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Lu G, Li Q. The controlling nutritional status score as a predictor of survival in hematological malignancies: a systematic review and meta-analysis. Front Nutr 2024; 11:1402328. [PMID: 38938670 PMCID: PMC11208478 DOI: 10.3389/fnut.2024.1402328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Objective The controlling nutritional status score (CONUT) has been widely used for ascertaining the prognosis of various cancers. However, its use in patients with hematological malignancies remains unclear. This review examined evidence on the utility of CONUT as a prognostic marker for patients with hematological malignancies. Methods All cohort studies that examined the association between CONUT and outcomes of hematological malignancies and were published on the databases of Embase, Scopus, CENTRAL, Web of Science, and PubMed were searched from the inception of the databases to 30 January 2024. The primary outcome was overall survival (OS), and the secondary outcome was progression-free survival (PFS). Results A total of 23 studies were available for review. A meta-analysis of 22 studies showed that high CONUT was significantly associated with poor OS in patients with hematological malignancies (HR: 1.95 95% CI: 1.62, 2.35 I 2 = 89%). The results remained unchanged on sensitivity and subgroup analyses based on study location, sample size, diagnosis, CONUT cutoff, and the Newcastle-Ottawa Scale score. Only six studies reported data on PFS, and the pooled analysis found that high CONUT was a significant marker for poor PFS in patients with hematological malignancies [hazards ratio (HR): 1.64 95% CI: 1.21, 2.20 I 2 = 70%]. These results, too, maintained significance in the sensitivity analysis. Conclusion CONUT is an independent predictor of poor OS in patients with hematological malignancies. The results appear to be valid across different cancer types and with different CONUT cutoffs. Scarce data also suggest that CONUT could predict PFS.
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Affiliation(s)
- Guimei Lu
- Department of Laboratory, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Qingqing Li
- Department of Endoscopy, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
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Jiao H, Wang L, Zhou X, Wu J, Li T. Prognostic Ability of Nutritional Indices for Outcomes of Bladder Cancer: A Systematic Review and Meta-Analysis. Urol Int 2023; 107:886-894. [PMID: 37643581 DOI: 10.1159/000531884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Nutrition has become an important parameter influencing the prognosis of several cancers. However, its impact on outcomes for bladder cancer (BC) is still unclear. This review examines the association between three commonly used nutritional indices, namely, the prognostic nutritional index (PNI), controlling nutritional status (CONUT), and the geriatric nutritional risk index (GNRI) and outcomes of BC. METHODS PubMed, CENTRAL, Scopus, Web of Science, Embase, and Google Scholar were explored for studies published up to April 13, 2023. Data from studies were pooled to examine the association between PNI, CONUT, or GNRI and overall survival (OS) and recurrence-free survival (RFS). RESULTS Thirteen studies were included. Meta-analysis demonstrated significantly poor OS with low PNI versus high PNI in BC patients (hazard ratio [HR]: 1.71; 95% confidence interval [CI]: 1.37, 2.14; I2 = 0%). This result remained significant in various subgroup analyses. However, no association was noted between PNI and RFS (HR: 1.22; 95% CI: 0.67, 2.24; I2 = 84%). Meta-analysis showed that patients with high CONUT scores had significantly poor OS (HR: 2.43; 95% CI: 1.82, 3.25; I2 = 0%) as well as RFS (HR: 2.90; 95% CI: 2.10, 4.01; I2 = 0%). Data on GNRI were scarce and conflicting. CONCLUSION Limited data show that PNI and CONUT are predictive of outcomes in BC. Low PNI was associated with poor OS, while high CONUT was associated with poor OS and RFS. Data on GNRI are too scarce to obtain conclusions. Further studies are needed to supplement the results.
