Prognostic significance of a combined and controlled nutritional status score and EBV-DNA in patients with advanced nasopharyngeal carcinoma:a long-term follow-up study

Objective:Several studies have reported that the controlling nutritional status(CONUT)score is a prognostic predictor for survival among patients with different types of cancer.We assessed the prognostic value of changes in the CONUT score during treatment and theΔCONUT-EBV DNA score in patients with advanced nasopharyngeal carcinoma(NPC).Methods:We retrospectively analyzed 433 patients with advanced NPC having no evidence of metastasis from January 2007 to June 2011;the patients underwent radical concurrent chemoradiotherapy(CCRT)at Sun Yat-sen University Cancer Center and were grouped based on theirΔCONUT andΔCONUT-EBV DNA scores.Kaplan-Meier curves were used to compare the patient outcomes according to the cut-offΔCONUT score and theΔCONUT-EBV DNA scoring system.Results:Among all patients,overall survival(OS)was independently predicted by a highΔCONUT score(P=0.031)and high EBV DNA(P<0.001).TheΔCONUT-EBV DNA score[OS area under the curve(AUC)=0.621;progression free survival(PFS)-AUC=0.612;distant metastasis-free survival(DMFS)-AUC=0.622]was more predictive of OS,PFS,and DMFS in patients with advanced NPC than theΔCONUT score(OS-AUC=0.547;PFS-AUC=0.533;DMFS-AUC=0.522)and pretreatment plasma EBV DNA levels alone(OS-AUC=0.600;PFS-AUC=0.591,DMFS-AUC=0.610).TheΔCONUT-EBV DNA score was significantly correlated with OS,PFS,and DMFS in patients with advanced NPC treated with CCRT.Conclusions:TheΔCONUT-EBV DNA score may be useful in clinical practice as a convenient biomarker for predicting the outcomes in patients with advanced NPC treated with CCRT.

Value of the controlling nutritional status score and psoas muscle thickness per height in predicting prognosis in liver transplantation

BACKGROUND Patients with end-stage liver disease usually have varying degrees of malnutrition,and severe malnutrition may affect the prognosis of patients after liver transplantation(LT).However,there is no recommended standard for the nutrition assessment of patients waiting for LT,and it is unknown whether malnutrition has an impact on the occurrence of postoperative complications.AIM The study aim was to investigate the value of the controlling nutritional status(CONUT)score and psoas muscle thickness per height(PMTH)in predicting prognosis in LT.METHODS We retrospectively analyzed the clinical data of 313 patients who underwent classic orthotopic LT from January 2016 to December 2018 in Tianjin First Central Hospital affiliated with Tianjin Medical University.The CONUT score is derived from the preoperative serum albumin and total cholesterol levels,and total lymphocyte count.Patients were divided into low(≤4),medium(5–8),and high(9–12)CONUT score groups perioperative characteristics,Clavien-Dindo grade III/IV/V postoperative complications,graft loss and infection,and cumulative postoperative survival in the three groups were compared 3 mo after LT.PMTH was calculated as the ratio of the transverse thickness of the psoas muscle in the umbilical plane to the height of the patient.The cutoff values of receiver operating characteristic curves were determined separately for men and women.The values were 14.1 cm/m2 for women and 17.9 cm/m2 for men.The patients were then divided into low and high PMTH groups by the cutoff values.The comparison of data between the two groups was the same as above.RESULTS Patients with medium and high CONUT scores had lower preoperative serum hemoglobin,more intraoperative red blood cell(RBC)transfusions,longer postoperative intensive care unit stay and hospital stays,higher 7 and 14 preoperative-day serum bilirubin levels,and a higher incidence of postoperative grade III/IV complications and infections than patients with low CONUT scores.Differences in the 3-mo cumulative survival among the three groups were not significant.Patients with a low PMTH had higher preoperative serum urea nitrogen,more intraoperative packed RBC and frozen plasma transfusions,longer times to postoperative ventilator extubation,higher incidence of total postoperative complications,and a lower 3-mo cumulative survival than those with a high PMTH.CONCLUSION A CONUT score≥5 and a low PMTH were both associated with poor prognosis in LT.The CONUT score had no predictive value for short-term patient survival after LT,but the PMTH was predictive of short-term patient survival after LT.

