Validation of the preoperative controlling nutritional status score as an independent predictor in a large Chinese cohort of patients with upper tract urothelial carcinoma

Abstract

BackgroundPretreatment controlling nutritional status (CONUT) score is a novel index which was used to predict outcomes in cancer patients. We aim to explore the prognostic significance of CONUT score in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).Patients and methodsA total of 662 UTUC patients between 2004 and 2016 were retrospectively analyzed. Patients were categorized into three groups based on CONUT score (Normal: 0‐1; Light: 2‐4; Moderate/severe: 5‐12). Associations of CONUT score with oncological outcomes were analyzed using Logistic and Cox regression analysis. Harrell concordance index was used to assess the predictive accuracy of the multivariate models. Subgroup analyses were conducted according to tumor grade and stage.ResultsThe median follow‐up duration was 41 months. Multivariate Logistic analysis showed that high CONUT score was independently associated with high‐grade disease, high pT stage, lymphovascular invasion, sessile carcinoma, variant histology, and positive surgical margins (each P < 0.05). Multivariate analysis demonstrated that CONUT score 5‐12 was an independent factor for worse cancer‐specific survival (CSS, hazard ratio [HR]:2.39, 95% confidence interval [CI] 1.55‐3.68, P < 0.0001), disease recurrence‐free‐survival (RFS, HR: 1.80, 95% CI 1.24‐2.60, P = 0.002), and overall survival (OS, HR: 2.26, 95% CI 1.53‐3.34, P < 0.0001). The estimated c‐index of the multivariate models for CSS, RFS, and OS increased from 0.755, 0.715 and 0.745 to 0.772, 0.723, and 0.756 when CONUT score supplemented. Subgroup analyses showed that especially in patients with high‐grade carcinoma and advanced stage (≥pT3), higher CONUT score predicts decreased CSS, RFS, and OS (all P < 0.05).ConclusionPreoperative CONUT score is a negative independent prognostic indicator for both pathologic and survival outcomes in UTUC, especially in those with high‐grade carcinoma and advanced stage. Adding this parameter into our clinical prediction model is appropriate so as to improve its predictive accuracy.

Clinical impact of controlling nutritional status score on the prognosis of patients with diffuse large B‐cell lymphoma

“…Controlling nutritional status (CONUT) score is a simplified nutritional index used to detect malnutrition and is calculated from serum albumin and total cholesterol levels and total lymphocyte counts. 22 Although it has been shown to have prognostic value for several cancers, heart disease, and cerebral hemorrhage, [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] there have been no studies evaluating its clinical impact on patients with DLBCL.…”

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

“…Many immune-nutritional indicators, such as prognostic nutrition indicator (PNI) 7 , neutrophil/lymphocyte ratio (NLR) 8 , and platelet/lymphocyte ratio (PLR) 9 , have been reported as useful prognostic indicators in CRC patients. Recently, controlling nutritional status (CONUT) score 10 , a newly proposed immune-nutritional related index, has been reported to be closely related to the prognosis of various tumors including gastric cancer 11 , CRC 12 , esophageal cancer 13 , upper tract urothelial carcinoma 14 , and hepatocellular carcinoma 15 . CONUT score comprises serum albumin, total cholesterol concentration and lymphocyte count, which respectively reflect host nutritional status, lipid metabolism and immune function.…”

Prognostic significance of pretreatment controlling nutritional status score in urological cancers: a systematic review and meta‐analysis

“…1 ). Finally, 12 articles with 13 studies were included for meta-analysis [ 15 – 18 , 22 – 29 ]. The features of the 13 studies were outlined in Table 2 .…”