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Affiliation(s)
- Huijie Jiao
- Department of Urology, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, China
| | - Lin Wang
- Department of Urology, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, China
| | - Xiaomei Zhou
- Department of Urology, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, China
| | - Jiacheng Wu
- Department of Urology, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, China
| | - Tiantian Li
- Department of Urology, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, China
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Di Vincenzo O, D'Elia L, Ballarin G, Pasanisi F, Scalfi L. Controlling Nutritional Status (CONUT) score and the risk of mortality or impaired physical function in stroke patients: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2023; 33:1501-1510. [PMID: 37336716 DOI: 10.1016/j.numecd.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/07/2023] [Accepted: 05/09/2023] [Indexed: 06/21/2023]
Abstract
AIMS The Controlling Nutritional Status (CONUT) score is a tool for assessing the risk of malnutrition (undernutrition) that can be calculated from albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration. CONUT score has been proposed as a promising prognostic marker in several clinical settings; however, a consensus on its prognostic value in patients with stroke is lacking. The aim of this systematic review and meta-analysis was to evaluate the relationship between CONUT score and clinical outcomes in patients with stroke based on all current available studies. DATA SYNTHESIS Systematic research on PubMed, Scopus and Web of Science from inception to February 2023 was performed on the association between CONUT score and clinical outcomes in patients with stroke. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Methodological quality was evaluated using the Newcastle-Ottawa Scale quality assessment tool. Pooled effect estimation was calculated by a random-effect model. Through the initial literature search, 15 studies (all high-quality) including 16 929 patients were found to be eligible and analysed in the meta-analysis. A significant risk of malnutrition (in most studies defined by a CONUT score ≥5) was directly associated with mortality, higher risk of poor functional outcome according to the modified Rankin Scale and total infection development. Evidence was consistent for acute ischaemic stroke and preliminary for acute haemorrhagic stroke. CONCLUSION CONUT score is an independent prognostic indicator, and it is associated with major disability and infection development during hospitalisation. PROSPERO ID CRD42022306560.
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Affiliation(s)
- Olivia Di Vincenzo
- Department of Public Health, School of Medicine, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery School of Medicine, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giada Ballarin
- Department of Movement Sciences and Wellbeing, "Parthenope" University, Via Ammiraglio Ferdinando Acton 38, 80133, Naples, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery School of Medicine, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Luca Scalfi
- Department of Public Health, School of Medicine, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
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Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022. World J Surg 2023; 47:11-34. [PMID: 36310325 PMCID: PMC9726826 DOI: 10.1007/s00268-022-06732-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature. METHODS A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system. RESULTS A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy. CONCLUSIONS These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.
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Liu H, Yang XC, Liu DC, Tong C, Wen W, Chen RH. Clinical significance of the controlling nutritional status (CONUT) score in gastric cancer patients: A meta-analysis of 9,764 participants. Front Nutr 2023; 10:1156006. [PMID: 37113291 PMCID: PMC10126262 DOI: 10.3389/fnut.2023.1156006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Background The clinical value of the controlling nutritional status (CONUT) score has been widely reported in multiple malignancies. The aim of this study is to investigate the association between the CONUT score and clinical outcomes in patients with gastric cancer. Methods A comprehensive literature search of electronic databases including PubMed, Embase, and Web of Science was performed up to December 2022. The primary endpoints were survival outcomes and postoperative complications. Subgroup analysis and sensitivity analysis were performed during the pooled analysis. Results Nineteen studies including 9,764 patients were included. The pooled results indicated that patients in the high CONUT group had a worse overall survival (HR = 1.70 95%CI: 1.54-1.87; P < 0.0001; I 2 = 33%) and recurrence-free survival (HR = 1.57; 95%CI: 1.36-1.82; P < 0.0001; I 2 = 30%), and a higher risk of complications (OR = 1.96; 95%CI: 1.50-2.57; P < 0.0001; I 2 = 69%). In addition, a high CONUT score was significantly associated with larger tumor size, higher percentage of microvascular invasion, later TNM stage and fewer patients receiving adjuvant chemotherapy, but not with tumor differentiation. Conclusion Based on existing evidence, the CONUT score could act as a valuable biomarker to predict clinical outcomes in patients with gastric cancer. Clinicians could use this useful indicator to stratify patients and formulate individual treatment plans.
