The prognostic value of serum albumin in cystectomy: a systematic review and meta-analysis

OBJECTIVE: To explore the risk stratification and perioperative optimization path of albumin in perioperative period, such as giving priority to eras + nutritional support for high-risk (low albumin) patients, giving priority to urinary diversion with lower risk of complications, and strengthening postoperative monitoring and rehabilitation resource allocation. METHODS: The Cochrane Library, Embase, PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodicals Database (VIP), Chinese Biomedical Literature Service System (SinoMed), and Wanfang databases were systematically searched from the inception to 20 June 2024. We conducted this meta-analysis about the prognostic indices of survival based on hazard ratio (HR), P-value or 95% confidence interval (95%CI) obtained from univariate or multivariate Cox regression analyses. Subgroup analysis, and sensitivity analysis were also conducted. Descriptive analyses were conducted when indicators could not be used for meta-analysis. RESULTS: Five articles, including 2,631 patients undergoing cystectomy, met the inclusion criteria. The fixed effect model showed that lower serum albumin was significantly associated with worse overall survival (OS) (HR: 1.73, 95% CI 1.42-2.11, p < 0.001) and cancer-specific survival (CSS)/recurrence-free survival (RFS) (HR: 1.66, 95% CI 1.19-2.30, p = 0.003). Furthermore, subgroup analysis based on the country of study and sample size indicated that our findings were reliable. CONCLUSIONS: Our meta-analysis revealed that lower serum albumin level is associated with worse prognosis in patients undergoing cystectomy and may serve as an adjunctive marker within comprehensive prognostic models in patients with cystectomy.