Controlling nutritional status (CONUT) score as a preoperative risk assessment index for older patients with colorectal cancer

Controlling nutritional status score as a survival prognosticator in patients with head and neck cancer

PURPOSE

This study aimed to evaluate the prognostic significance of the preoperative Controlling Nutritional Status (CONUT) score in head and neck squamous cell carcinoma (HNSCC).

METHODS

Patients with HNSCC who underwent radical surgery between 2008 and 2017 were retrospectively analyzed and randomly divided into training and validation cohorts by 3:1 ratio. The CONUT score, based on serum albumin, total cholesterol, and lymphocyte count measured within 1 week before surgery, was used. Univariate and multivariate Cox regression identified survival-related variables, forming the basis for predictive models developed in the training cohort and validated in the validation cohort.

RESULTS

A total of 636 patients were enrolled in this study, including 477 patients in the training cohort and 159 patients in validation cohort. A CONUT cutoff value of 2 effectively stratified patients into two distinct prognostic groups with significant survival differences in both the training and validation cohorts. In the multivariate Cox model, a high CONUT score emerged as an independent negative prognosticator of overall survival (OS) and cancer specific survival (CSS) in both training and validation cohorts. The CONUT score-based nomograms accurately predicted OS (concordance index: 0.778 in training cohort and 0.709 in validation cohort) and CSS (concordance index: 0.830 in training cohort and 0.778 in validation cohort).

CONCLUSION

The preoperative CONUT score is a useful prognostic marker for surgically treated HNSCC, enhancing nomogram-based risk models to identify high-risk patients and guide treatment decisions effectively.

The association between controlling nutritional status and postoperative pulmonary complications in patients with colorectal cancer

Background

Postoperative pulmonary complications (PPCs) significantly impact surgical outcomes, and Controlling Nutritional Status (CONUT) score, a simple and easily available nutritional score, has been demonstrated to be significantly associated with postoperative patient outcomes and complications, including PPCs. However, there are few studies that specifically focus on patients undergoing radical surgery for colorectal cancer (CRC).

Methods

We retrospectively analyzed the clinical data of 2,553 patients who underwent radical surgery for CRC at the Sixth Affiliated Hospital of Sun Yat-sen University. Patients were divided into three groups: normal nutrition group (CONUT≤1), mild malnutrition group (2 ≤ CONUT≤4), and moderate-to-severe malnutrition group (CONUT≥5). Risk factors for PPCs and all-cause mortality were evaluated by multivariate regression. In addition, we assessed surgical outcomes including ICU admission, hospital stay, 1-year mortality and tumor-related mortality.

Results

The incidence of PPCs was 9.0% (n = 230). Multiple regression showed that the higher the CONUT score, the higher the risk of PPCs (mild malnutrition group vs. normal nutrition group, OR: 1.61, 95% CI: 1.18-2.20, p = 0.003; moderate-to-severe malnutrition group vs. normal nutrition group, OR: 2.41, 95% CI: 1.51-3.84, p < 0.001). All-cause mortality was significantly higher in moderate-to-severe malnutrition group than that in normal nutrition group, HR: 1.88, (95% CI: 1.34-2.62, p < 0.001). Older age, male sex, chronic heart disease, open surgery, blood transfusion during surgery, distant metastasis of tumor and colon tumor were all risk factors for PPCs. Furthermore, the malnutrition groups had poor surgical outcomes including postoperative pneumonia (mild vs. normal nutrition, OR: 1.64, 95% CI: 1.07-2.52, p = 0.024; moderate-to-severe vs. normal nutrition, OR: 2.51, 95% CI: 1.36-4.62, p = 0.00), ICU admission (mild vs. normal nutrition, OR: 2.16, 95% CI: 1.31-3.56, p = 0.002; moderate-to-severe vs. normal nutrition, OR: 3.86, 95% CI: 2.07-7.20, p < 0.001), hospital stay ≥14 days (mild vs. normal nutrition, OR: 1.30, 95% CI: 1.08-1.56, p = 0.006) and 1-year mortality (mild vs. normal nutrition, HR: 1.65, 95% CI: 1.11-2.46, p = 0.014; moderate-to-severe vs. normal nutrition, HR: 2.27, 95% CI: 1.28-4.02, p = 0.005).

Conclusion

The preoperative CONUT score is a potential indicator for predicting PPCs and surgical outcomes in CRC patients.

Association of Methylenetetrahydrofolate Reductase Gene rs1801133 Polymorphism and Controlling Nutritional Status (CONUT) Score with Colorectal Cancer Susceptibility

Background

Susceptibility to some cancers is linked to methylenetetrahydrofolate reductase (MTHFR) polymorphisms and the Controlling Nutritional Status (CONUT) score in some populations. However, their relationship with susceptibility to colorectal cancer (CRC) susceptibility in the Hakka Chinese population remains unclear.

Methods

In total, 620 CRC patients and 734 controls were enrolled. MTHFR rs1801133 was genotyped, medical records (age, sex, smoking history, alcohol consumption, hypertension, diabetes mellitus, and family history of cancer, and blood cell parameters) were collected, and the relationship between this information and CRC susceptibility was analyzed.

Results

There were significant differences in the distribution of CONUT classification (p=0.002), and proportions of history of smoking (p<0.001), hypertension (p<0.001), diabetes mellitus (p<0.001), and family history of cancer (p=0.002) between patients and controls. There were statistically significant differences in MTHFR rs1801133 genotypes distribution (58.7% C/C, 35.5% C/T, and 5.8% T/T in patients vs 65.5%, 31.2%, and 3.3% in controls, p=0.010) and allele distribution (76.5% C, and 23.5% T allele in patients vs 81.1%, and 18.9% in controls, p=0.003) between patients and controls. Logistic regression analysis indicated that non-normal CONUT range (non-normal vs normal, odds ratio (OR): 1.451, 95% confidence interval (CI): 1.119-1.882, p=0.005), and MTHFR rs1801133 variant (C/T + T/T vs C/C, OR: 1.373, 95% CI: 1.091-1.728, p=0.007), older age (≥65 vs <65 years, OR: 1.298, 95% CI: 1.023-1.646, p=0.032), male sex (OR: 1.354, 95% CI: 1.067-1.718, p=0.013), and history of alcohol drinking (OR: 2.232, 95% CI: 1.164-4.282, p=0.016) were independently associated with CRC risk.

Conclusion

Individuals carried MTHFR rs1801133 variant and with non-normal CONUT range, advanced age, history of alcohol consumption may be at increased CRC risk in the Hakka population.

Comorbidity assessment methods and their significance in predicting the results of treatment of older patients undergoing elective abdominal surgeries for cancer - A scoping review

INTRODUCTION

The scoping review was performed to identify methods of comorbidity assessment and to evaluate their significance in predicting the results of treatment of older patients undergoing elective abdominal surgeries for cancer.

MATERIALS AND METHODS

Ovid MEDLINE, Embase, CENTRAL, Web of Science, ClinicalTrials.gov and European Trials Register were searched for eligible studies investigating the impact of comorbidity on various postoperative outcomes of patients aged ≥65. Findings were narratively reported.

RESULTS

The review identified 40 studies with a total population of 59,612 patients, using eight different methods of comorbidity assessment. The most used was Charlson Comorbidity Index (60 % of studies) and presence of specific comorbid conditions (38 %). No study provided rationale for the choice of specific comorbidity measure. Most of the included studies reported short-term results (75 %), such as postoperative complications (43 %) and mortality (18 %) as main clinical endpoint. The results were inconsistent across the studies.

DISCUSSION

There is still no consensus regarding the choice of comorbidity measures and their role in postoperative outcome prediction. Further efforts are needed to develop new, well-designed, more effective comorbidity assessments tools.

Prognostic Value of the Controlling Nutritional Status (CONUT) Score in Patients Who Underwent Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy

The Controlling Nutritional Status (CONUT) score is a novel nutritional index that integrates the serum albumin level, peripheral blood lymphocyte count, and total cholesterol level. This retrospective study explores its prognostic significance in patients undergoing cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). We included 436 patients who underwent CRS-HIPEC, categorized into low (0-3) and high (4-12) CONUT score groups, and performed logistic regression analysis to predict one-year mortality and postoperative morbidity. Our findings revealed that high CONUT scores correlate with increased one-year mortality (47.1% vs. 20.3%, p < 0.001) and morbidity (39.2% vs. 18.2%, p < 0.001) compared to low CONUT scores. Multivariable regression analysis confirmed high CONUT scores as independent predictors of one-year mortality (odds ratio: 2.253, 95% CI: 1.014-5.005, p = 0.046) and postoperative morbidity (odds ratio: 2.201, 95% CI: 1.066-4.547, p = 0.033). These results underscore the CONUT score's effectiveness as an independent marker for evaluating risks associated with CRS-HIPEC, emphasizing its potential to improve risk stratification.

An Analysis of Preoperative Inflammatory Indicators That Influence the Drainage Tube Retention Time in Patients with Breast Cancer Surgery

Objective

The study was aimed to investigate the influence factor between preoperative inflammatory indicators and drainage tube retention time in patients with breast cancer.

Methods

This retrospective study enrolled 121 patients with breast cancer who were undergoing surgery between October 2020 and June 2021. The enumeration data were used the Chi-square test, and the measurement data were used the t-test analysis. The univariate and multivariate logistic regression models were performed to access the risk factors for affecting drainage tube retention time in patients with breast cancer. The receiver operating characteristic curve (ROC) was performed to test the prediction effect of the model.

Results

Through the median extraction time of postoperative drainage tube retention time, all patients were divided into two groups: drainage tube retention time (DTRT) < 13 (d) and drainage tube retention time (DTRT) ≥ 13 (d). The results showed that type of surgery, total lymph nodes (TLN), pathological T stage, NLR were related to the drainage tube retention time (P<0.05). Moreover, the univariate and multivariate logistic regression analysis performed that Hb, type of surgery, pathological T stage, chest wall drainage tube, NRI were the independent risk predictors of affecting drainage tube retention time. Furthermore, a significant correlation existed between NRI and drainage tube retention at different times (P < 0.05).

