Low albumin levels predict worse survival for neuroendocrine tumor patients receiving peptide-based radiation therapy
In 557 neuroendocrine tumor patients receiving peptide receptor radionuclide therapy (PRRT), low albumin and elevated CRP predicted worse overall survival, while derived neutrophil-to-lymphocyte ratio did not improve prognostic accuracy.
Quick Facts
What This Study Found
Hypoalbuminemia (HR 0.91 per unit) and elevated CRP (HR 1.02 per unit) independently predicted shorter overall survival in PRRT-treated NET patients. GPS score of 2 vs. 0 had HR 3.60. Albumin was the single most valuable addition to established prognostic models, while dNLR added no value.
Key Numbers
557 patients, treated 2005-2015. Albumin HR: 0.91 per unit (95% CI: 0.87-0.95). GPS 2 vs 0 HR: 3.60 (95% CI: 2.24-5.79). CRP/albumin ratio HR: 1.84 (95% CI: 1.43-2.37). dNLR was not significant.
How They Did This
Retrospective cohort study of 557 NET patients treated with PRRT at a tertiary referral center (2005-2015), using Cox proportional hazard models and Akaike information criterion for model comparison.
Why This Research Matters
PRRT is a major peptide-based cancer therapy for neuroendocrine tumors. Identifying which patients benefit most through simple blood tests like albumin and CRP could help clinicians personalize treatment decisions and avoid exposing unlikely responders to radiation.
The Bigger Picture
This study reinforces that the inflammatory state of cancer patients—measurable through simple, inexpensive blood tests—significantly affects outcomes of peptide-based cancer therapies. Incorporating albumin and CRP into PRRT treatment planning could improve patient selection and outcome prediction.
What This Study Doesn't Tell Us
Retrospective single-center design limits generalizability. Blood markers were measured at variable time points relative to PRRT. ESR analysis was exploratory in a subset only. The study did not assess whether modifying inflammation markers could improve outcomes.
Questions This Raises
- ?Could improving albumin levels before PRRT enhance treatment outcomes?
- ?Should hypoalbuminemia be a factor in deciding whether to offer PRRT to NET patients?
- ?Would ESR outperform albumin as a prognostic marker in a prospective validation study?
Trust & Context
- Key Stat:
- HR 3.60 for GPS 2 vs 0 Patients with both low albumin and high CRP (GPS score 2) had 3.6x higher mortality risk during PRRT than those with normal values
- Evidence Grade:
- Large retrospective cohort study (n=557) with appropriate statistical methodology. Robust finding for albumin/CRP but limited by retrospective design and single-center data.
- Study Age:
- Published in 2025 using data from 2005-2015; findings are applicable to current PRRT clinical practice.
- Original Title:
- Hypoalbuminemia, but not derived neutrophil to lymphocyte ratio (dNLR), predicts overall survival in neuroendocrine tumours undergoing peptide receptor radionuclide therapy: A retrospective, cohort study of 557 patients.
- Published In:
- Journal of neuroendocrinology, 37(3), e13379 (2025)
- Authors:
- Papantoniou, Dimitrios, Fröss-Baron, Katarzyna, Garske-Román, Ulrike, Sundin, Anders, Thiis-Evensen, Espen, Grönberg, Malin, Welin, Staffan, Tiensuu Janson, Eva
- Database ID:
- RPEP-12949
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked Questions
What is peptide receptor radionuclide therapy (PRRT)?
PRRT is a targeted cancer treatment that uses radioactive molecules attached to peptides (usually somatostatin analogues) that bind to receptors on neuroendocrine tumor cells. This delivers radiation directly to the tumor while sparing surrounding tissue. It is most commonly used for advanced neuroendocrine tumors.
Why does low albumin predict worse outcomes with PRRT?
Low albumin (hypoalbuminemia) reflects poor nutritional status and systemic inflammation, both of which indicate a weaker overall health condition. Patients in a more inflamed, nutritionally depleted state may be less able to tolerate treatment and may have more aggressive disease, leading to shorter survival.
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Cite This Study
https://rethinkpeptides.com/research/RPEP-12949APA
Papantoniou, Dimitrios; Fröss-Baron, Katarzyna; Garske-Román, Ulrike; Sundin, Anders; Thiis-Evensen, Espen; Grönberg, Malin; Welin, Staffan; Tiensuu Janson, Eva. (2025). Hypoalbuminemia, but not derived neutrophil to lymphocyte ratio (dNLR), predicts overall survival in neuroendocrine tumours undergoing peptide receptor radionuclide therapy: A retrospective, cohort study of 557 patients.. Journal of neuroendocrinology, 37(3), e13379. https://doi.org/10.1111/jne.13379
MLA
Papantoniou, Dimitrios, et al. "Hypoalbuminemia, but not derived neutrophil to lymphocyte ratio (dNLR), predicts overall survival in neuroendocrine tumours undergoing peptide receptor radionuclide therapy: A retrospective, cohort study of 557 patients.." Journal of neuroendocrinology, 2025. https://doi.org/10.1111/jne.13379
RethinkPeptides
RethinkPeptides Research Database. "Hypoalbuminemia, but not derived neutrophil to lymphocyte ra..." RPEP-12949. Retrieved from https://rethinkpeptides.com/research/papantoniou-2025-hypoalbuminemia-but-not-derived
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkPeptides research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.