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Affiliation(s)
- Hui Liu
- Department of Interventional Radiology, Xiangya School of Medicine Affiliated Haikou Hospital, Central South University, Haikou, Hainan, China
| | - Xiao-Chuan Yang
- Department of Interventional Radiology, Xiangya School of Medicine Affiliated Haikou Hospital, Central South University, Haikou, Hainan, China
| | - Ding-Cheng Liu
- Department of Interventional Radiology, Xiangya School of Medicine Affiliated Haikou Hospital, Central South University, Haikou, Hainan, China
| | - Chao Tong
- Department of Interventional Radiology, Xiangya School of Medicine Affiliated Haikou Hospital, Central South University, Haikou, Hainan, China
| | - Wen Wen
- Department of Hepatobiliary Surgery, Xiangya School of Medicine Affiliated Haikou Hospital, Central South University, Haikou, Hainan, China
- *Correspondence: Wen Wen,
| | - Ri-Hui Chen
- Department of Interventional Radiology, Xiangya School of Medicine Affiliated Haikou Hospital, Central South University, Haikou, Hainan, China
- Ri-Hui Chen,
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Tsutsui Y, Yoshio S, Tomiyama T, Shimagaki T, Itoh S, Harada N, Yoshida Y, Yoshikawa S, Kakazu E, Kanto T, Yoshizumi T. Preoperative serum brain-derived neurotrophic factor as a predictive biomarker for sepsis after living-donor liver transplantation. Hepatol Res 2023; 53:72-83. [PMID: 36057110 DOI: 10.1111/hepr.13834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/17/2022] [Accepted: 08/28/2022] [Indexed: 01/03/2023]
Abstract
AIM Although the survival rate after living-donor liver transplantation (LDLT) is improving, sepsis still limits the prognosis. Immune dysfunction and sarcopenia are often observed in LDLT patients, and increase susceptibility to infection. Brain-derived neurotrophic factor (BDNF) is a myokine produced by immune cells and skeletal muscle. We aimed to determine whether serum BDNF could be a feasible biomarker for sepsis of LDLT patients. METHODS We measured serum samples from 124 patients who underwent LDLT and 9 healthy volunteers for BDNF. We examined its correlation with incidence rate of sepsis. To clarify the source of BDNF, we examined its expression in lymphocytes, skeletal muscle cells, and hepatocytes. RESULTS Patients who experienced sepsis showed worse short-term survival. Preoperative serum BDNF was lower in LDLT patients compared with healthy volunteers, and was also lower in Child-Pugh C compared with Child-Pugh A or B. Serum BDNF was inversely correlated with Model for End-Stage Liver Disease and controlling nutritional status (CONUT) scores, but had a weak positive correlation with skeletal muscle mass index (SMI). Multivariate analysis revealed that serum BDNF was independently associated with sepsis. Preoperative serum BDNF was a better predictor of sepsis in LDLT patients than CONUT score or SMI. Serum BDNF was positively correlated with lymphocyte counts, especially T cells. In vitro, T cells and skeletal muscle cells produced BDNF. CONCLUSIONS Preoperative serum BDNF could be a predictive biomarker for sepsis after LDLT, by reflecting the systemic condition including hepatic function, nutritional status, and immune status.