Conclusion

NRI is an independent risk factor for postoperative drainage tube extraction time and can effectively predict the probability of drainage tube retention time. Thus, it can also provide personalized nursing intervention for patients with breast cancer after drainage tube retention time and the rehabilitation process.

The impact of comorbidity on the diagnosis delay, treatment options and prognosis for advanced oral cancer: A retrospective result of the POROMS database

This study aimed to reveal the underlying mechanisms linking advanced oral squamous cell carcinoma (OSCC) with its comorbidities. Data extracted from the POROMS database included 448 advanced OSCC patients in stage III or IV (AJCC 8th) with primary tumors between August 2015 and August 2021. Time to diagnosis delay increased from 4.5, 5.3-6.5 months when the Adult Comorbidity Evaluation-27 (ACE-27) worsened from none, mild (RR: 1.155, 1.043-1.279; P = 0.006) to moderate-severe (RR: 1.431, 1.251-1.636; P < 0.001). With the number of comorbidities increased from 0, 1-2 (RR: 1.188, 1.078-1.310; P = 0.001) to 3 (RR: 1.563, 1.296-1.885; P < 0.001), the time to diagnosis delay increased from 4.5, 5.4-7.1 months. As the level and number of comorbidities increased, the likelihood of treatment completion gradually declined, especially in those older than 65 years (P = 0.003). The presence of comorbidity was an independent prognostic factor for disease-free survival (HR: 1.431, 1.022-2.005; P = 0.037). Comorbidities may lead to poorer prognosis by directly causing delays in diagnosis, limiting treatment options, and increasing the risk of death in advanced OSCC patients.

The prognostic value of the controlling nutritional status (CONUT) score in predicting outcomes of esophageal cancer patients receiving radiotherapy with or without chemotherapy

Background

Controlling nutritional status (CONUT) scores and systemic immune-inflammation index (SII) values are associated with the prognosis of several common malignancies. The current study aimed to explore the prognostic value of CONUT scores and SII values in patients with esophageal cancer (EC) receiving radical radiotherapy (RT) or concurrent chemoradiotherapy (CCRT).

Methods

We calculated the pre-RT CONUT scores and SII values of 62 patients with EC receiving RT or CCRT. Receiver operating characteristic (ROC) curves were used to determine the adequate cut-off values. The Kaplan-Meier method and Cox proportional hazard model were used to analyze the association between CONUT scores and SII values and prognosis.

Results

The 1-year progression-free survival (PFS) and 1-year overall survival (OS) rates of the 62 patients were 51.61% and 66.13%, respectively. Based on the time-dependent ROC curve for the 1-year OS of all patients, the optimal cut-off value was 622.02 for the SII and a score of 1 for the CONUT score. The univariate analysis showed that the CONUT score (P=0.036), tumor-nodal-metastasis (TNM) stage (P<0.01), and CCRT (P=0.008) significantly affected the survival of EC patients. The multifactorial analysis showed that the CONUT score (P=0.041) and TNM stage (P<0.01) were independent prognostic factors affecting clinical outcomes in patients with EC undergoing radical RT or CCRT.

Conclusions

The pre-RT CONUT score could be an effective predictor of prognosis in patients with EC receiving radical RT or CCRT; however, the pre-RT SII value had no clinical value in predicting survival in our study.

Idiopathic Epiretinal Membrane Surgery in Patients Aged Over 80 Years: Efficacy and Safety

Purpose

To evaluate the efficacy and safety of idiopathic epiretinal membrane (ERM) surgery in patients aged over 80 years.

Methods

Consecutive patients who underwent pars plana vitrectomy (PPV) combined with ERM and internal limiting membrane (ILM) peeling with retrobulbar anesthesia were recruited. Based on age, the patients were divided into the elderly group (≥ 80 years of age) and the control group (< 80 years of age). The best-corrected visual acuity (BCVA) and surgical complications were regarded as the main measurement indicators.

Results

This study included 43 eyes from 43 patients aged 80 to 91 years and 86 eyes from 86 patients aged 54 to 79 years. Surgical intervention substantially improved BCVA both in the elderly and control groups (p = 0.005 and p < 0.001, respectively). Statistical analyses showed no significant difference in the incidence of surgical complications between the two groups (p = 0.631). The operations in either group were not delayed or canceled for the reason of complications of retrobulbar anesthesia, severe anxiety, or physical discomfort in the perioperative period. Moreover, no patient required a second operation. Also, no stroke, myocardial infarction, or death occurred during the follow-up period. All the surgical complications were treated satisfactorily.

Conclusion

Our outcomes indicate that PPV combined with ERM and ILM peeling with retrobulbar anesthesia is effective and safe in elderly patients aged 80 years or older. Based on age alone, we believe that advancing age should not be the risk factor for idiopathic ERM surgery.

Prognostic Value of Preoperative Controlling Nutritional Status in Hypopharyngeal Cancer Patients Undergoing Surgery-Oriented Comprehensive Treatment

OBJECTIVES

The preoperative controlling nutritional status (pCONUT) score has been shown correlated with the prognosis of some cancerous diseases; however, little is known about the effect of pCONUT score on hypopharyngeal cancer (HPC). Therefore, the objective of our study was to demonstrate the relationship between the pCONUT score and the clinical outcome of patients with HPC.

PATIENTS AND METHODS

Ninety-four patients with HPC who underwent surgery between May 2012 and Dec 2020 were enrolled in this study. We evaluated retrospectively their pCONUT scores and calculated the cutoff value regarding the patients' overall survival using the X-tile software. Kaplan-Meier and Cox proportional hazard regression model were used to determine how the pCONUT score affected overall survival.

RESULTS

A cutoff level of 4 was determined to be optimal for the pCONUT score, by which the patients were grouped into high pCONUT score (≥4, n = 22, 23.4%) or low pCONUT score (<4, n = 72, 76.6%) groups. The univariate analysis showed that high pCONUT scores correlated with reduced overall survival (hazard ratio: 2.925, 95% confidence interval: 1.526-5.607, P = .001). Furthermore, the multivariate analysis also showed that high pCONUT scores increased the risk of overall death (hazard ratio: 2.639, 95% confidence interval: 1.365-5.101, P = .004).

CONCLUSIONS

The pCONUT score is considered a useful prognostic factor in patients with HPC.

Impact of the Controlling Nutritional Status (CONUT) score as a prognostic factor for all-cause mortality in older patients without cancer receiving home medical care: hospital ward-based observational cohort study

OBJECTIVES

Malnutrition in cancer-free older patients receiving home medical care may affect prognosis, but indicators of long-term nutrition-related prognosis have not been developed. This study investigated the utility of the Controlling Nutritional Status (CONUT) score as a prognostic factor for older patients without cancer receiving home medical care.

DESIGN

This was a single-centre, hospital ward-based observational cohort study.

SETTING AND PARTICIPANTS

In total, 625 cancer-free older patients (median age, 81.0 years; 47.4% males) receiving continuous home medical care through clinics were enrolled on admission to a hospital ward from March 2011 to September 2018.

PRIMARY OUTCOME MEASURES

Continuous cumulative survival curves were obtained using the Kaplan-Meier method after dividing the CONUT score into four groups. The prognostic factors for overall mortality were evaluated using the Cox proportional hazards model. Comparisons with other predictive tools were performed.

RESULTS

The Kaplan-Meier curves of CONUT scores revealed a stepwise shortening of the median survival time with increasing scores. The HR of CONUT scores adjusted by age, sex and other confounding variables was 1.422 (95% CI 1.232 to 1.643, p<0.001). The areas under the receiver operating characteristic curve of the CONUT score for 1-year and 5-year survival were 0.684 and 0.707, respectively. The CONUT score displayed greater predictive utility than other nutrition-related predictive tools.

CONCLUSIONS

The CONUT score on hospital admission could be used to predict overall mortality in older patients without cancer receiving home medical care. It is expected to be a simpler and cheaper screening tool for assessing the nutritional status in the field of home medical care.

Preoperative controlling nutritional status score predicts systemic disease recurrence in patients with resectable biliary tract cancer

INTRODUCTION

This study aimed to evaluate the association between the preoperative Controlling Nutritional Status (CONUT) score, survival outcomes, and recurrence pattern in patients with resectable biliary tract cancer (BTC).

METHODS

A total of 224 BTC patients (gallbladder, n = 69; intrahepatic bile ducts, n = 26; perihilar bile ducts, n = 72; distal bile duct, n = 57) who underwent surgery with curative intent were enrolled. The best cutoff point of the preoperative CONUT score in discriminating survival was determined using χ2 scores. The sites of recurrence were subclassified as locoregional or distant.

RESULTS

Patients were subdivided into the CONUT-low (score ≤ 3, n = 156) and the CONUT-high (score > 3; n = 68) groups. In-hospital mortality occurred more frequently in the CONUT-high group than in the CONUT-low group (7.4% vs. 1.3%; p = 0.028). A high preoperative CONUT score was independently associated with worse overall survival (hazard ratio [HR] 1.906, p = 0.001), worse disease-specific survival (HR 1.840, p = 0.006), and worse recurrence-free survival (HR 1.680, p = 0.005). Recurrence developed in 110 (49.1%) patients. A high preoperative CONUT score was independently associated with a higher risk of distant recurrence (HR 2.245, p = 0.001), but not locoregional recurrence. The incidences of distant recurrence at 5 years were 55.4% and 34.2% in the CONUT-high and CONUT-low groups, respectively (p = 0.001).

CONCLUSIONS

The preoperative CONUT score independently predicts survival outcomes and may serve as a surrogate marker of aggressive systemic disease recurrence in patients with resectable BTC.

Risk of non-colorectal cancer-related death in elderly patients with the disease: A comparison of five preoperative risk assessment indices

BACKGROUND

A considerable number of elderly patients with colorectal cancer (CRC) die of non-CRC-related causes. The Controlling Nutritional Status (CONUT) score, American Society of Anesthesiologists Physical Status classification, Charlson Comorbidity Index, National Institute on Aging, and National Cancer Institute Comorbidity Index, and Adult Comorbidity Evaluation-27 score are all known predictors of survival in patients with CRC. However, the utility of these indices for predicting non-CRC-related death in elderly CRC patients is not known.

