Abstract
Postoperative pulmonary complications (PPCs) significantly impact surgical outcome. We investigated the predictive ability of controlling nutritional status (CONUT) for PPC after lung resection in patients with non-small cell lung cancer (NSCLC). We retrospectively reviewed data of 922 patients with NSCLC who underwent complete resection from January 2016–December 2017. We analyzed the frequency and characteristics of PPCs and compared receiver operating characteristic (ROC) curves of various prognostic models to predict PPCs. A CONUT score higher than 1 was considered as a high CONUT score. Total incidence of PPCs was 8.6% (n = 79). The proportion of pneumonia was significantly larger in the high CONUT group (P < 0.05). The CONUT consistently had a higher area under curve (AUC) value (0.64) than other prognostic models (prognostic nutritional index (PNI): AUC = 0.61, Glasgow prognostic score (GPS): AUC = 0.57, and assessment of respiratory risk in surgical patients in Catalonia (ARISCAT): AUC = 0.54). Multivariate analysis identified underweight [Odds ratio (OR) = 4.57, P = 0.002] and high CONUT score (OR = 1.91, P = 0.009) as independent PPCs prognostic factors. One-year mortality rate for high CONUT score was significantly higher (hazard ratio = 7.97; 95% confidence interval, 1.78–35.59). Preoperative CONUT score is an independent predictor of PPCs and 1-year mortality in patients with resectable NSCLC.
Highlights
Postoperative pulmonary complications (PPCs) significantly impact surgical outcome
We evaluated the ability of controlling nutritional status (CONUT), prognostic nutritional index (PNI), Glasgow prognostic score (GPS), and ARISCAT scores to predict PPCs using the receiver operating characteristic (ROC) curve
We analyzed the relationship between CONUT status and 1-year mortality; we found that 1-year mortality was higher in the high CONUT group compared to the low CONUT group (15 of 555 [2.7%] vs. 4 of 367 [0.1%], P < 0.001)
Summary
Postoperative pulmonary complications (PPCs) significantly impact surgical outcome. We investigated the predictive ability of controlling nutritional status (CONUT) for PPC after lung resection in patients with non-small cell lung cancer (NSCLC). It has been shown that systemic inflammation-based prognostic scores, such as the prognostic nutritional index (PNI) and Glasgow prognostic score (GPS), have independent prognostic value regardless of tumor stage in various malignancies, including non-small cell lung cancer (NSCLC)[7,8,9,10,11]. Similar to these inflammation-based prognostic scores, the controlling nutritional status (CONUT) score, which is calculated using serum albumin, total cholesterol, and total peripheral lymphocyte count, was suggested as a screening tool for early detection of under-nutrition[12]. Previous studies have demonstrated its relationship with long-term clinical outcomes in various malignancies[13,14,15,16,17,18]
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