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Affiliation(s)
- Yuriko Tsutsui
- Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan.,Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sachiyo Yoshio
- Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan
| | - Takahiro Tomiyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomonari Shimagaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichi Yoshida
- Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan
| | - Shiori Yoshikawa
- Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan
| | - Eiji Kakazu
- Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan
| | - Tatsuya Kanto
- Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Ionele CM, Turcu-Stiolica A, Subtirelu MS, Ungureanu BS, Sas TN, Rogoveanu I. Osteoporosis Assessment among Adults with Liver Cirrhosis. J Clin Med 2022; 12:jcm12010153. [PMID: 36614954 PMCID: PMC9820827 DOI: 10.3390/jcm12010153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/09/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Osteopenic bone disease occurs frequently in patients with chronic liver cirrhosis, which most frequently presents with hepatic osteodystrophy. Thus, the relationship between nutritional status and bone mineral density has been poorly measured in liver cirrhosis. This single-center study consisted of a group of 70 patients diagnosed with liver cirrhosis. The nutritional status was evaluated with the Controlling Nutritional Status index, and volumetric vertebral bone mineral density was measured with quantitative computed tomography. Among the 70 patients included, osteopenia and osteoporosis were found in 71% and 24.3%, respectively. Malnutrition assessed with the Controlling Nutritional Status index was observed in 56 (80%) patients and was more frequent in alcoholic cirrhosis patients than viral cirrhosis patients (87.24% vs. 65.22%). Significant positive correlation with Controlling Nutritional Status score was found with Model for End-Stage Liver Disease (rho = 0.576, p-value < 0.0001), Child−Pugh score (rho = 0.670, p-value < 0.0001), International Normalized Ratio (rho = 0.517, p-value = 0.001), aspartate aminotransferase (rho = 0.293, p-value = 0.045), and bilirubin (rho =0.395, p-value = 0.02). Among the liver cirrhosis patients, 15 had osteoporosis and 49 had osteopenia at the lumbar spine (L1-L4 vertebrae), as determined by bone mass density via quantitative computed tomography. A non-significant relationship between Controlling Nutritional Status index-assessed nutritional status and bone mass density was documented. Regarding osteoporosis, no differences were found between the viral and alcohol types of liver cirrhosis patients (p-value = 0.870). Age, obesity, grade of varices, Child−Pugh score, and Model for End-Stage Liver Disease score were associated with osteoporosis in patients with liver cirrhosis.
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Affiliation(s)
- Claudiu Marinel Ionele
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Adina Turcu-Stiolica
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence:
| | - Mihaela Simona Subtirelu
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Bogdan Silviu Ungureanu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200638 Craiova, Romania
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Teodor Nicusor Sas
- Department of Radiology and Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ion Rogoveanu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200638 Craiova, Romania
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Nomograms including the controlling nutritional status score in patients with hepatocellular carcinoma undergoing transarterial chemoembolisation for prediction survival: a retrospective analysis. Br J Nutr 2022; 128:1966-1974. [PMID: 34881693 DOI: 10.1017/s000711452100492x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This retrospective study investigated the predictive value of the Controlling Nutritional Status (CONUT) score in patients with intermediate-stage hepatocellular carcinoma (HCC) who received transarterial chemoembolization (TACE). Nomograms were developed to predict progression-free and overall survival (PFS, OS). The medical data of 228 patients with HCC and treated with TACE were collected. The patients were apportioned to 2 groups according to CONUT score: low or high (<4, ≥4). Univariate and multivariate analyses were performed using Cox regression for OS and PFS. OS and PFS were estimated by the Kaplan-Meier curve and compared with the log-rank test. Nomograms were constructed to predict patient OS and PFS. The nomograms were evaluated for accuracy, discrimination, and efficiency. The cut-off value of CONUT score was 4. The higher the CONUT score, the worse the survival; Kaplan-Meier curves showed significant differences in OS and PFS between the low and high CONUT score groups (P = 0·033, 0·047). The nomograms including CONUT, based on the prognostic factors determined by the univariate and multivariate analyses, to predict survival in HCC after TACE were generated. The CONUT score is an important prognostic factor for both OS and PFS for patients with intermediate HCC who underwent TACE. The cut-off value of the CONUT score was 4. A high CONUT score suggests poor survival outcomes. Nomograms generated based on the CONUT score were good models to predict patient OS and PFS.