Prognostic value of serum carcinoembryonic antigen combined with nutritional status control score in patients with colorectal cancer

Objective To investigate the prognostic value of serum carcinoembryonic antigen(CEA)and controlling nutritional status(CONUT)score in patients with colorectal cancer.Methods We retrospectively studied 261 patients with colorectal cancer in our hospital.The patients were divided into two groups by CONUT=3 and CEA=5 ng/mL,and the effects of CONUT score and CEA level on the prognosis and clinicopathological parameters were statistically analyzed.Results(1)Different CONUT scores were significantly correlated with age,tumor diameter,differentiation type,and T stage(P<0.05).The older the patient was,the larger the tumor diameter,undifferentiated tumor,and T stage were,the higher the CONUT score was.(2)Seventy-five patients died during the follow-up period,and 45 patients died of progression or recurrence of colorectal cancer.The 5-year overall survival(OS)rate of the low CONUT score group was significantly higher than that of the high CONUT score group,and the 5-year OS rate of the low CEA group was significantly higher than that of the high CEA group;the difference was statistically significant(P<0.01).(3)According to the serum CEA level and CONUT score,the 5-year survival rates of CEAlow/CONUTlow,CEAlow/CONUThigh,CEAhigh/CONUTlow,and CEAhigh/CONUThigh were 84.7%,69%,55.3%,and 36.1%respectively,with statistical significance(P<0.01).(4)The Cox multivariate analysis showed that age,CONUT score,CEA combined with CONUT score,lymph node metastasis,and distant metastasis were independent risk factors for the prognosis of colorectal cancer patients.Conclusion:The combination of CEA detection and CONUT score can more accurately judge the prognosis of colorectal cancer patients.

Malnutrition Assessed Using the Geriatric Nutritional Risk Index Is Associated with Preoperative Incidence of Deep Vein Thrombosis in Japanese Patients Undergoing Total Knee Arthroplasty

Purpose: Few studies have evaluated the association between malnutrition and the risk of preoperative deep vein thrombosis (DVT) in patients undergoing primary total joint arthroplasty. This study aimed to investigate the prevalence of preoperative DVT in Japanese patients undergoing total knee arthroplasty (TKA) and the importance of malnutrition in the risk of preoperative DVT. Methods: We retrospectively analyzed 394 patients admitted for primary TKA at our institution between January 2019 and December 2023. All patients scheduled for TKA at our institution had serum D-dimer levels measured preoperatively. Lower-limb ultrasonography was examined to confirm the presence of DVT in patients with D-dimer levels ≥ 1.0 µg/mL or who were considered to be at high risk of DVT by the treating physician. Based on the results of lower-limb ultrasonography, all patients were divided into the non-DVT and DVT groups. The incidence of and risk factors for preoperative DVT were investigated, as well as the correlation of DVT with the patient’s nutritional parameters. We used two representative tools for nutritional assessment: the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status Score. Results: The mean age was 77.8 ± 6.9 years. Preoperative DVT was diagnosed in 57 of the 394 (14.5%) patients. Multivariate logistic regression analysis showed that advanced age and malnutrition status, assessed using the GNRI, were independent risk factors for preoperative DVT. Conclusion: A high incidence of preoperative DVT was observed in patients who underwent TKA. Malnutrition status, as assessed using the GNRI, increased the risk of preoperative DVT. Our findings suggest that clinicians should consider these factors when tailoring preventive strategies to mitigate DVT risk in patients undergoing TKA.

