Clinical significance of preoperative albumin and alkaline phosphatase in colorectal cancer: a systematic review and meta-analysis

Objective: To investigate the association between preoperative serum levels of albumin (ALB) and alkaline phosphatase (ALP) with postoperative outcome in colorectal cancer (CRC) patients. Methods: A thorough literature search was conducted across Embase, PubMed, and Cochrane Library databases, identifying 20 eligible studies encompassing 61,296 participants. Studies were primarily observational and case-control in nature, with some randomized controlled trials also included. The random effects model was utilized to synthesize the effect sizes, while study quality was appraised using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Assessment Tool. Results: Findings revealed that CRC patients with preoperative ALB levels below 3.5 g/dl were at an elevated risk for postoperative complications (OR = 2.56, 95% CI: 2.12-3.08), increased mortality (OR = 4.54, 95% CI: 2.0210.20), and a poorer prognostic survival risk (HR = 2.09, 95% CI: 1.58-2.77). Additionally, elevated ALP levels were associated with a higher risk of poor overall survival (HR = 1.67, 95% CI: 1.44-1.94). However, publication bias was noted in some studies. Conclusion: Preoperative hypoalbuminemia and elevated ALP levels are significantly linked to adverse postoperative events and reduced survival in CRC patients, suggesting their potential as prognostic biomarkers.