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The prognostic value of the Controlling Nutritional Status score on patients undergoing nephrectomy for upper tract urothelial carcinoma or renal cell carcinoma: a systematic review and meta-analysis. Br J Nutr 2022; 128:217-224. [PMID: 34338171 DOI: 10.1017/s0007114521002889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In recent years, the controlling nutritional status (CONUT) score has increasingly became an effective indicator associated with tumor prognosis. This study was conducted to synthesise data on the prognostic value of CONUT score on patients with upper tract urothelial carcinoma (UTUC) or renal cell carcinoma (RCC) undergoing nephrectomy. We designed and performed a systematic analysis of studies that verified the correlation between preoperative CONUT score and prognosis for UTUC and RCC using PubMed, Web of Science and Embase. The conclusion was clarified by pooled hazard ratios (HR) and 95% confidence intervals (95% CI). Subgroup analysis were further conducted in accordance with different primary tumor. Six studies involving 3529 patients were included in this evidence synthesis, which revealed that the CONUT score had a potential role to predict the survival of UTUC and RCC patients accepting surgery. Pooled analysis showed that the overall survival (OS, HR 2·32, p < 0·0001), cancer-specific survival (CSS, HR 2·68, p < 0·0001) and disease-free survival (DFS, HR 1·62, p < 0·00001) were inferior in the high CONUT score group when compared with low score group. Subgroup analysis revealed that this result was in line with UTUC (OS: HR 1·86, p = 0·02; CSS: HR 2·24, p = 0·01; DFS: HR 1·54, p < 0·00001) and RCC (OS: HR 3·05, p < 0·00001; CSS: HR 3·47, p < 0·00001; DFS: HR 2·21, p = 0·0005) patients respectively. Consequently, the CONUT score is a valuable preoperative index to predict the survival of patients with UTUC or RCC undergoing nephrectomy.
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Yu Y, Li X. A commentary on "Laparoscopic anatomical versus non-anatomical hepatectomy in the treatment of hepatocellular carcinoma: A randomised controlled trial" (Int J Surg 2022;102:106652). Int J Surg 2022; 104:106736. [DOI: 10.1016/j.ijsu.2022.106736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
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Arero G, Arero AG, Mohammed SH, Vasheghani-Farahani A. Prognostic Potential of the Controlling Nutritional Status (CONUT) Score in Predicting All-Cause Mortality and Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease: A Meta-Analysis. Front Nutr 2022; 9:850641. [PMID: 35614981 PMCID: PMC9125241 DOI: 10.3389/fnut.2022.850641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/30/2022] [Indexed: 01/01/2023] Open
Abstract
Background As defined by the Controlling Nutrition Status (CONUT) score, the prognostic significance of nutritional status has attracted attention in patients with cardiovascular disease. This meta-analysis aimed to determine the importance of CONUT score for prediction of all-cause mortality and major adverse cardiovascular events (MACE) in adult patients with coronary artery disease (CAD). Methods Observational studies conducted to evaluate the association of CONUT score with adverse clinical outcomes in patients with CAD were included. We searched MEDLINE, Embase, Scopus, Cochrane library, Google scholar, medRxiv pre-print as well as Science Direct search engine for studies published from the inception of each database until March 21, 2022. Studies reporting the utility of CONUT score in prediction of all-cause mortality and MACE among patients with CAD were eligible. Predictive potential of the CONUT score were summarized by pooling the multivariable adjusted hazard ratio (aHR) with 95% CI for the malnourished vs. normal nutritional status or per point CONUT score increase. Results Of 2,547 screened citation, nine observational studies involving 81,257 patients with CAD were analyzed. Malnutrition defined by the CONUT score was associated with significantly increased risk of all-cause mortality when compared with the normal nutritional state (aHR for mild, moderate, and severe malnutrition, respectively: (1.21 [95% CI: 1.15–1.27], I2 = 0%), (1.53 [95% CI: 1.26–1.84], I2 = 84%), and (2.24 [95% CI: 1.57–3.19], I2 = 77%). Similarly, moderate (aHR 1.71 [95% CI: 1.44–2.03], I2 = 0%) and severe (aHR 2.66 [95% CI: 1.82–3.89], I2 = 0%) malnutrition was associated with a significantly higher risk of MACE compared with the normal nutritional state. Additionally, per point increase in the CONUT score was correlated with 20 and 23% additional risk of all-cause mortality and MACE, respectively. Conclusion As defined by the CONUT score, malnutrition is an independent predictor of all-cause mortality and MACE in CAD patients. Nutritional assessment with CONUT score could allow clinicians to identify patients with CAD at high risk for adverse clinical outcomes.