METHODS

The study population comprised 364 patients aged 80 years or more who received curative resection for stage I-III CRC between 2000 and 2016. The association of each index with non-CRC-related death was compared by competing-risks analysis such as the cumulative incidence function and proportional subdistribution hazards regression analysis as well as time-dependent receiver-operating characteristic (ROC) analysis.

RESULTS

There were 85 deaths (40 CRC-related and 45 non-CRC-related) during a median observation period of 53.2 months. Cumulative incidence function analysis identified CONUT score as the most suitable for risk stratification for non-CRC-related death. In proportional subdistribution hazards regression, risk of non-CRC-related death increased significantly as CONUT score worsened (2/3/4 vs. 0/1, hazard ratio 1.73, 95% confidence interval [CI] 0.91-3.15; ≥5 vs. 2/3/4, hazard ratio 2.71, 95% CI 1.08-6.81). Time-dependent ROC curve analysis showed that CONUT score were consistently superior to other indices during the 5-year observation period.

CONCLUSIONS

The majority of deaths in elderly patients with CRC were not CRC-related. CONUT score was the most useful predictor of non-CRC-related death in these patients.

Controlling Nutritional Status (CONUT) as a Novel Postoperative Prognostic Marker in Breast Cancer Patients: A Retrospective Study

PURPOSE

This investigation seeks to elucidate the potential prognostic significance as well as the clinical utility of the controlling nutritional status (CONUT) score in breast cancer patients.

METHODS

Breast cancer patients managed in our center between January 2010 and December 2016 were recruited for our study. They comprised 187 patients who did not undergo neoadjuvant chemotherapy and 194 who did. A receiver operating characteristic curve (ROC) was utilized in identifying the ideal cut-off CONUT value. This cut-off score was then used to reclassify patients into those with high CONUT scores (≥1) and low CONUT scores (<1). The outcomes were analyzed by statistical methods.

RESULTS

Univariate and multivariate Cox regression survival analyses revealed that a CONUT score cut-off of 1 was able to significantly predict duration of disease-free survival (DFS) (p < 0.001; hazard ratio [HR]: 3.184; 95% CI: 1.786-5.677; and p < 0.001; HR: 2.465; 95% CI: 1.642-3.700) and overall survival (OS) (p < 0.001; HR: 2.326; 95% CI: 1.578-3.429; and p < 0.001; HR: 2.775; 95% CI: 1.791-4.300). The mean DFS and OS in those with lower CONUT scores were 41.59 (95% CI: 37.66-45.51 months) and 77.34 months (95% CI: 71.79-82.90 months), respectively. On the other hand, the average DFS and OS for all individuals in the raised CONUT score group were 39.18 (95% CI: 34.41-43.95 months) and 71.30 months (95% CI: 65.47-77.12 months), respectively. Moreover, Kaplan-Meier survival analysis revealed that those in the raised CONUT score cohort had remarkably worse DFS and OS survival rates compared to individuals in the low CONUT score cohort (Log-rank test, DFS: χ 2 = 12.900, p = 0.0003, and OS: χ 2 = 16.270, p < 0.0001).

CONCLUSION

The survival times of breast cancer patients may be reliably predicted using the CONUT score. This score is an easy, convenient, readily accessible, and clinically significant means of prognosticating patients with breast cancer.

Malnutrition and infection lead to poor prognosis and heavy financial burden of patients with chronic heart failure

Background

Chronic heart failure (CHF) is a major public health concern, as it is associated with poor prognosis and heavy financial burden. In recent years, there has been increasing interest in medications for CHF in China, but few studies pay attention to the effects of nutrition and infection.

Methods and results

This was a retrospective study collected patients with CHF admitted to the Department of Cardiology of Qilu Hospital of Shandong University from January 2017 to May 2018. Patients were classified according to the prognosis and the financial burden. Through comparison and regression analysis, we found that the factor associated with worse prognosis were decreased heart rate, albumin and prealbumin; β-blockers and mineralocorticoid receptor antagonism (MRA) were the factor improved the prognosis of patients with CHF; the factor overburdening financial condition were infection, decreased prealbumin, high Alanine aminotransferase (ALT), usage of recombinant human brain natriuretic peptide (rhBNP) and Levosimendan; aspirin and Sacubitril/Valsartan were the factor releasing financial burden of patients with CHF. Then, we grouped by Controlling Nutritional Status (CONUT) score, which enabled evaluation of the patient's protein reserve and immune defenses. Patients in the malnutrition group had higher infection ratios, longer hospital stays, and greater hospital expenses than the normal group. The improvement ratios of therapeutic outcomes in the moderate or severe malnutrition group were lower than in the normal and mild malnutrition group.

Conclusion

Malnutrition and infection caused poor prognosis and increased financial burden of patients with CHF. The high CONUT score indicated the CHF patient's unfavorable prognosis and heavy financial burden.

Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection

The prevalence and role of malnutrition in periprosthetic joint infection (PJI) remain unclear. This study aimed to use measurable nutritional screening tools to assess the prevalence of malnutrition in PJI patients during two-stage exchange arthroplasty and to explore the association between malnutrition and treatment failure. Our study retrospectively included 183 PJI cases who underwent 1st stage exchange arthroplasty and had available nutritional parameters, of which 167 proceeded with 2nd stage reimplantation. The recently proposed Musculoskeletal Infection Society (MSIS) Outcome Reporting Tool was used to determine clinical outcomes. The Controlling Nutritional Status (CONUT), Nutritional Risk Index (NRI), and Naples Prognostic Score (NPS) were used to identify malnutrition at 1st and 2nd stage exchange, respectively. Multivariate logistic regression analyses were performed to determine the association between malnutrition and treatment failure. Restricted cubic spline models were further used to explore the dose−response association. Additionally, risk factors for moderate-to-severe malnutrition were evaluated. Malnourished patients identified by CONUT, NPS, and NRI accounted for 48.1% (88/183), 98.9% (181/183), and 55.7% (102/183) of patients at 1st stage, and 9.0% (15/167), 41.9% (70/167), and 43.1% (72/167) at 2nd stage, indicating a significant improvement in nutritional status. We found that poorer nutritional status was a predictor of treatment failure, with CONUT performing best as a predictive tool. Moderate-to-severe malnutrition at 1st stage identified by CONUT was significantly related to treatment failure directly caused by PJI (odds ratio [OR] = 5.86), while the OR was raised to 12.15 at 2nd stage (OR = 12.15). The linear dose−response associations between them were also confirmed (P for nonlinearity at both 1st and 2nd stage > 0.05). As for total treatment failure, moderate-to-severe malnutrition as determined by CONUT was associated with a 1.96-fold and 8.99-fold elevated risk at the 1st and 2nd stages, respectively. Age ≥ 68 years (OR = 5.35) and an increased number of previous surgeries (OR = 2.04) may be risk factors for moderate-to-severe malnutrition. Overall, the prevalence of malnutrition in PJI patients is very high. Given the strong association between moderate-to-severe malnutrition identified by CONUT and PJI treatment failure, COUNT could be a promising tool to evaluate the nutritional status of PJI patients to optimize treatment outcomes.

Prognostic impact of the controlling nutritional status score in patients with hematologic malignancies: A systematic review and meta-analysis

Background

An increasing number of studies have validated the prognostic significance of the controlling nutritional status (CONUT) score in patients with solid tumors. However, the extent of the correlation between the CONUT score and clinical outcomes of patients with hematologic malignancies is unclear.

Objective

This study aimed to investigate the prognostic role of the CONUT score in patients with hematologic malignancies.

Methods

All relevant articles published up to November 15, 2021, were identified by systematically searching PubMed, Embase, Web of Science, and Cochrane Library. Pooled hazard ratios (HRs) and 95% confidence intervals were used to quantitatively analyze the association between the CONUT scores and clinical outcomes of patients with hematologic malignancies. Subgroup and sensitivity analyses were performed. Funnel plots as well as Begg’s and Egger’s tests were used to assess publication bias.

Results

Six studies with 1811 patients were included in the meta-analysis. The results showed that a high CONUT score was associated with worse overall survival (OS) (HR=1.34, 95%CI 1.14-1.59, P &lt; 0.001) and progression-free survival (PFS) (HR=1.20, 95%CI 1.10-1.32, P &lt; 0.001).

Conclusions

The CONUT score is an independent prognostic factor in patients with hematologic malignancies.

Systematic review registration

http://www.crd.york.ac.uk/prospero/, identifier CRD42021292621.

Association between patient's age and the utility of prognostic markers after pancreaticoduodenectomy for pancreatic cancer

BACKGROUND ＆ AIMS: Optimizing treatments balancing prognosis and therapeutic invasiveness is important in the management of pancreatic cancer (PC) owing to global ageing. This study aimed to verify the different utility of biomarkers by patients' age. MATERIALS ＆ METHODS: This is a single-center, retrospective cohort analysis involving 160 patients who undertook pancreaticoduodenectomy (PD) for PC. After comparing clinicopathological factors and survival after PD between aged (≥70 y/o) and young (＜70 y/o) patients, we compared neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), controlling nutrition (CONUT) score, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 as well as clinicopathological factors between long and short survivors in each group. We also performed Kaplan-Meyer analysis between patients stratified by biomarkers. RESULTS: Overall survival (OS) was significantly worse in aged patients (p = 0.002). In aged patients, CEA was significantly higher in short survivors. In young patients, CONUT score and CA19-9 were higher in short survivors. Kaplan-Meyer analysis showed that NLR and CEA stratified OS in aged patients, whereas CONUT score and CA19-9 could stratify OS in young patients. CONCLUSION: Our current results suggest that these biomarkers had different impact on survivals according to the patients' age.

