Preoperative controlling nutritional status as an optimal prognostic nutritional index to predict the outcome for colorectal cancer

BACKGROUND The controlling nutritional status(CONUT)score effectively reflects a patient’s nutritional status,which is closely related to cancer prognosis.This study invest-igated the relationship between the CONUT score and prognosis after radical surgery for colorectal cancer,and compared the predictive ability of the CONUT score with other indexes.AIM To analyze the predictive performance of the CONUT score for the survival rate of colorectal cancer patients who underwent potentially curative resection.METHODS This retrospective analysis included 217 patients with newly diagnosed colorectal.The CONUT score was calculated based on the serum albumin level,total lymphocyte count,and total cholesterol level.The cutoff value of the CONUT score for predicting prognosis was 4 according to the Youden Index by the receiver operating characteristic curve.The associations between the CONUT score and the prognosis were performed using Kaplan-Meier curves and Cox regression analysis.RESULTS Using the cutoff value of the CONUT score,patients were stratified into CONUT low(n=189)and CONUT high groups(n=28).The CONUT high group had worse overall survival(OS)(P=0.013)and relapse-free survival(RFS)(P=0.015).The predictive performance of CONUT was superior to the modified Glasgow prognostic score,the prognostic nutritional index,and the neutrophil-to-lymphocyte ratio.Meanwhile,the predictive performances of CONUT+tumor node metastasis(TNM)stage for 3-year OS[area under the receiver operating characteristics curve(AUC)=0.803]and 3-year RFS(AUC=0.752)were no less than skeletal muscle mass index(SMI)+TNM stage.The CONUT score was negatively correlated with SMI(P<0.01).CONCLUSION As a nutritional indicator,the CONUT score could predict long-term outcomes after radical surgery for colorectal cancer,and its predictive ability was superior to other indexes.The correlation between the CONUT score and skeletal muscle may be one of the factors that play a predictive role.

Effect of Jianpi Wenshen Granules on the Nutritional Control Status Score in Elderly Patients Undergoing Maintenance Hemodialysis

Objective:To explore the effect of Jianpi Wenshen Granules on the Controlling Nutritional Status(CONUT)score in elderly patients undergoing maintenance hemodialysis.Methods:Seventy elderly outpatients undergoing maintenance hemodialysis from January 2023 to January 2024 at the Blood Purification Centers of Taizhou Traditional Chinese Medicine Hospital and Taizhou Second People’s Hospital were selected as the study subjects.The patients were randomly divided into two groups:the study group and the control group,with 35 patients in each group.Both groups received maintenance hemodialysis,while the control group received only conventional Western medicine treatment,and the study group was additionally treated with Jianpi Wenshen Granules.The changes in biochemical and inflammatory markers before and after treatment were compared between the two groups.The nutritional status of the patients was assessed using the Controlling Nutritional Status(CONUT)score,and detailed statistics were gathered on anemia and albumin levels in both groups.Results:After treatment,the CONUT score in the study group significantly decreased compared to the control group,showing a significant correlation(P<0.05).Albumin and hemoglobin levels significantly increased,with a notable difference(P<0.05).There were no significant differences in alanine aminotransferase and aspartate aminotransferase levels between the two groups before and after treatment(P>0.05).Conclusion:In elderly patients undergoing maintenance hemodialysis,Jianpi Wenshen Granules improve the CONUT score and enhance nutritional status,demonstrating potential for clinical application and promotion.

Is nutritional status a new indicator to use in clinical practice for colorectal cancer patients?

In this editorial we comment on the interesting article by Liu et al.The topic of discussion is the need for a cost-effective and easy-to-use scoring system for predicting the prognosis of colorectal cancer patients.In this context,nutritional assessment plays a crucial role in the multimodal evaluation of patients.In particular,the controlling nutritional status score was found to be an effective tool in the clinical decision-making process,in order to customize treatment strategies and to improve patient outcomes.

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 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 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.

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.

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.

4个细菌菌株对小麦赤霉病的防治效果

用分离自不同地理环境的土壤、叶面芽孢杆菌及营养竞争球菌，对小麦赤霉病菌进行实验室抑菌、发酵试验和温室田间防效试验，结果证明ＹＮ１、ＧＪ６、ＳＮＳ１和Ｙ－１２４个菌株对小麦赤霉病均有显著防治作用。其中芽孢杆菌ＹＮ１、ＧＪ６对防治对象的分生孢于萌发、菌丝生长具有强烈的抑制作用；芽孢杆菌ＳＮＳ１具有使分生孢子芽管畸形和延缓菌丝生长的作用；营养竞争性球菌Ｙ－１２虽不具备抑制分生孢子萌发和菌丝生长的能力，但是田间试验表明其和ＹＮ１、Ｇ７６、ＳＮＳ１的防治水平与多菌灵的防效无显著差异（α＝０．０１）。因此，认为上述菌株均为防治小麦赤霉病有价值的生防菌株。