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Affiliation(s)
- Godana Arero
- Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
- *Correspondence: Godana Arero,
| | - Amanuel Godana Arero
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Addis Ababa, Ethiopia
| | | | - Ali Vasheghani-Farahani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Stallings E, Gaetano-Gil A, Alvarez-Diaz N, Solà I, López-Alcalde J, Molano D, Zamora J. Development and evaluation of a search filter to identify prognostic factor studies in Ovid MEDLINE. BMC Med Res Methodol 2022; 22:107. [PMID: 35399050 PMCID: PMC8996648 DOI: 10.1186/s12874-022-01595-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Systematic reviews (SRs) are valuable resources as they address specific clinical questions by summarizing all existing relevant studies. However, finding all information to include in systematic reviews can be challenging. Methodological search filters have been developed to find articles related to specific clinical questions. To our knowledge, no filter exists for finding studies on the role of prognostic factor (PF). We aimed to develop and evaluate a search filter to identify PF studies in Ovid MEDLINE that has maximum sensitivity. Methods We followed current recommendations for the development of a search filter by first identifying a reference set of PF studies included in relevant systematic reviews on the topic, and by selecting search terms using a word frequency analysis complemented with an expert panel discussion. We evaluated filter performance using the relative recall methodology. Results We constructed a reference set of 73 studies included in six systematic reviews from a larger sample. After completing a word frequency analysis using the reference set studies, we compiled a list of 80 of the frequent methodological terms. This list of terms was evaluated by the Delphi panel for inclusion in the filter, resulting in a final set of 8 appropriate terms. The consecutive connection of these terms with the Boolean operator OR produced the filter. We then evaluated the filter using the relative recall method against the reference set, comparing the references included in the SRs with our new search using the filter. The overall sensitivity of the filter was calculated to be 95%, while the overall specificity was 41%. The precision of the filter varied considerably, ranging from 0.36 to 17%. The NNR (number needed to read) value varied largely from 6 to 278. The time saved by using the filter ranged from 13–70%. Conclusions We developed a search filter for OVID-Medline with acceptable performance that could be used in systematic reviews of PF studies. Using this filter could save as much as 40% of the title and abstract screening task. The specificity of the filter could be improved by defining additional terms to be included, although it is important to evaluate any modification to guarantee the filter is still highly sensitive. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01595-9.
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Chen J, Song P, Peng Z, Liu Z, Yang L, Wang L, Zhou J, Dong Q. The Controlling Nutritional Status (CONUT) Score and Prognosis in Malignant Tumors: A Systematic Review and Meta-Analysis. Nutr Cancer 2022; 74:3146-3163. [PMID: 35382655 DOI: 10.1080/01635581.2022.2059091] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Increasing evidences indicate that the controlling nutritional status (CONUT) score is associated with cancer prognosis. This study was conducted to investigate the prognostic significance of pretreatment CONUT score on patients with various malignant tumors. The correlation between CONUT score and clinical outcomes of tumor patients were studied by electronic literature retrieval. Pooled hazard ratios (HR), odds ratios (OR) and 95% confidence intervals (95% CI) were calculated to clarify the conclusion. Subgroup analysis were conducted in line with cancer type, cancer stage, treatment, sample size and cut-off value. A total of 62 studies involving 25224 patients were included in this study. Pooled analysis showed that higher CONUT scores were associated with shorter overall survival (HR 1.62, 95% CI 1.45-1.79, p < 0.001), cancer-specific survival (HR 1.80, 95% CI 1.48-2.13, p < 0.001), progress/recurrence-free survival (HR 1.54, 95% CI 1.23-1.85, p < 0.001) and disease-free survival (HR 1.56, 95% CI 1.39-1.74, p < 0.001). In addition, high CONUT score was correlated to higher incidence of postoperative complications (OR 1.64, 95% CI 1.38-1.95, p < 0.001) and mortality (OR 4.22, 95% CI 2.22-8.02, p < 0.001). Consequently, the pretreatment CONUT score is a valuable indicator to predict the clinical outcomes of patients with various malignant tumors.