Prognostic significance of Naples prognostic score in operable renal cell carcinoma

Background

Naples prognostic score (NPS), a novel scoring system based on nutritional and inflammatory status, is associated with prognosis in several cancers. This study aimed to evaluate the prognostic significance of preoperative NPS in patients undergoing nephrectomy.

Patients and Methods

This study retrospectively analyzed patients with renal cell carcinoma (RCC) who underwent radical or partial nephrectomy between 2010 and 2013. The clinicopathological characteristics of patients stratified by preoperative NPS were compared. Survival analysis was performed using the Kaplan–Meier method and log-rank test. Univariate and multivariate Cox proportional hazards models were used to identify independent prognostic factors. Receiver operating characteristic curves were used to evaluate prediction efficiency.

Results

A total of 638 patients with operable RCC were included. The high-NPS group (NPS group 2) was significantly associated with older age (P < 0.001), larger tumor size (P < 0.001), worse pathological T stage (P < 0.001), positive lymph node pathology (P = 0.002), higher tumor grade (P < 0.001), and greater tumor necrosis (P < 0.001). Multivariable analysis demonstrated that the high-NPS subgroup had significantly worse overall survival (OS) [hazard ratio (HR): 2.25, 95% confidence interval (CI): 1.45–3.50, P < 0.001] and progression-free survival (PFS) (HR: 2.26, 95% CI: 1.48–3.44, P < 0.001). Among several preoperative scoring systems, NPS had the strongest discriminatory power for predicting OS and PFS.

Conclusion

Preoperative NPS can serve as a simple novel risk stratification tool to optimize the prognosis of patients with operable RCC. Further prospective and large-scale studies are needed to validate our findings.

Preoperative Naples prognostic score is a reliable prognostic indicator for newly diagnosed glioblastoma patients

Background

Glioblastoma (GBM) accounts for approximately 80% of malignant gliomas and is characterized by considerable cellularity and mitotic activity, vascular proliferation, and necrosis. Naples prognostic score (NPS), based on inflammatory markers and nutritional status, has a prognostic ability in various cancers. In the current study, we aim to explore the prognostic value of operative NPS in GBM patients and compare the prognostic ability between NPS and controlling nutritional status (CONUT).

Materials and methods

The retrospective analysis was carried out on consecutive newly diagnosed GBM patients who had underwent tumor resection at West China Hospital from February 2016 to March 2019. All statistical analyses were conducted using SPSS software and R software.

Results

A total of 276 newly diagnosed GBM patients were enrolled in the current study. Overall survival (OS) (p < 0.001) and tumor location (p = 0.007) were significantly related to NPS. Serum albumin concentrate, cholesterol concentrate, neutrophil-to-lymphocyte ratio, lymphocyte ratio, and CONUT score were all significantly associated with NPS (p < 0.001). The Kaplan–Meier curve indicated that NPS (log-rank test, p < 0.001) and CONUT score (log-rank test, p = 0.023) were significantly associated with OS. Multivariate Cox regression revealed that both NPS and CONUT score served as independent prognostic indicators. The prognostic model with NPS had the strongest prognostic capability and best model-fitting.

Conclusion

In the current study, NPS is found as an independent prognostic indicator for patients with newly diagnosed GBM, and the prognostic ability of NPS is superior to CONUT score.

Prognostic Roles of Inflammation- and Nutrition-Based Indicators for Female Patients with Cancer

Purpose

The incidence, progression, and prognosis of cancer could be affected by inflammation and nutrition. Female patients have different inflammatory and nutritional states depending on their age and tumor types. It is important to screen for suitable prognostic indicators in female patients with cancer of different ages and tumor types.

Patients and Methods

Baseline clinicopathologic and laboratory characteristics of 1502 female patients with cancer were obtained from a multicenter cohort study. Concordance indices (C-indices) were used to evaluate the prediction accuracy of following inflammation- and nutrition-based indicators: advanced lung cancer inflammation index (ALI), systemic immune inflammation index (SII), modified geriatric nutritional risk index (mGNRI), albumin-to-globulin ratio (AGR), prognostic nutritional index (PNI), lymphocyte-to-C-reactive protein ratio (LCR), controlling nutritional status score (CONUT), modified Glasgow prognostic score (mGPS), and lymphocyte-to-C-reactive protein score (LCS).

Results

The most suitable indicators in different female populations with cancer had C-indices as follows: LCR (0.668; 95% CI, 0.644–0.693) for all females; AGR (0.681; 95% CI, 0.619–0.743) for young females; LCR (0.667; 95% CI, 0.628–0.706) for middle-aged females; ALI (0.597; 95% CI, 0.574–0.620) for elderly females; LCR (0.684; 95% CI, 0.621–0.747) for females with reproductive system cancer; and ALI (0.652; 95% CI, 0.624–0.680) for females with non-reproductive system cancer.

Conclusion

The most suitable indicators for the different female populations with cancer are summarized as follows: LCR for all females, AGR for young females, LCR for middle-aged females, ALI for elderly females, LCR for females with reproductive system cancer, and ALI for females with non-reproductive system cancer.

Prognostic role of controlling nutritional status score in hematological malignancies

BACKGROUND

Controlling nutritional status (CONUT) score, based on three indexes including serum albumin (ALB), total cholesterol (CHO), and absolute lymphocyte count (ALC), has been closely associated with the prognosis of cancer patients. Multiple studies revealed the significance of CONUT score in hematological malignancies, including diffuse large B-cell lymphoma (DLBCL), peripheral T-cell lymphoma (PTCL), multiple myeloma (MM), and leukemia.

OBJECTIVE

This review aimed to explore the prognostic role of CONUT score in hematological malignancies.

METHODS

We conducted this review through Pubmed to summarize the published studies on the CONUT score in hematological malignancies, using the terms: Controlling nutritional status, CONUT score, hematological malignancy, lymphoma, multiple myeloma, and leukemia.

RESULT

CONUT score can reflect not only the nutritional status but also the inflammatory status of patients with hematological malignancies. It can assist in predicting the survival of patients with DLBCL, PTCL, MM, adult T-cell leukemia (ATL), myelodysplastic syndrome (MDS), and acute myeloid leukemia with myelodysplasia related changes (AML-MRC).

CONCLUSION

CONUT score plays an important role in predicting the prognosis of patients with hematological malignancies.

Total Risk Points Predict Short- and Long-term Outcomes Following Colorectal Cancer Resection in Older Patients

BACKGROUND/AIM

Estimation of physiological ability and surgical stress (E-PASS) is reported to be useful as a predictor of postoperative complications and poor long-term survival after colorectal cancer. The total risk points (TRP) system is a simplified scoring system of E-PASS, and this study evaluated the utility of TRP in colorectal cancer resection in older patients.

PATIENTS AND METHODS

The clinicopathological data of 237 patients who underwent curative resection for colorectal cancer from 2015 to 2020 were analyzed retrospectively. The data were compared between a high TRP group (≥1,000, n=38) and a low TRP group (<1,000, n=199). We also conducted an analysis to determine risk factors of postoperative complications and poor long-term survival.

RESULTS

TRP showed statistically significant correlations with the comprehensive risk score (CRS) of E-PASS (R=0.999, p<0.001). The high TRP group experienced postoperative complications (Clavien-Dindo grade ≥2) more frequently (42.1% vs. 11.1%, p<0.001). Multivariate analysis showed that high TRP [odds ratio (OR)=5.214; 95% confidence interval (95%CI)=2.338-11.629; p<0.001] and age ≥80 (OR=2.760; 95%CI=1.308-5.826; p=0.008) were independent predictors of postoperative complications. Overall survival (OS) was poor in the high TRP group (5-year OS, 61.2% vs. 82.6%, p<0.001) compared with the low TRP group, and in the low prognostic nutritional index (<45) group (5-year OS, 70.9% vs. 86.3%, p=0.013) compared with the high prognostic nutritional index (≥45) group. Multivariate analysis showed that high TRP [hazard ratio (HR)=3.202; 95%CI=1.324-7,745; p=0.010] was an independent prognostic factor for poor OS.

CONCLUSION

Patients aged ≥80 years should be closely monitored regarding postoperative complications. Reducing TRP to less than 1,000 is important to reduce postoperative complications and improve OS.

The Controlling Nutritional Status (CONUT) Score and Prognosis in Malignant Tumors: A Systematic Review and Meta-Analysis

Increasing evidences indicate that the controlling nutritional status (CONUT) score is associated with cancer prognosis. This study was conducted to investigate the prognostic significance of pretreatment CONUT score on patients with various malignant tumors. The correlation between CONUT score and clinical outcomes of tumor patients were studied by electronic literature retrieval. Pooled hazard ratios (HR), odds ratios (OR) and 95% confidence intervals (95% CI) were calculated to clarify the conclusion. Subgroup analysis were conducted in line with cancer type, cancer stage, treatment, sample size and cut-off value. A total of 62 studies involving 25224 patients were included in this study. Pooled analysis showed that higher CONUT scores were associated with shorter overall survival (HR 1.62, 95% CI 1.45-1.79, p < 0.001), cancer-specific survival (HR 1.80, 95% CI 1.48-2.13, p < 0.001), progress/recurrence-free survival (HR 1.54, 95% CI 1.23-1.85, p < 0.001) and disease-free survival (HR 1.56, 95% CI 1.39-1.74, p < 0.001). In addition, high CONUT score was correlated to higher incidence of postoperative complications (OR 1.64, 95% CI 1.38-1.95, p < 0.001) and mortality (OR 4.22, 95% CI 2.22-8.02, p < 0.001). Consequently, the pretreatment CONUT score is a valuable indicator to predict the clinical outcomes of patients with various malignant tumors.

Controlling Nutritional Status (CONUT) Predicts Survival in Gastric Cancer Patients With Immune Checkpoint Inhibitor (PD-1/PD-L1) Outcomes

Objective: The controlling nutritional status (CONUT), based on total lymphocyte count (TL), total cholesterol level (T-CHOL), and serum albumin (ALB), can provide a useful immunological prognostic biomarker for cancer patients. The present study aims to investigate the correlation between CONUT and prognosis in gastric cancer patients receiving immune checkpoint inhibitor (ICI) treatment.