Prognostic value of Controlling Nutritional Status score for postoperative complications and biochemical recurrence in prostate cancer patients undergoing laparoscopic radical prostatectomy

Background:Controlling Nutritional Status(CONUT)score was used for screening the preoperative nutritional status.The correlation between the CONUT score and the prognosis of patients with prostate cancer(PCa)has yet to be elucidated.Herein,we analyzed the prognostic value of CONUT scores in patients with PCa who underwent laparoscopic radical prostatectomy.Materials and methods:Data of 244 patients were retrospectively evaluated.Perioperative variables and follow-up data were analyzed.The patients were categorized into 2 groups according to their preoperative CONUT scores.Postoperative complication and incontinence rates were also compared.The Kaplan-Meier method was used to estimate the median biochemical recurrence-free survival(BCRFS)between the 2 groups.Univariate and multivariate Cox regression analyses were performed to identify the potential prognostic factors for BCRFS.Results:Patients were categorized into the low-CONUT group(CONUT score<3,n=207)and high-CONUT group(CONUT score≥3,n=37).The high-CONUT group had a higher overall complication rate(40.5%vs.19.3%,p=0.004),a higher major complication rate(10.8%vs.3.9%,p=0.013),and longer postoperative length of stay(8 days vs.7 days,p=0.017).More fever,urinary infection,abdominal infection,scrotal edema,rash,and hemorrhagic events(all p values<0.05)were observed in the high-CONUT group.A higher rate of urinary incontinence was observed in the high-CONUT group at 1(34.4%vs.13.2%,p=0.030)and 3 months(24.1%vs.8.2%,p=0.023)postoperatively.The high-CONUT group had shorter medium BCRFS(23.8 months vs.54.6 months,p=0.029),and a CONUT score≥3 was an independent risk factor for a shorter BCRFS(hazards ratio,1.842;p=0.026).Conclusions:The CONUT score is a useful predictive tool for higher postoperative complication rates and shorter BCRFS in patients with PCa who undergo laparoscopic radical prostatectomy.

Prognostic value of preoperative immune-nutritional scoring systems in remnant gastric cancer patients undergoing surgery

BACKGROUND Remnant gastric cancer(GC)is defined as GC that occurs five years or more after gastrectomy.Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer(RGC)patients are crucial.A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary.AIM To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC.METHODS The clinical data of 54 patients with RGC were collected and analyzed retrospectively.Prognostic nutritional index(PNI),controlled nutritional status(CONUT),and Naples prognostic score(NPS)were calculated by preoperative blood indicators,including absolute lymphocyte count,lymphocyte to monocyte ratio,neutrophil to lymphocyte ratio,serum albumin,and serum total cholesterol.Patients with RGC were divided into groups according to the immune-nutritional risk.The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed.Cox regression and Kaplan–Meier analysis was performed to analyze the difference in overall survival(OS)rate between various immune-nutritional score groups.RESULTS The median age of this cohort was 70.5 years(ranging from 39 to 87 years).No significant correlation was found between most pathological features and immune-nutritional status(P>0.05).Patients with a PNI score<45,CONUT score or NPS score≥3 were considered to be at high immune-nutritional risk.The areas under the receiver operating characteristic curves of PNI,CONUT,and NPS systems for predicting postoperative survival were 0.611[95%confidence interval(CI):0.460–0.763;P=0.161],0.635(95%CI:0.485–0.784;P=0.090),and 0.707(95%CI:0.566–0.848;P=0.009),respectively.Cox regression analysis showed that the three immunenutritional scoring systems were significantly correlated with OS(PNI:P=0.002;CONUT:P=0.039;NPS:P<0.001).Survival analysis revealed a significant difference in OS between different immune-nutritional groups(PNI:75 mo vs 42 mo,P=0.001;CONUT:69 mo vs 48 mo,P=0.033;NPS:77 mo vs 40 mo,P<0.001).CONCLUSION These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC,in which the NPS system has relatively effective predictive performance.