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Affiliation(s)
- Junhao Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Pan Song
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Zhufeng Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenghuan Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Luchen Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Linchun Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Jing Zhou
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Dong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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A novel combined prognostic nutritional index and aspartate aminotransferase-to-platelet ratio index-based score can predict the survival of patients with hepatocellular carcinoma who undergo hepatic resection. Surg Today 2022; 52:1096-1108. [PMID: 35066743 DOI: 10.1007/s00595-021-02440-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Inflammation-, nutrition-, and liver fibrosis-related markers are recognized as prognostic for hepatocellular carcinoma (HCC) patients. This study, therefore, assessed the preoperative prognostic utility of the combination of these markers in patients with HCC. METHODS This single-center retrospective study included patients who underwent hepatic resection for HCC between 2004 and 2017. A total of 454 patients were divided into training (n = 334) and validation (n = 120) cohorts by random sampling. The predictive impact on surgical outcomes was evaluated using receiver operating characteristic (ROC) curves of these prognostic values in the training cohort. RESULTS The prognostic nutritional index (PNI) and aspartate aminotransferase-to-platelet ratio index (APRI) were the strongest diagnostic values (areas under the ROC curves: 0.627 and 0.646, respectively). A scoring system (over 0-2 points) was developed using optimal cutoff values (for PNI < 46.5 scored as 1 point; for APRI > 0.98 scored as 1 point). An increased PNI-APRI score was an independent prognostic factor for both the overall and disease-free survival in HCC patients. Finally, the clinical feasibility of the PNI-APRI score was confirmed in the validation cohort. CONCLUSIONS The PNI-APRI score is a useful marker for predicting surgical outcomes of HCC patients.
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Aruğaslan E, Zengin A, Karataş MB, Akyüz Ş. Prognostic Significance of Controlling Nutritional Status Score (CONUT) in Patients Undergoing Pericardiocentesis. ACTA CARDIOLOGICA SINICA 2022; 38:84-90. [PMID: 35068887 PMCID: PMC8743483 DOI: 10.6515/acs.202201_38(1).20210718a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/18/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Malnutrition is associated with a poor prognosis in cardiovascular diseases, however the prognostic impact of the Controlling Nutritional Status (CONUT) score in patients with pericardial effusion (PE) is not known. METHODS This was a retrospective study conducted among 301 consecutive patients with PE who underwent pericardiocentesis. CONUT score was calculated from serum albumin level, total cholesterol level and lymphocyte count. The prognostic role of admission CONUT score on long-term mortality was evaluated. RESULTS The patients were divided into two groups according to long-term mortality. A total of 131 patients died during follow-up. In multivariable regression analysis, chronic heart failure [hazard ratio (HR): 3.21, 95% confidence interval (CI): 1.18-8.70, p < 0.01], malignancy (HR: 5.67, 95% CI: 3.34-9.63, p < 0.01) and CONUT score (HR: 1.21, 95% CI: 1.10-1.33, p < 0.01) were found to be independent predictors of long-term mortality. CONUT score was significantly higher in the patients who died (5.8 ± 2.4 vs. 3.6 ± 2.2, p < 0.01). In receiver operating characteristics analysis, a CONUT score ≥ 4.5 predicted long-term mortality with 66% sensitivity and 69% specificity (area under curve: 0.73, 95% CI: 0.67-0.79, p < 0.01). CONCLUSIONS In patients with PE, CONUT score is an independent prognostic factor for mortality.
