Predictive value of CONUT score combined with serum CA199 levels in postoperative survival of patients with pancreatic ductal adenocarcinoma: a retrospective study

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BackgroundCurrently, many nutritional indicators, including controlling nutritional status score (CONUT), can be used to assess a patient’s nutritional status and have been reported as reliable predictors of multiple malignancies. However, the value of CONUT score in predicting postoperative outcomes in patients with hilar cholangiocarcinoma has not been explored. In this study, its predictive value will be discussed and compared with the known predictors the neutrophil lymphocyte ratio (NLR) and prognostic nutritional index (PNI).MethodsPreoperative CONUT scores, PNI and NLR levels of 94 Hilar cholangiocarcinoma (HCCA) patients who underwent radical-intent resection of hepatobiliary surgery in our hospital from March 2010 to April 2019 were retrospectively collected and analyzed. They were grouped according to their optimal cutoff value and the prognostic effects of patients in each group were compared respectively.ResultsCONUThigh was more frequent in patients with Clavien–Dindo classification of ≥IIIa (P = 0.008) and Bile leakage presence (P = 0.011). Kaplan-Meier curves analyzing the relationship between CONUT, PNI, and NLR values and HCCA patient survival (including total survival (OS) and recurrence-free survival (RFS) showed significant differences between groups (P <0.001). Meanwhile, multi-factor analysis found that Degree of cure, PNI, NLR, and preoperative CONUT score were independent prognostic factors for OS and RFS. The predictive power of CONUT score was higher than that of NLR and PNI based on time-dependent receiver operating Characteristic (ROC) analysis and the net reclassification index (NRI) and integrated discriminatory index (IDI) values (P < 0.05).ConclusionCONUT score may be of some clinical reference value in evaluating postoperative prognosis of HCCA patients.

Section: Introductionmentioning

confidence: 99%

Controlling Nutritional Status (CONUT) Score as a New Indicator of Prognosis in Patients With Hilar Cholangiocarcinoma Is Superior to NLR and PNI: A Single-Center Retrospective Study

Wang

Peng

et al. 2021

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“…The baseline characteristics of the seven included studies are presented in Table 2 . Four studies were conducted in Japan ( 9 , 10 , 13 , 16 ), and three were performed in China ( 12 , 14 , 15 ). The sample size ranged from 72 to 589, with a median of 307.…”

Section: Resultsmentioning

confidence: 99%

“…The sample size ranged from 72 to 589, with a median of 307. Six studies were retrospective ( 9 , 10 , 12 – 14 , 16 ), and one was prospective ( 15 ). All studies included patients with pancreatic ductal adenocarcinoma (PDAC).…”

Section: Resultsmentioning

confidence: 99%

Prognostic Value of Pretreatment Controlling Nutritional Status Score for Patients With Pancreatic Cancer: A Meta-Analysis

Zou

Sun

2022

BackgroundPrevious studies have explored the prognostic value of the pretreatment Controlling Nutritional Status (CONUT) score of patients with pancreatic cancer. However, the results of those studies were inconsistent. We used meta-analysis to investigate the impact of the CONUT score on the prognosis for patients with pancreatic cancer.MethodsWe thoroughly searched the PubMed, Web of Science, Embase, and Cochrane Library databases for relevant articles from inception to November 19, 2021. Combined hazard ratios (HRs) and 95% confidence intervals (95% CIs) were used to estimate the prognostic value of the CONUT score with respect to survival duration. The pooled odds ratios (ORs) and 95% CIs were used to estimate the correlation between the CONUT score and clinical characteristics.ResultsThe database search found seven studies with 2,294 patients for inclusion in this meta-analysis. A high CONUT score was significantly associated with poor overall survival (OS) (HR = 1.56, 95% CI = 1.13–2.16, p = 0.007), but not with recurrence-free survival (RFS) (HR = 1.47, 95% CI = 0.97–2.23, p = 0.072) of patients with pancreatic cancer. Moreover, there was a significant association between an elevated CONUT score and male patients (OR = 1.34, 95% CI = 1.03–1.75, p = 0.029). However, there was no significant association between the CONUT score and the clinical stage (OR = 1.11, 95% CI = 0.46–2.71, p = 0.576), lymph node metastasis (OR = 0.73, 95% CI = 0.39–1.36, p = 0.323), lymphatic vessel invasion (OR = 0.84, 95% CI = 0.55–1.28, p = 0.411), invasion of the portal vein system (OR = 1.04, 95% CI = 0.51–2.13, p = 0.915), and nerve plexus invasion (OR = 1.22, 95% CI = 0.83–1.80, p = 0.318) in patients with pancreatic cancer.ConclusionsThe results of our meta-analysis indicate that a high CONUT score predicts a poor OS in patients with pancreatic cancer. The CONUT score may be an effective prognostic factor in pancreatic cancer in clinical practice.

“…Previous studies have identified that CA19-9 is a reliable and validated indicator for predicting prognosis of patients with pancreatic cancer (23,24). Also, Wang et al (25) proved that serum CA19-9 levels may act as an independent factor to predict postoperative survival of patients with PDAC. Therefore, CA19-9 which is included in our model could increase specificity and sensitivity of the nomogram.…”

Section: Discussionmentioning

confidence: 98%

Development and Validation of a Nomogram Based on Nutritional Indicators and Tumor Markers for Prognosis Prediction of Pancreatic Ductal Adenocarcinoma

Zhou

Cao

et al. 2021

PurposeThis study aimed to develop and validate a nomogram with preoperative nutritional indicators and tumor markers for predicting prognosis of patients with pancreatic ductal adenocarcinoma (PDAC).MethodsWe performed a bicentric, retrospective study including 155 eligible patients with PDAC. Patients were divided into a training group (n = 95), an internal validation group (n = 34), an external validation group (n = 26), and an entire validation group (n = 60). Cox regression analysis was conducted in the training group to identify independent prognostic factors to construct a nomogram for overall survival (OS) prediction. The performance of the nomogram was assessed in validation groups and through comparison with controlling nutritional status (CONUT) and prognostic nutrition index (PNI).ResultsThe least absolute shrinkage and selection operator (LASSO) regression, univariate and multivariate Cox regression analysis revealed that serum albumin and lymphocyte count were independent protective factors while CA19-9 and diabetes were independent risk factors. The concordance index (C-index) of the nomogram in the training, internal validation, external validation and entire validation groups were 0.777, 0.769, 0.759 and 0.774 respectively. The areas under curve (AUC) of the nomogram in each group were 0.861, 0.845, 0.773, and 0.814. C-index and AUC of the nomogram were better than those of CONUT and PNI in the training and validation groups. The net reclassification index (NRI), integrated discrimination improvement (IDI) and decision curve analysis showed improvement of accuracy of the nomogram in predicting OS and better net benefit in guiding clinical decisions in comparison with CONUT and PNI.ConclusionsThe nomogram incorporating four preoperative nutritional and tumor markers including serum albumin concentration, lymphocyte count, CA19-9 and diabetes mellitus could predict the prognosis more accurately than CONUT and PNI and may serve as a clinical decision support tool to determine what treatment options to choose.