Methods: We retrospectively enrolled 146 patients with gastric cancer treated with ICIs (PD-1/PD-L1 inhibitors) from August 2016 to December 2020. The clinicopathologic characteristics were analyzed by Chi-square test or Fisher’s exact test. The Kaplan–Meier and log-rank test were used to calculate and compare progression-free survival (PFS) and overall survival (OS). The prognostic and predictive factors of PFS and OS were identified by univariate and multivariate analyses. A nomogram was developed to estimate 1-, 3-, and 5-year PFS and OS probability.

Results: Through the CONUT score, there were 75 (51.37%) patients in the low CONUT group and 71 (48.63%) patients in the high CONUT group. There was a correlation between the CONUT score and age (p = 0.005), pathology (p = 0.043), ALB (p = 0.020), PALB (p = 0.032), and Hb (p = 0.001). The CA724, TNM stage, and treatment (ICIs vs. chemotherapy) were the independent prognostic factors for PFS and OS by multivariate analyses. Patients with high CONUT score had poorer PFS and OS (χ² = 3.238, p = 0.072, and χ² = 4.298, p = 0.038). In the subgroup analysis, the patients with high CONUT score were associated with shorter PFS and OS with ICIs or chemotherapy. With the PD-1/PD-L1 positive expression, the patients with high CONUT score had shorter PFS and OS than those with low CONUT score. Furthermore, the patients with high CA724 value were associated with shorter PFS and OS. The toxicity assessment in ICIs or chemotherapy was significantly associated with anemia. The nomograms were constructed to predict the probability of 1-, 3-, and 5-year PFS, and 1-, 3-, and 5-year OS with C-indices of 0.749 and 0.769, respectively.

Conclusion: The CONUT, as a novel immuno-nutritional biomarker, may be useful in identifying gastric cancer patients who are unlikely to benefit from ICI treatment.

The Relationship between the SARC-F Score and the Controlling Nutritional Status Score in Gastrointestinal Diseases

We sought to examine the relationship between the SARC-F score and the Controlling Nutritional Status (CONUT) score in patients with gastrointestinal diseases (GDs, n = 735, median age = 71 years, and 188 advanced cancer cases). The SARC-F score ≥ 4 (highly suspicious of sarcopenia) was found in 93 cases (12.7%). Mild malnutritional condition was seen in 310 cases (42.2%), moderate in 127 (17.3%) and severe in 27 (3.7%). The median SARC-F scores in categories of normal, mild, moderate and severe malnutritional condition were 0, 0, 1 and 1 (overall p < 0.0001). The percentage of SARC-F score ≥ 4 in categories of normal, mild, moderate and severe malnutritional condition were 4.4%, 12.9%, 26.8% and 25.9% (overall p < 0.0001). The SARC-F score was an independent factor for both the CONUT score ≥ 2 (mild, moderate or severe malnutrition) and ≥5 (moderate or severe malnutrition). In the receiver operating characteristic (ROC) curve analysis for the CONUT score ≥ 2, C reactive protein (CRP) had the highest area under the ROC (AUC = 0.70), followed by the SARC-F score (AUC = 0.60). In the ROC analysis for the CONUT score ≥ 5, CRP had the highest AUC (AUC = 0.79), followed by the SARC-F score (AUC = 0.63). In conclusion, the SARC-F score in patients with GDs can reflect malnutritional status.

Clinical significance of controlling nutritional status score (CONUT) in evaluating outcome of postoperative patients with gastric cancer

The stomach is the main digestive organ in humans. Patients with gastric cancer often develop digestive problems, which result in poor nutrition. Nutritional status is closely related to postoperative complications and quality of life (QoL) in patients with gastric cancer. The controlling nutritional status (CONUT) score is a novel tool to evaluate the nutritional status of patients. However, the relationship of the CONUT score with postoperative complications, QoL, and psychological status in patients with gastric cancer has not been investigated. The present follow-up study was conducted in 106 patients who underwent radical gastrectomy in our hospital between 2014 and 2019. The CONUT score, postoperative complications, psychological status, postoperative QoL scores, and overall survival (OS) of patients with gastric cancer were collected, and the relationship between them was analyzed. A significant correlation was observed between the CONUT score and postoperative complications of gastric cancer (P < 0.001), especially anastomotic leakage (P = 0.037). The multivariate regression analysis exhibited that the CONUT score (P = 0.002) is an independent risk factor for postoperative complications. The CONUT score was correlated with the state anxiety questionnaire (S-AI) for evaluating psychological status (P = 0.032). However, further regression analysis exhibited that the CONUT score was not an independent risk factor for psychological status. Additionally, the CONUT score was associated with postoperative QoL. The multivariate regression analysis exhibited that the CONUT score was an independent risk factor for the global QoL (P = 0.048). Moreover, the efficiency of CONUT score, prognostic nutrition index, and serum albumin in evaluating complications, psychological status, and QoL was compared, and CONUT score was found to outperform the other measures (Area Under Curve, AUC = 0.7368). Furthermore, patients with high CONUT scores exhibited shorter OS than patients with low CONUT scores (P = 0.005). Additionally, the postoperative complications (HR 0.43, 95% CI 0.21–0.92, P = 0.028), pathological stage (HR 2.26, 95% CI 1.26–4.06, P = 0.006), and global QoL (HR 15.24, 95% CI 3.22–72.06, P = 0.001) were associated with OS. The CONUT score can be used to assess the nutritional status of patients undergoing gastric cancer surgery and is associated with the incidence of postoperative complications and QoL.

Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort

Background: Malnutrition increases worse outcomes during hospital admission for elective colorectal cancer (CRC) surgery in older adults. Methods: This work was designed an observational, monocentric, case-control study nested in a cohort of patients undergoing elective surgery for CRC disease at the Hospital Universitario de la Ribera (HULR) (Alzira, Valencia, Spain) between 2011 and 2019. The study considered patients with a CONUT score in the range of moderate to severe malnutrition (>4 points), with control patients with normal nutritional situations or mild malnutrition. Results: Moderate-to-severe malnutrition cases presented a greater length of stay (LOS), a higher incidence of adverse events (both medical and surgical complications), a higher incidence of surgical-wound infection, a greater need for blood transfusion, and a greater amount of transfused packed red blood cells. During hospitalization, the percentage of patients without nutritional risk decreased from 46 to 9%, and an increase in mild, moderate, and severe risk was observed. Patients with severe nutritional risk at hospital admission had significantly increased mortality at 365 days after discharge (HR: 2.96 (95% CI 1.14–7.70, p = 0.002)). After adjusting for sex, age, and Charlson index score, patients with severe nutritional risk at admission maintained a higher mortality risk (HR: 3.08 (95% CI 1.10–8.63, p = 0.032)). Conclusion: Malnutrition prevalence is high in older adults undergoing CRC elective surgery. Furthermore, this prevalence increases during hospital admission. Malnutrition is linked to worse outcomes, such as LOS, surgical and clinical complications, and mortality. For this reason, nutritional interventions are very important in the perioperative period

Comparison of nutritional and immunological scoring systems predicting prognosis in T1-2N0 colorectal cancer

PURPOSE

Previous studies have shown that the new nutritional and immunological status scoring systems of the Naples prognostic score (NPS), controlling nutritional status score (CONUT), and the older prognostic nutritional index (PNI) are independent predictors in colorectal cancer. This study compares the prognostic value of NPS, CONUT, and PNI in T1-2N0 colorectal cancer.

METHODS

We retrospectively evaluated 305 consecutive stage I (T1-2N0M0) colorectal cancer patients who underwent radical surgery from January 2010 to December 2015 at our hospital. The NPS results were divided into 3 groups (0, 1, and 2 groups), and the PNI and CONUT results were divided into 2 groups (low and high groups).

RESULTS

The patients with low PNI had worse overall survival (OS) and disease-free survival (DFS) than those with high PNI (P < 0.001 and P < 0.001, respectively). Multivariate analysis showed that PNI was independently associated with OS and DFS (P < 0.001 and P < 0.001, respectively), but NPS and CONUT results were not.

CONCLUSION

The PNI is an independent predictor in stage I colorectal cancer, but NPS and CONUT results are not.

T Cell Aging in Patients with Colorectal Cancer-What Do We Know So Far?

Simple Summary

This review describes the role of T cell aging in colorectal cancer development. T cells are important mediators in cancer immunity. Aging affects T cells, leading to various dysfunctions which can impede antitumor immunity. While some hallmarks of T cell aging have been observed in colorectal cancer patients, the functional role of such cells is not clear. Therefore, understanding how aged T cells influence overall patient outcome could potentially help in the pursue to develop new therapies for the elderly.

Abstract

Colorectal cancer (CRC) continues to be one of the most frequently diagnosed types of cancers in the world. CRC is considered to affect mostly elderly patients, and the number of diagnosed cases increases with age. Even though general screening improves outcomes, the overall survival and recurrence-free CRC rates in aged individuals are highly dependent on their history of comorbidities. Furthermore, aging is also known to alter the immune system, and especially the adaptive immune T cells. Many studies have emphasized the importance of T cell responses to CRC. Therefore, understanding how age-related changes affect the outcome in CRC patients is crucial. This review focuses on what is so far known about age-related T cell dysfunction in elderly patients with colorectal cancer and how aged T cells can mediate its development. Last, this study describes the advances in basic animal models that have potential to be used to elucidate the role of aged T cells in CRC.

