Prognostic Value of Controlling Nutritional Status Score in Advanced Hypopharyngeal Cancer

Abstract

ObjectiveThe purpose of this study was to investigate the prognostic significance of the preoperative controlling nutritional status (CONUT) score in patients with resectable advanced hypopharyngeal cancer.MethodsThis retrospective study included 113 advanced hypopharyngeal cancer patients who underwent curative resection in our hospital from 2013 to 2017. The association between the CONUT score and clinicopathological variables was evaluated. The association between CONUT score and survival was analyzed using Kaplan–Meier survival curves and Cox regression. The efficacy of the CONUT score and other immune‐nutritional markers to predict prognosis was compared using a time‐dependent receiver operating characteristic (ROC).ResultsPatients were divided into the high‐CONUT score group (≥3) and the low‐CONUT score group (≤2) according to ROC analysis. The CONUT score was associated with body mass index (p = 0.047), monocyte (p = 0.021), pharyngocutaneous fistula (p = 0.045), flap repairment (p = 0.034), tumor (T) classification (p = 0.034), node (N) classification (p = 0.036), subsite of tumor (p = 0.035), and negative pathologic factors (p < 0.001). Tumor, node, metastasis (TNM) stage, negative pathologic factors, adjuvant radiotherapy, postoperative chemoradiotherapy, and CONUT score were independent prognostic factors for survival. Patients with a higher CONUT score had worse overall survival (OS) (hazard ratio: 2.76, 95% confidence interval [CI]: 1.44–5.29, p = 0.002) and disease‐free survival (hazard ratio: 2.51, 95% CI: 1.28–4.91, p = 0.007). The area under the curve of the CONUT score (0.799) to predict 5‐year OS was greater than those of Preoperative Nutritional Index (0.769), platelet‐to‐lymphocyte ratio (0.643), neutrophil‐to‐lymphocyte ratio (0.565), and lymphocyte‐to‐monocyte ratio (0.577).ConclusionThe CONUT score is a prognostic marker for patients with resectable advanced hypopharyngeal cancer.Level of Evidence3 Laryngoscope, 133:2613–2620, 2023

Chemotherapy following immune checkpoint inhibitors in recurrent or metastatic head and neck squamous cell carcinoma: clinical effectiveness and influence of inflammatory and nutritional factors

“…The CONUT score is a nutritional scoring tool used to screen and identify hospitalized patients with malnutrition [ 34 ]. This score, calculated from serum albumin, total lymphocyte count, and total cholesterol, has recently emerged as a tool to assess the nutritional and immunological status of patients with malignancies [ 18 , 21 , 53 ]. The PNI, which is calculated based on the serum albumin concentration and peripheral blood lymphocyte count, is a nutritional scoring tool that is used to assess the nutritional and immune status of patients with cancer [ 19 ].…”

“…The neutrophil-to-lymphocyte ratio (NLR) is a well-known prognostic factor for head and neck cancer [ 26 ]. Furthermore, various factors that can be easily assessed through blood tests, including the platelet to lymphocyte ratio (PLR) [ 27 , 28 ], lymphocyte to monocyte ratio (LMR) [ 29 ], systemic immune-inflammation index (SII) [ 30 , 31 ], C-reactive protein (CRP) to albumin ratio (CAR) [ 32 , 33 ], controlling nutritional status (CONUT) score [ 18 , 34 ], prognostic nutrition index (PNI) [ 23 , 35 ], prognostic index (PI) [ 36 ], and the Glasgow Prognostic Score (GPS) [ 17 ], have been identified as valuable indicators for predicting the prognosis of individuals undergoing treatment for head and neck cancer [ 27 , 28 , 32 , 33 , 37 ]. However, it is unclear whether they are helpful in subsequent chemotherapy following ICI for RMHNSCC.…”

Prognostic and clinicopathological significance of the Controlling Nutritional Status (CONUT) score in patients with lymphoma: a meta-analysis

“…The CONUT system was first proposed in 2005 by Ignacio et al 15 and initially used as a screening approach to evaluating patients’ nutritional status. Additionally, CONUT is a significant prognostic factor in various types of cancer, such as breast cancer,16 hepatocellular carcinoma,17 urothelial carcinoma,18 colorectal cancer,19 hypopharyngeal cancer20 and prostate cancer 21. The legitimacy of using CONUT scores while predicting the prognosis of lymphoma cases has been widely investigated but no consistent results can be obtained 22–28.…”

Prognostic Value of Inflammatory and Nutritional Biomarkers of Immune Checkpoint Inhibitor Treatment for Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck

“…However, most of these biomarkers are research-based and unsuitable for clinical application. By contrast, several inflammatory and nutritional biomarkers have been reported to be associated with prognosis [ 13 , 14 , 15 , 16 , 17 ]. In particular, the neutrophil-to-lymphocyte ratio (NLR) is a well-known biomarker that has been reported to be an independent prognostic factor in head and neck cancer [ 18 ].…”

“…In particular, the neutrophil-to-lymphocyte ratio (NLR) is a well-known biomarker that has been reported to be an independent prognostic factor in head and neck cancer [ 18 ]. In addition, many inflammatory and nutritional biomarkers that can be easily measured from blood tests, such as the platelet-to-lymphocyte ratio (PLR) [ 19 , 20 ], lymphocyte-to-monocyte ratio (LMR) [ 21 ], systemic immune-inflammation index (SII) [ 22 , 23 ], CRP-to-Alb ratio (CAR) [ 24 , 25 ], the controlling nutritional status (CONUT) score [ 14 , 26 ], prognostic nutrition index (PNI) [ 27 , 28 ], prognostic index (PI) [ 29 ], and the Glasgow Prognostic Score (GPS) [ 13 ], have been reported to be useful for predicting prognosis after treatment in head and neck and other cancers [ 19 , 20 , 24 , 25 , 30 ]. However, it is unclear which biomarkers best predict prognosis after ICI treatment, and their prognostic value in RMHNSCC has not been thoroughly investigated.…”