基于CONUT、WPCBAL、PNI评分对终末期肺癌患者生存预测的比较分析

目的:探索控制营养状况(Controlling Nutritional Status,CONUT)评分、WPCBAL评分、预后营养指数(Prognostic Nutritional Index,PNI)等3种预后评分系统对晚期肺癌患者生存时间的预测效能。方法:收集2018年12月—2021年12月在山东省第一医科大学附属肿瘤医院住院期间发生死亡,且具有评估所需全部数据的138例晚期肺癌患者的相关资料,进行回顾性分析。3个评分系统不同组别人群生存期差异的比较采用Log-rank检验,评估系统对终末期肺癌患者2周生存期的预测效能用受试者工作特征(ROC)曲线进行评价。结果:138例终末期肺癌患者的中位年龄为63.5岁,末次入院的中位生存时间为14 d,2周死亡率为51.4%。Log-rank检验结果显示,CONUT≥5分组的生存时间比CONUT<5分组更短,差异有统计学意义(11 d vs 16 d,P=0.046);WPCBAL≥5分组的生存时间比WPCBAL<5分组更短,差异有统计学意义(8 d vs 16 d,P=0.002)。ROC曲线显示,CONUT、WPCBAL对晚期肺癌患者2周生存状态的预测有一定价值,ROC曲线下面积分别为0.613、0.677。CONUT评分以5为截点时,预测晚期肺癌患者2周生存期的灵敏度、特异度分别为0.61、0.54;WPCBAL评分以5为截点时,预测晚期肺癌患者2周生存期的灵敏度、特异度分别为0.76、0.54。结论:CONUT评分、WPCBAL评分对预测晚期肺癌患者短期生存状态有一定价值,但特异度相对较低,仍需进一步研究。

术前CONUT评分联合HRR可帮助评估接受肾输尿管根治术UTUC患者的预后

目的探讨术前控制营养状况(CONUT)评分与血红蛋白和红细胞分布宽度比值(HRR)对上尿路尿路上皮癌(UTUC)患者根治术后生存的预测价值。方法回顾性分析2011年5月—2017年6月在徐州医科大学附属医院行手术治疗的145例UTUC患者。收集患者的临床病理资料,应用受试者工作特征曲线(ROC)确定CONUT评分和HRR的最佳截断值并进行分组,建立CONUT-HRR评分系统。比较不同CONUT-HRR评分与UTUC患者临床病理指标的相关性,采用Kaplan-Meier生存曲线和Cox比例风险回归模型评估CONUT-HRR评分在UTUC患者预后预测中的应用价值。结果术前CONUT评分和HRR预测患者肿瘤特异性生存期(CSS)的最佳截断值分别为3和10.41。将患者分为3组:CONUT-HRR 0分组62例(CONUT评分<3分且HRR≥10.41);CONUT-HRR 1分组51例(CONUT评分<3分且HRR<10.41,或者CONUT评分≥3分且HRR≥10.41);CONUT-HRR 2分组32例(CONUT评分≥3分且HRR<10.41)。CONUT-HRR评分与年龄、手术方式、病理T分期、淋巴结转移和脉管浸润情况有关(P均<0.05)。Kaplan-Meier生存曲线结果显示,CONUT-HRR 0分、1分和2分组的5年CSS率分别为96.4%、65.8%和30.9%,组间差异均具有统计学意义(P<0.001)。Cox回归模型分析显示,CONUT-HRR评分、病理T分期、淋巴结转移和脉管浸润是UTUC患者CSS的独立影响因素。结论术前CONUT-HRR评分可作为一项评估UTUC患者预后简便且可靠的指标,评分越高,提示患者预后越差。

