High CONUT score predicts poor survival and postoperative HBV reactivation in HBV-related hepatocellular carcinoma patients with low HBV-DNA levels

Abstract

BackgroundPostoperative hepatitis B virus (HBV) reactivation (PHR) is associated with resection-induced immunosuppression in patients with HBV-related hepatocellular carcinoma (HCC). Controlling Nutritional Status (CONUT) score is an effective index for evaluating immune-nutrition function. However, the value of COUNT in predicting PHR in HBV-HCC patients remains unknown. MethodsTotally, 209 HCC patients were enrolled. ResultsPreoperative immune function (CD3+CD4+, CD3+CD8+, IgG and IgM) in patients with high CONUT score was significantly worse than that in patients with low CONUT score (P<0.05). Blood test results on postoperative day 7 showed the same trend. In addition, patients with high CONUT score experienced a significantly larger decrease in the proportions of CD3+CD4+ and CD3+CD8+ than those with low CONUT score (P < 0.05). In patients with high CONUT score, the incidence of overall complications was also significantly higher (P = 0.029) and hospital-stay was significantly longer (P = 0.020). Besides, overall survival and recurrence free survival in patients with high CONUT score were significantly worse than those in patients with low CONUT score (48.32 vs. 38.12 months, P<0.001; 36.08 vs. 27.03 months, P = 0.001). The incidence of PHR was significantly higher in patients with high COUNT score (P<0.001), and CONUT score was strongly associated with PHR (P<0.001). Additionally, the fellow subgroup results also demonstrated that COUNT score was more effective in predicting PHR in patients with HBV-DNA level <500 copies/ml than patients with HBV-DNA 500–1000 copies/ml. ConclusionCONUT score is an effective indicator predicting survival and PHR in HBV-HCC patients, especially in those with HBV-DNA levels <500 copies/ml.