The prognostic significance of controlling nutritional status (CONUT) score for surgically treated renal cell cancer and upper urinary tract urothelial cancer: a systematic review and meta-analysis

In order to evaluate the predictive effect of the controlled nutritional status (CONUT) score on the prognosis of patients with renal cell carcinoma (RCC) and upper urinary tract urothelial carcinoma (UTUC), a meta-analysis was performed. This systematic review has been registered on PROSPERO, the registration ID is CRD42021251879. A systematic search of the published literature using PubMed, Web of Science, Cochrane Library, EMBASE, and MEDLINE was performed. The fields of "renal cell cancer," "upper tract urothelial cancer," and "controlling nutritional status" and other fields were used as search terms. STATA 16 software was used to carry out data merging and statistical analysis of binary variables, Q test and χ² tests were used to verify the heterogeneity between the included works of studies. Subgroup analysis and sensitivity analysis were used to explain the sources of heterogeneity between studies. Begg's test was used to assess publication bias between studies. From the first 542 studies retrieved, through strict inclusion and exclusion criteria, 7 studies finally met the requirements and were included in the meta-analysis. Pooled results indicated that high CONUT indicates worse over survival (OS) [HR = 1.70, 95% CI (1.43-2.03), P = 0.02], cancer-specific survival (CSS) [HR = 1.84, 95% CI (1.52-2.23), P = 0.01], recurrence-free survival (RFS) [HR = 1.60, 95% CI (1.26-2.03), P = 0.116], and disease-free survival (DFS) [HR = 1.47, 95% CI (1.20-1.81), P = 0.03]. Based on cancer type, cutoff value, region, and sample size, a subgroup analysis was performed. The results showed that OS and CSS were not affected by the above factors, and the high CONUT score before surgery predicted worse OS and CSS. In conclusion, this meta-analysis revealed that the preoperative CONUT score is a potential independent predictor of the postoperative prognosis of RCC/UTUC patients. A high CONUT predicts worse OS/CSS/DFS and RFS in patients.

Sixty-Day Mortality of Patients With Metastatic Colorectal Cancer Randomized to Systemic Treatment vs Primary Tumor Resection Followed by Systemic Treatment: The CAIRO4 Phase 3 Randomized Clinical Trial

Importance

The role of primary tumor resection (PTR) in synchronous patients with metastatic colorectal cancer (mCRC) who had unresectable metastases and few or absent symptoms of their primary tumor is unclear. Studying subgroups with low postoperative mortality may identify patients who potentially benefit from PTR.

Objective

To determine the difference in 60-day mortality between patients randomized to systemic treatment only vs PTR followed by systemic treatment, and to explore risk factors associated with 60-day mortality.

Design, Setting, and Participants

CAIRO4 is a randomized phase 3 trial initiated in 2012 in which patients with mCRC were randomized to systemic treatment only or PTR followed by systemic treatment with palliative intent. This multicenter study was conducted by the Danish and Dutch Colorectal Cancer Group in general and academic hospitals in Denmark and the Netherlands. Patients included between August 2012 and December 2019 with histologically proven colorectal cancer, unresectable metastases, and a primary tumor with few or absent symptoms were eligible.

Interventions

Systemic treatment, consisting of fluoropyrimidine-based chemotherapy with bevacizumab vs PTR followed by fluoropyrimidine-based chemotherapy with bevacizumab.

Main Outcomes and Measures

The aim of the current analysis was to compare 60-day mortality rates in both treatment arms. A secondary aim was the identification of risk factors for 60-day mortality in the treatment arms. These aims were not predefined in the study protocol.

Results

A total of 196 patients were included in the intention-to-treat analysis (112 [57%] men; median [IQR] age, 65 [59-70] years). Sixty-day mortality was 3% (95% CI, 1%-9%) in the systemic treatment arm and 11% (95% CI, 6%-19%) in the PTR arm (P = .03). In a per-protocol analysis, 60-day mortality was 2% (95% CI, 1%-7%) vs 10% (95% CI, 5%-18%; P = .048). Patients with elevated serum levels of lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and/or neutrophils who were randomized to PTR had a significantly higher 60-day mortality than patients without these characteristics.

Conclusions and Relevance

Patients with mCRC who were randomized to PTR followed by systemic treatment had a higher 60-day mortality than patients randomized to systemic treatment. Especially patients randomized to the PTR arm with elevated serum levels of lactate dehydrogenase, neutrophils, aspartate aminotransferase, and/or alanine aminotransferase were at high risk of postoperative mortality. Final study results on overall survival have to be awaited.

Trial Registration

ClinicalTrials.gov Identifier: NCT01606098.

Preoperative Nutritional Scores as Host-Related Prognostic Factors for Both Overall Survival and Postoperative Complications in Patients With Stage II to III Colorectal Cancer

BACKGROUND

In the TNM eighth edition, nutritional status and inflammatory scores are newly described as host-related prognostic factors for esophageal cancer, hepatocellular carcinoma, and pancreatic cancer. However, only age and race are listed as host-related prognostic factors for colorectal cancer.

OBJECTIVE

The purpose of this study was to evaluate the prognostic significance of nutritional and inflammatory scores for postoperative outcomes in patients with colorectal cancer.

DESIGN

This was a retrospective study using a database that prospectively collects data.

SETTINGS

The study was conducted at a high-volume multidisciplinary tertiary cancer center in Japan.

PATIENTS

Study participants were 1880 consecutive patients with stage II to III colorectal cancer who underwent curative resection at the National Cancer Center Hospital between 2004 and 2012. Two nutritional scores (prognostic nutritional index and controlling nutritional status score) and 4 inflammatory scores (modified Glasgow prognostic score, neutrophil:lymphocyte ratio, platelet:lymphocyte ratio, and C-reactive protein:albumin ratio) were calculated.

MAIN OUTCOME MEASURES

Correlations of nutritional scores and inflammatory scores with overall survival and postoperative complications were measured.

RESULTS

After adjusting for key clinical and pathologic factors by multivariable analysis, 2 nutritional scores (prognostic nutritional index and controlling nutritional status score) and 2 inflammatory scores (neutrophil:lymphocyte ratio and C-reactive protein:albumin ratio) were independent prognostic factors for overall survival. With respect to discriminative ability, time-dependent receiver operating characteristic curves and Harrell concordance index revealed that prognostic nutritional index and controlling nutritional status score were superior to the 4 inflammatory scores for predicting overall survival. Multivariable logistic regression analyses also revealed that prognostic nutritional index, controlling nutritional status score, and C-reactive protein:albumin ratio were independent predictors for postoperative complications.

LIMITATIONS

The retrospective design of the study was a limitation.

CONCLUSIONS

Preoperative nutritional scores are promising host-related prognostic factors for overall survival and postoperative complications in patients with stage II and III colorectal cancer. See Video Abstract at http://links.lww.com/DCR/B587.

EVALUACIN DE SCORE NUTRICIONALES PREOPERATORIOS COMO FACTORES PRONSTICOS PARA SOBREVIDA Y COMPLICACIONES POSTOPERATORIAS EN PACIENTES CON CANCER COLORECTAL ETAPA II Y III

ANTECEDENTES:En las últimas etapificaciones T-N-M, tanto el estado nutricional como inflamatorio han sido descritos como factores pronósticos en cáncer de esófago, hepático y pancreático. Sin embargo en cáncer colorectal solo la edad y la raza son enumerados como factores pronósticos.OBJETIVO:Evaluar la importancia pronóstica de los scores nutricionales e inflamatorias para los resultados posoperatorios en pacientes con cáncer colorrectal.DISEÑO:Estudio retrospectivo utilizando una base de datos.AJUSTE:Centro oncológico teciario en Japón.PACIENTES:Fueron incluidos en el estudio 1880 pacientes, consecutivos, con cancer colorectal etapa II y III sometidos a reseeción curativa en el National Cancer Center Hospital entre 2004 y 2012. Se aplicaron dos scores: nutricional (índice nutricional pronóstico y puntuación del estado nutricional) e inflamatorias (Glasgow modificada, proporción de neutrófilos a linfocitos, de plaquetas a linfocitos y de proteína C reactiva a albúmina).PRINCIPALES MEDIDAS DE RESULTADO:Evaluar scores nutricional e inflamatorio con sobrevida y complicaciones postoperatoria.RESULTADOS:Después de ajustar los factores clínicos y patológicos clave mediante análisis multivariable, dos scores nutricionales (índice nutricional pronóstico y puntuación del estado nutricional de control) y dos inflamatorias (proporción de neutrófilos a linfocitos y proporción de proteína C reactiva a albúmina) fueron pronósticos independientes factores para la sobrevida. Con respecto a la capacidad discriminativa, las curvas de características operativas del receptor, dependientes del tiempo y el índice de concordancia de Harrell, revelaron que el índice nutricional pronóstico y del estado nutricional de control eran superiores a las cuatro inflamatorias para predecir la sobrevida general. Los análisis de regresión logística multivariable también revelaron que el índice nutricional pronóstico, el estado nutricional de control y la relación proteína C reactiva / albúmina fueron predictores independientes de complicaciones postoperatorias.LIMITACIONES:Estudio de tipo retrospectivo.CONCLUSIONES:Los scores nutricionales preoperatorias son factores pronósticos prometedores relacionados con la sobrevida y las complicaciones postoperatorias en pacientes con cáncer colorrectal en estadio II y III. Consulte Video Resumen en http://links.lww.com/DCR/B587.

Clinical Significance of Pretreatment Red Blood Cell Distribution Width as a Predictive Marker for Postoperative Morbidity After Esophagectomy for Esophageal Cancer: A Retrospective Study

Background

Clinical significance of red blood cell distribution (RDW) as a predictive marker for the incidence of postoperative morbidity after esophagectomy for esophageal cancer has not been established.

Methods

This study included 634 consecutive patients who underwent three-incisional esophagectomy with lymphadenectomy for esophageal cancer between April 2005 and November 2020. Correlation between pretreatment RDW and patient background, cancer background, and short-term outcome after esophagectomy were retrospectively investigated.

Results

Eighty patients (12.6%) had a high pretreatment RDW (> 14.2), which correlated with malnutrition estimated by body mass index, hemoglobin, total lymphocyte count, albumin, and total cholesterol. High pretreatment RDW was an independent risk factor for postoperative severe morbidity of grade IIIb or higher based on the Clavien–Dindo classification (hazard ratio [HR] 3.90, 95% confidence interval [CI] 1.707–8.887; p = 0.0012) and reoperation (HR 4.39, 95% CI 1.552–12.390; p = 0.0053) after open esophagectomy (OE). However, RDW was not associated with postoperative morbidity incidence after minimally invasive esophagectomy (MIE).

