The prognostic role of controlling nutritional status scores in patients with solid tumors

Liang, Ruofei; Li, Junhong; Mao, Li; Yang, Yuan; Liu, Yan‐Hui

doi:10.1016/j.cca.2017.09.021

Cited by 53 publications

(49 citation statements)

References 23 publications

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“…To the best of our knowledge, this is the first study to uncover that preoperative CONUT-CTC score is associated with tumour progression and can be considered an independent marker for better predicting the prognosis of patients with CRC treated with curative resection. The CONUT score is proposed as a blood-based marker for reflecting host immune-nutritional status [20,23], and growing evidence has shown that higher preoperative CONUT score indicates worse nutritional condition and pro-tumour immunity status [20,[22][23][24], which facilitates the migration, invasion and metastasis of tumour cells [31][32][33][34][35] and affects patients' prognosis with multiple solid tumours [21], including lung [36], liver [37], gastric [38] and colorectal cancer [22][23][24]. As a component of peripheral blood in patients with cancer, CTC was originally considered to be an important mediator of tumour recurrence and metastasis [6] and was also reported to be significantly associated with poor prognosis in a variety of malignancies [9,11,39].…”

Section: Discussionmentioning

confidence: 99%

“…It consists of three blood parameters, including the serum albumin levels, total peripheral lymphocyte counts and total cholesterol concentration, which are representative markers of protein reserves, calorie deficiency, and impaired immune defences, respectively [20]. Emerging evidence has demonstrated that CONUT score was associated with the prognosis of patients with solid tumours [21], including CRC [22][23][24]. However, the relationship between preoperative CONUT score and CTC remains unknown, and the combined use of these two indices (CONUT-CTC) for evaluating the prognosis of CRC patients treated with curative resection has not yet been explored.…”

Section: Introductionmentioning

confidence: 99%

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Combined Features Based on Preoperative Controlling Nutritional Status Score and Circulating Tumour Cell Status Predict Prognosis for Colorectal Cancer Patients Treated with Curative Resection

Yang¹,

Chen²,

Wang³

et al. 2019

Int. J. Biol. Sci.

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Background : The preoperative controlling nutritional status (CONUT) score and circulating tumour cell (CTC) status are associated with poor prognosis of colorectal cancer (CRC). The aim of the present study is to determine whether the combination of CONUT and CTC (CONUT-CTC) could better predict the prognosis of CRC patients treated with curative resection. Methods : Preoperative CONUT score was retrospectively calculated in 160 CRC patients who underwent curative resection at Zhongnan Hospital of Wuhan University from 2015 to 2017. Preoperative CTC counts were enumerated from 5 ml peripheral vein blood by a CTCBIOPSY® device. According to the preoperative CONUT and CTC status, the patients were divided into three groups: CONUT-CTC (0), CONUT-CTC (1) and CONUT-CTC (2). The relationship between CONUT score and CTC, as well as the associations of CONUT-CTC status with clinicopathological factors and survival, were evaluated. Results : Preoperatively, the number and positive rate of CTC were positively correlated with the preoperative CONUT score (P<0.01). An elevated CONUT-CTC score was significantly associated with deeper tumour invasion (P=0.025), lymphatic vessel invasion (P=0.002), venous invasion (P<0.001) and higher pTNM stage (P=0.033). Kaplan-Meier analysis and log-rank tests revealed significant decreases in recurrence-free survival (RFS) and cancer-specific survival (CSS) among CRC patients with CONUT-CTC score of 0, 1 and 2 (P<0.001). In pTNM stage-stratified analysis, high CONUT-CTC score was significantly associated with the poor (P<0.001) and CSS (P<0.001) of patients with stage III disease, but not correlated with the prognosis of patients with stage II disease (RFS: P=0.077; CSS: P<0.090). Further univariate and multivariate analyses showed that CONUT-CTC was an independent factor affecting patients' RFS [hazard ratio (HR)=2.66, 95% confidence interval (CI):1.79-3.96, P<0.001] and CSS (HR=3.75, 95%CI: 2.14-6.57, P<0.001). In time-dependent receiver operating characteristics (ROC) analyses, CONUT-CTC score had a higher area under the ROC curve (AUC) for the prediction of RFS and CSS than did preoperative CONUT score or CTC status. Conclusion : The preoperative CONUT-CTC score is associated with tumour progression and poor prognosis in patients with CRC treated with curative resection, indicating that better information on CRC prognosis could be obtained from combined preoperative host immune-nutritional status and CTC detection.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combined Features Based on Preoperative Controlling Nutritional Status Score and Circulating Tumour Cell Status Predict Prognosis for Colorectal Cancer Patients Treated with Curative Resection

Yang¹,

Chen²,

Wang³

et al. 2019

Int. J. Biol. Sci.

