unresectable Stage III M0 disease and an albumin level of 3.4 gm/dl or greater ( p < 0.05). Five of the 22 patients who underwent resection had a preadmission albumin level of less than 3.4 gm/dl. The median survival for these patients was 9.7 months compared with 20.5 months for those with a level of 3.4 gm/dl or greater. These findings suggest that resection of Stage III disease in patients with an albumin level of 3.4 gm/dl or greater prolongs survival. Another group of 5 patients with resectable Stage III disease and an albumin level of less than 3.4 gm/dl were force-fed an elemental diet while undergoing a regimen of preoperative radiation therapy. There was no improvement in survival, and 3 died of the disease prior to resection. It is concluded that the determination of the serum albumin level in patients with Stage III lung cancer has prognostic and therefore decision-making value in selecting patients for aggressive medical or surgical therapy.