Preoperative controlling nutritional status (CONUT) score as a predictor of long-term outcome after curative resection followed by adjuvant chemotherapy in stage II-III gastric Cancer

Xuechao Liu,Yongming Chen,Yingbo Chen,Deyao Zhang,Enzi Lin,Xiaowei Sun,Wei Li,Zhiwei Zhou

doi:10.1186/s12885-018-4616-y

Abstract

BackgroundThe prognostic value of preoperative controlling nutritional status (CONUT) has been reported in many malignancies. In present study, we aimed to clarify the prognostic impact of CONUT in gastric cancer (GC) receiving curative resection and adjuvant chemotherapy.MethodsWe retrospectively reviewed 697 consecutive patients undergoing curative surgery followed by adjuvant chemotherapy for Stage II-III GC between November 2000 and September 2012. Patients were classified into high (≥3) and low (≤2) CONUT groups according to the receiver operating characteristic (ROC) analysis.ResultsOf the included patients, 217 (31.1%) belonged to the high CONUT group. The high CONUT group had a significantly lower 5-year cancer-specific survival (CSS) rate than the low CONUT group (39.3 vs. 55.5%, P < 0.001). High CONUT score was significantly associated with larger tumor size, more lymph node metastasis, and poorer nutritional status, including lower body mass index (BMI), higher prognostic nutritional index (PNI) and the presence of preoperative anemia (all P < 0.05). Multivariate analysis revealed that CONUT score was an independent prognostic factor (HR: 1.553; 95% CI: 1.080–2.232; P = 0.017). Of note, in the low PNI group, CONUT score still effectively stratified CSS (P = 0.016). Furthermore, the prognostic significance of CONUT score was also maintained when stratified by TNM stage (all P < 0.05).ConclusionsCONUT score is considered a useful nutritional marker for predicting prognosis in stage II-III GC patients undergoing curative resection and adjuvant chemotherapy, and may help to facilitate the planning of preoperative nutritional interventions.

Highlights

The prognostic value of preoperative controlling nutritional status (CONUT) has been reported in many malignancies
According to the nutritional status in CONUT score, the patients were divided into four groups: none (261 patients, 37.4%), light (396 patients, 56.8%), moderate (39 patients, 5.6%), and severe
When stratified by TNM stage, the prognostic significance of CONUT score was maintained in patients with stage II (P = 0.048) and stage III (P < 0.001) gastric cancer (GC)

Summary

Introduction

The prognostic value of preoperative controlling nutritional status (CONUT) has been reported in many malignancies. There is increasing interest for clinicians to identify prognostic factors for tailored treatment One such factor that has arisen substantial attention is the nutritional and immunological status, which is reported to be associated with the clinical outcomes in various malignancies [4,5,6]. The controlling nutritional status (CONUT) score, another screening tool for nutritional status, is calculated from the serum albumin concentration, total cholesterol level and total peripheral lymphocyte count, which are representative markers of protein reserves, calorie deficiency, and impaired immune defenses, respectively [10]. Serum albumin concentration is a major indicator of nutritional status and an important determinant of the immune response. The combination of the three components into CONUT may better reflect the balance of nutritional status and enhance the ability to accurately predict general condition

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