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“…Our analysis indicates that the appropriate cutoff value of the CONUT score to predict postoperative major complications would be between 4 and 5. Previous meta-analyses have shown the relationship between the CONUT score and long-term outcomes in patients with GI and solid tumors [7,8]; however, the number of included studies were relatively small, and the association between the CONUT score and short-term outcomes was not described. Furthermore, the clinical significance of the CONUT score for postoperative shortterm outcome was still controversial because most of the previous studies focused on long-term outcome and not on short-term outcome [12][13][14][15][16][17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 91%

“…com/doi/10.1159/000500233) [5]. Patients are divided into 4 groups according to the total score: normal (0-1), light (2-4), moderate (5)(6)(7)(8), and severe malnutrition (9)(10)(11)(12).…”

Section: Methodsmentioning

confidence: 99%

“…Assessment of the CONUT score is a feasible method, and has previously been reported to be a good method for metabolic assessments [6]. Recent evidence shows that the CONUT score is associated with poor prognosis in gastrointestinal (GI) cancers [7,8]. However, the clinical significance of the CONUT score for postoperative short-term outcomes remains controversial in the field of GI and hepatopancreatobiliary (HPB) surgical oncology.…”

Section: Introductionmentioning

confidence: 99%

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

Takagi¹,

Domagała²,

Polak

et al. 2019

Ann Nutr Metab

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The controlling nutritional status (CONUT) score is associated with prognosis in gastrointestinal (GI) cancer patients, but the clinical significance of the CONUT score for postoperative short-term outcome remains controversial. The aim of this study was to investigate the impact of the CONUT score on postoperative outcomes in patients with GI and hepatopancreatobiliary (HPB) cancers. We conducted a systematic literature search of Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. Meta-analyses were performed to estimate the pooled risk ratio (RR) for postoperative complications in patients with lower CONUT score versus higher CONUT score. Furthermore, we explored the most appropriate cutoff value of the CONUT score to predict postoperative complications. Ten retrospective studies (5,138 patients) were included in this meta-analysis. Patients with higher CONUT score had an increased risk of mortality (RR 5.38, 95% CI 2.19–13.2, p < 0.001, I² = 0%), postoperative major complications (RR 1.56, 95% CI 1.05–2.33, p= 0.03, I² = 79%), and overall complications (RR 1.38, 95% CI 1.16–1.63, p < 0.001, I² = 6%). We found that the cutoff of CONUT ≤4 vs. CONUT ≥5 had the highest pooled RR compared with other cutoff values (RR 4.79, 95% CI 0.97–23.5, p= 0.05, I² = 91%). In conclusion, the present study suggests that the preoperative CONUT score was associated with an increased risk of mortality and complications in GI and HPB surgical oncology. Patients with higher CONUT score as compared with those having a lower score had approximately a fivefold mortality risk and an increased risk up to 55% on major and overall complications after GI and HPB surgery. Our analysis indicates that the appropriate cutoff value of the CONUT score to predict postoperative major complications would be between 4 and 5. The preoperative evaluation of the CONUT score would be helpful for predicting the risk of postoperative outcomes.

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Prognostic factors in conversion surgery following nab‐paclitaxel with gemcitabine and subsequent chemoradiotherapy for unresectable locally advanced pancreatic cancer: Results of a dual‐center study

Igarashi

Yamada

Hoshino

et al. 2022

Annals of Gastroent Surgery

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Background In pancreatic ductal adenocarcinoma (PDAC), only radical surgery improves long‐term survival. We focused on surgical outcome after induction gemcitabine along with nab‐paclitaxel (GnP) and subsequent chemoradiotherapy (CRT) with S‐1 administration for unresectable locally advanced (UR‐LA) PDAC. Methods We retrospectively analyzed 144 patients with UR‐LA PDAC between 2014 and 2020. The first‐line regimen of induction chemotherapy was GnP for 125 of the 144 patients. Of the 125 patients who received GnP, 41 who underwent radical resection after additional preoperative CRT were enrolled. We evaluated the prognostic factors for this treatment strategy. Results The median length of preoperative GnP was 8.8 months, and 30 (73%) patients had normalized CA19‐9 levels. R0 resection was achieved in 36 (88%) patients. Postoperative major complications of ≥Clavien–Dindo grade IIIa developed in 16 (39%) patients. With a median follow‐up of 35.2 months, 14 (34%) patients developed distant metastasis postoperatively. Using the Kaplan–Meier method, prognostic analysis of the 41 cases revealed the 3‐y overall survival rate (OS) was 77.4% and the 5‐y OS was 58.6%. In univariate analysis, length of preoperative GnP (≥8 months), CA19‐9 normalization, and good nutritional status at operation (prognostic nutritional index ≥41.7) were significantly associated with favorable prognosis. Multivariate analysis revealed CA19‐9 normalization (hazard ratio [HR] 0.23; P = .032) and prognostic nutritional index ≥41.7 (HR 0.05; P = .021) were independent prognostic factors. Conclusion For surgical outcome after induction GnP and subsequent CRT for UR‐LA PDAC, CA19‐9 normalization and maintenance of good nutritional status during treatment until surgery were important for prolonged prognosis.

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The prognostic role of controlling nutritional status scores in patients with solid tumors

Cited by 53 publications

References 23 publications

Combined Features Based on Preoperative Controlling Nutritional Status Score and Circulating Tumour Cell Status Predict Prognosis for Colorectal Cancer Patients Treated with Curative Resection

Combined Features Based on Preoperative Controlling Nutritional Status Score and Circulating Tumour Cell Status Predict Prognosis for Colorectal Cancer Patients Treated with Curative Resection

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

Prognostic factors in conversion surgery following nab‐paclitaxel with gemcitabine and subsequent chemoradiotherapy for unresectable locally advanced pancreatic cancer: Results of a dual‐center study

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