Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma

Abstract

Background: Preoperative nutritional status is reportedly associated with postoperative outcomes in patients with hepatocellular carcinoma. This study aimed to investigate the significance of the controlling nutritional status (CONUT) score and the prognostic nutritional index (PNI) as predictors of postoperative outcomes. Methods: We retrospectively reviewed data from 331 patients who underwent hepatectomy for hepatocellular carcinoma between January 2007 and December 2015. Patients were divided into 2 groups based on their CONUT score and the PNI. We evaluated the effect of the CONUT score and PNI on perioperative outcomes. Multivariate analysis was performed to identify independent predictors of in-hospital mortality after hepatectomy. ­Results: The high CONUT group had a significantly higher ­incidence of 30-day mortality (p < 0.001), in-hospital mortality (p = 0.002), ascites (p = 0.006), liver failure (p = 0.02), sepsis (p = 0.01), and enteritis (p < 0.001). The low PNI group was also significantly associated with 30-day mortality (p < 0.001), in-hospital mortality (p = 0.003), liver failure (p < 0.001), sepsis (p = 0.02), enteritis (p = 0.02), and hospital stay (p = 0.01). In multivariate analyses, a high CONUT score was an independent predictor of in-hospital mortality after hepatectomy (hazard ratio [HR] 9.41, p = 0.038), but the PNI was not (HR 5.86, p = 0.08). Conclusions: Preoperative assessment of the CONUT score is helpful for evaluating patients’ nutritional status and mortality risk after liver surgery.

The Controlling Nutritional Status Score and Postoperative Complication Risk in Gastrointestinal and Hepatopancreatobiliary Surgical Oncology: A Systematic Review and Meta-Analysis

“…Three studies reported the CONUT score to be associated with an increased risk of major complications after esophagectomy (p = 0.034), colectomy (p < 0.001), and hepatectomy (p < 0.01) [13,16,19]. In contrast, no significant differences between groups were shown in 4 studies [17,18,20,21].…”

“…A total of 5,138 patients were selected for the meta-analysis, including patients with esophageal cancer [12,13], gastric cancer [14], colorectal cancer [15,16], primary liver cancer [17][18][19][20], and pancreatic cancer [21].…”

“…Regarding the cutoff value of the CONUT score, patients were divided into 2 groups depending on CONUT scores as defined in the original studies: CONUT ≤1 vs. CONUT ≥2 in one study [20], CONUT ≤2 vs. CONUT ≥3 in 2 studies [12,15], CONUT ≤3 vs. CONUT ≥4 in 4 studies [14,17,19,21], and CONUT ≤4 vs. CONUT ≥5 in 3 studies [13,16,18]. The prevalence in patients with high CONUT score ranged between 6.0 and 43.7%.…”

“…Five studies reported postoperative mortality [12,13,18,20,21]. One study showed that the high CONUT group had a significantly higher incidence of mortality after hepatectomy (p = 0.002), and was an independent predictor of mortality after hepatectomy in multivariable analyses (RR 9.41, p = 0.038) [18]. However, the other 4 studies showed no statistical differences in patients following esophagectomy, hepatectomy, and pancreatectomy [12,13,20,21].…”

“…Data regarding the overall complications (CDc ≥2) were reported in 5 studies [13][14][15][16]18]. Two studies showed significant differences between groups in patients following esophagectomy (p = 0.024) and colectomy (p = 0.002) [13,16], while 3 studies showed no significant differences in patients following gastrectomy (p = 0.133), colectomy (p = 0.81), and hepatectomy (p = 0.24) [14,15,18].…”