Conclusions

Pretreatment RDW may be a surrogate marker for nutritional status and could be a predictive marker for postoperative severe morbidity, reoperation, and possibly pneumonia after OE. On the contrary, the lower invasiveness of MIE may have reduced the effect of pretreatment malnutrition on morbidity incidence, which could explain the insignificant relationship between RDW and poor short-term outcomes in MIE.

Supplementary Information

The online version contains supplementary material available at 10.1245/s10434-021-10719-2.

Validation of the conventional Glasgow Prognostic Score and development of the improved Glasgow Prognostic Score in patients with stage 0-III colorectal cancer after curative resection

AIM

Many inflammation-nutrition scores, including the Glasgow Prognostic Score (GPS), have been reported as prognostic biomarkers in patients with colorectal cancer (CRC). We aimed to examine the predictive ability of the GPS and to improve the GPS.

METHODS

We included a total of 438 patients with stage 0-III CRC who underwent curative surgery from 2010 to 2013. They were divided into a training set comprising 221 patients and a validation set comprising 227 patients, according to the date of surgery. In the training set, the GPS was verified using a Cox regression model, and cut-off values for C-reactive protein (CRP) and albumin for relapse-free survival (RFS) were calculated using receiver operating characteristics (ROC) curves. The improved GPS (iGPS) was developed with additional optimal cut-off values. We also compared the iGPS with the conventional GPS in the validation set.

RESULTS

The high GPS (GPS: 1-2) was correlated with RFS and overall survival (OS) in the training set. Cut-off values of CRP and albumin for RFS were 1.6 and 3.9, and we modified the GPS accordingly, adding the cut-off values of 2 and 3.9 to CRP and albumin, respectively. In the validation set, a high iGPS was an independent prognostic factor for RFS (hazard ratio [HR]: 2.273; 95% confidence interval [CI]: 1.212-4.364; P = .011), although the conventional GPS was not.

CONCLUSION

The iGPS was a more accurate prognostic predictor for patients with stage 0-III CRC.

Nutritional status and risk of contrast-associated acute kidney injury in elderly patients undergoing percutaneous coronary intervention

Background

This study aimed to investigate the connection between malnutrition evaluated by the Controlling Nutritional Status (CONUT) score and the risk of contrast-associated acute kidney injury (CA-AKI) in elderly patients who underwent percutaneous coronary intervention (PCI).

Methods

A total of 1308 patients aged over 75 years undergoing PCI was included. Based on the CONUT score, patients were assigned to normal (0–1), mild malnutrition (2–4), moderate-severe malnutrition group (≥ 5). The primary outcome was CA-AKI (an absolute increase in ≥ 0.3 mg/dL or ≥ 50% relative serum creatinine increase 48 h after contrast medium exposure).

Results

Overall, the incidence of CA-AKI in normal, mild, moderate-severe malnutrition group was 10.8%, 11.0%, and 27.2%, respectively (p < 0.01). Compared with moderate-severe malnutrition group, the normal group and the mild malnutrition group showed significant lower risk of CA-AKI in models adjusting for risk factors for CA-AKI and variables in univariate analysis (odds ratio [OR] = 0.48, 95% confidence interval [CI]: 0.26–0.89, p = 0.02; OR = 0.46, 95%CI: 0.26–0.82, p = 0.009, respectively). Furthermore, the relationship were consistent across the subgroups classified by risk factors for CA-AKI except anemia. The risk of CA-AKI related with CONUT score was stronger in patients with anemia. (overall interaction p by CONUT score = 0.012).

Conclusion

Moderate-severe malnutrition is associated with higher risk of CA-AKI in elderly patients undergoing PCI.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10157-021-02061-4.

Controlling Nutritional Status (CONUT) score as a predictive marker for short-term complications following gastrectomy of gastric cancer: a retrospective study

Background

It is well established that the controlling nutritional status (CONUT) score was correlated with long-term outcomes in gastric cancer (GC), but the significance of CONUT for postoperative short-term outcomes remains unclear. The study aimed to characterize the relationship between CONUT and short-term complications following gastrectomy of GC.

Methods

We collected data on 1479 consecutive GC patients at Nanjing Drum Tower Hospital between January 2016 and December 2018. Univariate and multivariate analyses of predictive factors for postoperative complications were performed. The cutoff value of the CONUT score was determined by Youden index.

Results

Among all of the patients, 431 (29.3%) patients encountered postoperative complications. Multivariate analyses identified CONUT was an independent predictor for postoperative short-term complications (OR 1.156; 95% CI 1.077–1.240; P < 0.001). Subgroup analysis elucidated that CONUT was related to postoperative complications both in early gastric cancer and advanced gastric cancer. We further explored that patients with high CONUT score had prolonged hospital stay (12.3 ± 6.0 vs 11.1 ± 4.6, P < 0.001) and more total hospital charges (7.6 ± 2.4 vs 7.1 ± 1.6, P < 0.001).

Conclusions

The present study demonstrated that the preoperative CONUT was an independent predictor for short-term complications following gastrectomy of GC.

Clinical significance of postoperatif controlling nutritional status (CONUT) score in glioblastoma multiforme

PURPOSE

The Controlling Nutritional Status (CONUT) Score, a new parameter that reflects the immuno-nutritional status, has been closely associated with prognosis in many cancer types. However, the prognostic significance of the CONUT score in Glioblastoma Multiforme (GBM) is not known. In this study, we aimed to show the prognostic significance of the CONUT score in the postoperative period in patients with GBM.

METHODS

120 patients followed up with GBM were included in the study, retrospectively. According to the receiver operating characteristic (ROC) curve analysis, the optimal cut-off values were determined for the CONUT score, and the patients were divided into low (<2.5) and high (≥2.5) CONUT groups. Systemic immune inflammation index (SII), prognostic nutritional index (PNI), and neutrophil-lymphocyte ratio (NLR) were grouped according to the cut-off point of 1111, 46.5, and 4.48, respectively. Cox regression analyzes were used to assess their prognostic significance for progression-free survival (PFS) and overall survival (OS).

RESULTS

The high CONUT score group was found to have worse PFS and OS than the low CONUT score group (p < 0.001, p < 0.001). In univariate analysis, age, gender, comorbidity, CONUT score, SII, PNI, NLR were found to be significant for both PFS and OS. In multivariate analysis, only age and CONUT score were found as independent prognostic factors for both PFS (p: 0.040, p < 0,001) and OS (p: 0,041, p < 0,001).

CONCLUSION

The CONUT score in the postoperative period in patients with GBM is an independent prognostic parameter that predicts progression and survival.

Prognostic Potential of the Preoperative Controlling Nutritional Status (CONUT) Score in Predicting Survival of Patients with Cancer: A Systematic Review

The nutritional status of a patient has prognostic potency concerning short- and long-term outcomes, including survival, in many diseases. The controlling nutritional status (CONUT) score is a method for assessing nutritional status and predicting outcomes of several diseases. This study sought to systematically identify the prognostic role of preoperative CONUT score on posttreatment overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) in patients with cancer. The PubMed, SCOPUS, and Google Scholar databases and Google were searched for all dates until December 2019. Original articles investigating the association of preoperative CONUT score with survival in cancer patients who underwent surgery were included. Duplicate and irrelevant reports were screened out and the remaining articles assessed for quality and data extracted during critical analysis. Results of multivariate analysis were used to evaluate the prognostic competence of CONUT score in predicting survival. The search method identified an initial 181 articles, of which 32 were included in the final analysis. Lower OS, CSS, and RFS rates were reported by 100%, 100%, and 87.0% of the included studies, respectively, in cancer patients with high CONUT scores. A prognostic role of the CONUT score for prediction of OS, CSS, and RFS in cancer patients was shown by 91.7%, 90.9%, and 52.6% of the studies, respectively. The receiver operating characteristic curve area under the curve (AUC) value of the CONUT score for predicting OS, CSS, and RFS was at an acceptable level (>0.5) in all studies with available AUC values (n = 19). Sixty percent (12 of 20) of the studies reported that high CONUT score was significantly related to lower BMI. The findings promote confidence that a high preoperative CONUT score is associated with poor survival rate and is an independent prognostic factor of OS and CSS in patients with various types of cancer. Evaluation of the preoperative CONUT score might help clinicians in decision-making with respect to surgical implications.

The associations between nutritional status, physical function and skeletal muscle mass of geriatric patients with colorectal cancer

BACKGROUND & AIMS

Nutritional status is associated with physical function and body composition. However, these relationships in patients with colorectal cancer remain poorly understood. This study aimed to investigate the association between nutritional status, physical function, and skeletal muscle mass in geriatric patients with colorectal cancer.

METHODS

Preoperative patients diagnosed with colorectal cancer were recruited for this cross-sectional observational study. The correlations were calculated using Spearman's rank correlation coefficient, and the intergroup differences in physical function and skeletal muscle mass between categories according to nutritional assessment were analyzed using the Mann-Whitney U test or Kruskal-Wallis test.

RESULTS

We recruited 127 patients (median age 71.0 years). Hand grip strength was correlated with geriatric nutritional risk index (GNRI) (male: p = 0.033; female: p = 0.014), albumin (male: p = 0.014; female: p = 0.003), and controlling nutritional status (CONUT) score (male: p = 0.004; female: p = 0.011) in both gender, and correlated with body mass index (BMI) (p = 0.027) in male patients. Psoas volume index (PVI) was positively correlated with BMI (male: p = 0.005; female: p < 0.001). In addition, intergroup comparisons for categories according to BMI showed PVI was significantly lower in the malnutrition category (male: p = 0.017; female: p < 0.001). Albumin and CONUT score were correlated with five-times sit-to-stand test (male: p = 0.011; female: p = 0.049, male: p = 0.031; female: p = 0.012, respectively) and short physical performance battery (male: p = 0.065; female: p = 0.028, male: p = 0.002; female: p = 0.006, respectively). Moreover, patients in lower albumin category had longer time on 5-times sit-to-stand test (male: p = 0.018; female: p = 0.009) and had lower scores on short physical performance battery (male: p = 0.027; female: p = 0.039).