术前CONUT评分预测HBV相关的HCC患者术后生存率

目的了解控制营养状况(controlling nutritional status,CONUT)评分预测乙型肝炎病毒(HBV相关的肝细胞性肝癌(HCC)患者术后总体生存率的能力,并将与常用分期评分标准进行比较。方法回顾性分析温州医科大学附属第一医院2007年1月至2013年6月收治的373例HBV相关的HCC患者临床资料。生成受试者工作特征曲线(ROC),并计算曲线下面积(AUC),评估不同评分系统辨别1、3、5年存活率的能力。再将患者分为高CONUT组(CONUT>2,n=15)和低CONUT组(CONUT≤2,n=216),比较两组的临床病理特征及术后总生存期(OS)的差异,通过Cox模型进行单因素、多因素分析,明确影响患者预后的独立危险因素。结果 ROC曲线下面积比较显示,CONUT的AUC值始终较高。低CONUT组的5年OS高于高CONUT组(P<0.05)。将临床病理特征以及CONUT和CLIP评分等进行OS的单因素和多因素分析,结果显示,CLIP评分(P=0.004,HR 1.400,95%CI 1.113~1.762),纤维蛋白原<1 g/L或>4 g/L(P=0.002,HR 1.976,95%CI 1.272~3.072),TNM分期(P=0.003,HR 1.767,95%CI 1.212~2.575)和CONUT>2(P=0.010,HR 1.697,95%CI 1.132~2.544)为患者预后的独立危险因素。结论 CONUT>2分可以作为HBV相关HCC患者预后的独立危险因素;在与Okuda评分、CLIP评分、BCLC分期评分标准比较中,CONUT具有更好的预测价值。

简化营养评分应用于老年严重肢体缺血病人的营养筛查

目的:运用老年营养风险指数(GNRI)和控制营养状态评分(CONUT)评估老年严重肢体缺血(CLI)病人的营养状况,探讨老年CLI病人的营养状况以及GNRI和CONUT的应用价值。方法:选取2016年1月至2021年5月入院进行血管腔内治疗(EVT)的107名年龄≥55岁的CLI病人为研究对象,根据GNRI评分对病人进行营养分级,分为中高、低和无风险组,根据CONUT评分分为中重度、轻度和正常组。分析营养指标与营养评分的相关性。结果:107名病人中,根据GNRI评分,中高、低、无风险组病人分别占33%、22%和45%;中高组病人HGB、CHOL、LDL-C、TG和PA显著低于无风险组病人,中高组的TG和PA也明显小于低组,差异有统计学意义(P<0.05)。而CONUT评分中,中重度、轻度组和正常组病人分别占20%、51%和29%。中重度组的HGB、LDL-C、PA明显低于正常组和轻度组的病人,中重度组的TG和HDL-C显著低于正常组,差异有统计学意义(P<0.05)。基于GNRI和CONUT评分发现GNRI的两组病人在慢性肾衰竭(CKD 4-5)的患病率上有明显差异(P<0.05),其余临床特征无明显差异(P>0.05)。相关性分析结果显示,CONUT评分与HGB、TG、HDL-C、LDL-C,PA呈负相关,与Cre呈正相关。GNRI与HGB、CHOL、TG、LDL-C以及PA呈正相关(P<0.05)。结论:临床工作者应该重视对CLI病人的营养筛查,GNRI和CONUT是便捷有效的营养筛查工具,值得推广到临床应用。

控制营养状态评分在乙肝肝硬化中的临床价值

目的 基于控制营养状态(CONUT)评分,探讨肝硬化患者中营养不良情况,并分析该评分与乙肝肝硬化患者临床指标之间的关系。方法 以2020年1月至2022年8月在山东大学齐鲁医院住院的298例乙肝相关肝硬化患者为研究对象,回顾性收集患者入院后的首次检验资料,以CONUT评分评估患者的营养状况,与以体质量指数(BMI)、白蛋白(ALB)为标准的评估情况进行对比。结果 应用CONUT评分,298例肝硬化患者存在不同程度的营养不良,其中轻度营养不良的有68例(22.82%),中度营养不良的有176例(59.06%),重度营养不良的有54例(18.12%);在不同Child分级中,CONUT评分的分布差异有统计学意义。结论 肝硬化患者存在不同程度的营养不良,CONUT评分与肝硬化患者的临床分级严重程度密切相关,并且可以指导临床治疗。