CONCLUSIONS

Hand grip strength correlated with various nutritional assessment tools, and PVI was correlated with BMI in particular. Five-times sit-to-stand test and short physical performance battery were correlated with serum albumin concentration and CONUT score. Physical function and skeletal muscle mass are associated with nutritional status, and hand grip strength might be more strongly associated with nutritional status.

Prognostic value of the controlling nutritional status (CONUT) score in intrahepatic cholangiocarcinoma patients especially who had long-time alcohol consumption

Our study is to investigate the preoperative prognostic value of the Controlling Nutritional Status score in intrahepatic cholangiocarcinoma patients after curative resection. One hundred and sixty-seven patients admitted to our hospital between January 2012 and December 2018 were included retrospectively. Time-dependent receiver operating characteristic (ROC) curve analysis was conducted to evaluate the ability of the Controlling Nutritional Status score to predict recurrence and survival. Patients with high Controlling Nutritional Status score (≥3) had significantly poorer RFS compared to those with low Controlling Nutritional Status score (low: <3) (p = 0.000) in Kaplan-Meier survival curve. Multivariate analyses identified Controlling Nutritional Status score, lymph node metastasis, tumor numbers and preoperative CEA as independent prognostic factors for RFS. Lymph node metastasis was the independent risk factor of OS. The Cox regression model with Controlling Nutritional Status score had better prognostic value for recurrence than the Cox regression model without Controlling Nutritional Status score in long-time alcohol consumption intrahepatic cholangiocarcinoma patients (AUC: 0.760 vs 0.706, p = 0.036). CONUT score may be a more powerful prognostic biomarker, which is tightly associated with other tumor characteristics, to predict recurrence but not survival, especially in long-time alcohol consumption intrahepatic cholangiocarcinoma patients after curative-intent surgery.

Nutritional and inflammatory measures predict survival of patients with stage IV colorectal cancer

Background

This study aimed to evaluate the prognostic impact of nutritional and inflammatory measures (controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and modified Glasgow prognostic score (mGPS)) on overall survival (OS) in patients with stage IV colorectal cancer (CRC).

Methods

Subjects were 996 patients with stage IV CRC who were referred to the National Cancer Center Hospital between 2001 and 2015. We retrospectively investigated correlations between OS and CONUT score, PNI, and mGPS. Multivariate analyses were performed using Cox proportional hazards regression models.

Results

After adjusting for known factors (age, gender, BMI, ECOG performance status, location of primary tumor, CEA levels, histological type, M category, and prior surgical treatment), all three measures were found to be independent prognostic factors for OS in patients with stage (CONUT score, p < 0.001; PNI, p < 0.001; mGPS, p < 0.001). Significant differences in OS were found between low CONUT score (0/1) (n = 614; 61%) and intermediate CONUT score (2/3) (n = 276; 28%) (hazard ratio (HR) = 1.20, 95% confidence interval (CI): 1.02–1.42, p = 0.032), and intermediate CONUT score and high CONUT score (≥4) (n = 106; 11%) (HR = 1.30, 95% CI: 1.01–1.67, p = 0.045). Significant differences in OS were found between mGPS = 0 (n = 633; 64%) and mGPS = 1 (n = 234; 23%) (HR = 1.84, 95% CI: 1.54–2.19, p < 0.001), but not between mGPS = 1 and mGPS = 2 (n = 129; 13%) (HR = 1.12, 95% CI: 0.88–1.41, p = 0.349). Patients with low PNI (< 48.0) (n = 443; 44%) showed a significantly lower OS rate than those with high PNI (≥48.0) (n = 553; 56%) (HR = 1.39, 95% CI: 1.19–1.62, p < 0.001).

Conclusions

CONUT score, PNI, and mGPS were found to be independent prognostic factors for OS in patients with stage IV CRC, suggesting that nutritional and inflammatory status is a useful host-related prognostic indicator in stage IV CRC.

The value of preoperative controlling nutritional status score in evaluating short-term and long-term outcomes of patients with colorectal cancer following surgical resection

Background: This study aimed to explore the value of controlling nutritional status (CONUT) score in assessing short-term and long-term outcomes of colorectal cancer (CRC) patients, and construct CONUT-based nomograms to predict risk of postoperative comorbidities and survival.

Methods: We retrospectively enrolled 512 patients from 2012 to 2014. Patients were categorized into low-CONUT and high-CONUT groups. Logistic regression analysis was used to determine characteristics influencing postoperative comorbidities. Kaplan-Meier survival curve and Cox proportional hazards analysis were used to determine characteristics affecting prognosis. The receiver operating characteristic was used to compare ability of the CONUT score with other immune-nutritional indicators to predict prognosis.

Results: Logistic regression analysis suggested that high CONUT score was an independent risk factor affecting postoperative comorbidities (odds ratio, 1.792; 95% confidence interval [CI], 1.113-2.886; P = 0.016). Patients with low-CONUT score had longer disease-free survival (DFS) (P < 0.001) and overall survival (OS) (P < 0.001) compared to those with high-CONUT score, especially at the early stage. CONUT score was an independent factor affecting both DFS (hazard ratio [HR], 1.820; 95% CI, 1.204-2.752; P = 0.005) and OS (HR, 1.815; 95% CI, 1.180-2.792; P = 0.007). The area under the curve of CONUT score was higher than for other immune-nutritional indicators. The CONUT-based nomograms had good predictive capability.

Conclusions: CONUT score is a strong independent predictor of postoperative comorbidities and long-term outcomes in CRC patients, and might be a better prognostic factor than other immune-nutritional indicators. The CONUT-based nomograms are conducive to the individualized formulation of follow-up strategies and treatment plans.

Prognostic role of pre-sarcopenia and body composition with long-term outcomes in obstructive colorectal cancer: a retrospective cohort study

Background

The clinical significance of pre-sarcopenia in colorectal cancer obstruction has not yet been described. The present study aimed to determine the short- and long-term oncologic impacts of pre-sarcopenia in obstructive colorectal cancer.

Methods

We retrospectively analyzed 214 patients with obstructive colon cancer between January 2004 and December 2013. Initial staging computed tomography (CT) scans identified pre-sarcopenia and visceral obesity by measuring the muscle and visceral fat areas at the third lumbar vertebra level. Both short-term postoperative and long-term oncologic outcomes were analyzed.

Results

Among all 214 patients, 71 (33.2%) were diagnosed with pre-sarcopenia. Pre-sarcopenia had a negative oncologic impact in both disease-free survival (DFS) and overall survival (OS), (hazard ratio [HR] = 1.86, 95% confidence interval [CI] 1.04–3.13, p = 0.037, and HR = 1.92, CI 1.02–3.60, p = 0.043, respectively). Visceral adiposity, body mass index (BMI), and neutrophil-lymphocyte ratio (NLR) did not significantly impact DFS and OS.

Conclusion

Pre-sarcopenia is a clinical factor significantly associated with OS and DFS but not with short-term complications in obstructive colorectal cancer. In future, prospective studies should incorporate body composition data in patient risk assessments and oncologic prediction tools.

Prognostic value of the controlling nutritional status (CONUT) score in intrahepatic cholangiocarcinoma patients especially who had long-time alcohol consumption

Our study is to investigate the preoperative prognostic value of the Controlling Nutritional Status score in intrahepatic cholangiocarcinoma patients after curative resection. One hundred and sixty-seven patients admitted to our hospital between January 2012 and December 2018 were included retrospectively. Time-dependent receiver operating characteristic (ROC) curve analysis was conducted to evaluate the ability of the Controlling Nutritional Status score to predict recurrence and survival. Patients with high Controlling Nutritional Status score (≥3) had significantly poorer RFS compared to those with low Controlling Nutritional Status score (low: <3) (p = 0.000) in Kaplan–Meier survival curve. Multivariate analyses identified Controlling Nutritional Status score, lymph node metastasis, tumor numbers and preoperative CEA as independent prognostic factors for RFS. Lymph node metastasis was the independent risk factor of OS. The Cox regression model with Controlling Nutritional Status score had better prognostic value for recurrence than the Cox regression model without Controlling Nutritional Status score in long-time alcohol consumption intrahepatic cholangiocarcinoma patients (AUC: 0.760 vs 0.706, p = 0.036). CONUT score may be a more powerful prognostic biomarker, which is tightly associated with other tumor characteristics, to predict recurrence but not survival, especially in long-time alcohol consumption intrahepatic cholangiocarcinoma patients after curative-intent surgery.

Controlling nutritional status (CONUT) score is a predictive marker for patients with traumatic brain injury

OBJECT

We designed this study to evaluate whether controlling nutritional status (CONUT) score was valuable in predicting outcome of patients with traumatic brain injury (TBI).

METHODS

Clinical and laboratory data of patients admitted with TBI in our hospital between January 2015 and January 2018 was retrospectively collected. We divided patients into two groups according to in-hospital and 90-day outcome respectively and compared baseline characteristics of two groups. Multivariate analyses were conducted to evaluate whether CONUT score was associated with outcome of included patients. Receiver operating characteristics (ROC) curves were drawn to compare the predictive value of CONUT score and constructed models.

RESULTS

A total of 365 patients were included in our study. Multivariate logistic regression analyses showed that CONUT score was independently associated with in-hospital mortality (OR = 1.244, 95% CI: 1.099-1.408, p = 0.001) and 90-day outcome (OR = 1.441, 95% CI: 1.193-1.741, p < 0.001). ROC curve showed that area under the ROC curve (AUC) of CONUT score for predicting in-hospital mortality and 90-day outcome were 0.790 (95% CI: 0.745-0.836, p < 0.001) and 0.839 (95% CI: 0.792-0.886, p < 0.001), respectively.

CONCLUSION

CONUT score is independently associated with in-hospital mortality and 90-day outcome of patients with TBI.