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Affiliation(s)
| | - Ahmet Zengin
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Baran Karataş
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Şükrü Akyüz
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Fujio A, Usuda M, Hara Y, Kakizaki Y, Okada K, Miyata G, Unno M, Kamei T. Usefulness of Preoperative Controlling Nutritional Status in Predicting Prolonged Hospitalization and Incidence of Postoperative Delirium for Elderly Hepatectomy with Hepatocellular Carcinoma. TOHOKU J EXP MED 2022; 256:43-52. [DOI: 10.1620/tjem.256.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Atsushi Fujio
- Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital
| | - Masahiro Usuda
- Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital
| | - Yasuyuki Hara
- Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital
| | - Yuta Kakizaki
- Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital
| | - Kaoru Okada
- Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital
| | - Go Miyata
- Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine
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Yugawa K, Maeda T, Kinjo N, Kawata K, Ikeda S, Edahiro K, Edagawa M, Omine T, Kometani T, Yamaguchi S, Konishi K, Tsutsui S, Matsuda H. Prognostic Impact of Lymphocyte-C-Reactive Protein Ratio in Patients Who Underwent Surgical Resection for Hepatocellular Carcinoma. J Gastrointest Surg 2022; 26:104-112. [PMID: 34258673 DOI: 10.1007/s11605-021-05085-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/12/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Systemic inflammation-related factors, either independently or in combination, are recognized as prognostic factors for various cancers. The ratio of lymphocyte count to C-reactive protein concentration (lymphocyte-CRP ratio; LCR) is a recently identified prognostic marker for several cancers. Here, we examined the prognostic value of the LCR in patients with hepatocellular carcinoma (HCC). METHODS This was a single-center retrospective study of patients who underwent surgical resection for HCC between 2004 and 2017. Patients were divided into high- and low-LCR status groups, and the relationships between LCR status, prognosis, and other clinicopathological characteristics were analyzed. RESULTS A total of 454 patients with HCC were enrolled and assigned to the high- (n=245) or low- (n=209) LCR groups. Compared with the high-LCR group, patients in the low-LCR group had a significantly lower serum albumin level (median 4.1 vs. 3.9 g/dL, P <0.0001), lower platelet count (median 14.0 vs. 12.0 ×104/μL, P=0.0468), lower prothrombin time (median 93.2 vs. 89.6 %, P=0.0006), and larger tumor size (median 2.3 vs. 2.5 cm, P=0.0056). Patients with low-LCR status had significantly worse outcomes of overall survival and disease-free survival than patients with high-LCR status (P=0.0003 and P=0.0069, respectively). Low-LCR status was significantly associated with worse overall survival in multivariate analysis (hazard ratio 1.57, 95% confidence interval 1.14-2.17, P=0.0058). CONCLUSIONS Low-LCR status may predict worse outcomes in patients with HCC. Measurement of LCR is routine and can easily be applied for risk stratification in the assessment of patients with HCC.
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Affiliation(s)
- Kyohei Yugawa
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan
| | - Takashi Maeda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan.
| | - Nao Kinjo
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan
| | - Koto Kawata
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan
| | - Shinichiro Ikeda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan
| | - Keitaro Edahiro
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan
| | - Makoto Edagawa
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan
| | - Takahiro Omine
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan
| | - Takuro Kometani
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan
| | - Shohei Yamaguchi
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan
| | - Kozo Konishi
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan
| | - Shinichi Tsutsui
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan
| | - Hiroyuki Matsuda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan
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Peng J, Hao Y, Rao B, Cao Y. Prognostic impact of the pre-treatment controlling nutritional status score in patients with non-small cell lung cancer: A meta-analysis. Medicine (Baltimore) 2021; 100:e26488. [PMID: 34190175 PMCID: PMC8257916 DOI: 10.1097/md.0000000000026488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/08/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The influence of pre-treatment controlling nutritional status (CONUT) score on the prognosis of non-small cell lung cancer (NSCLC) patients is inconclusive. We performed this meta-analysis to evaluate the prognostic significance of CONUT score in NSCLC patients. METHODS A systematic literature review was conducted using PubMed, Embase, and the Cochrane Library databases. The hazard ratio (HR) and 95% confidence interval (CI) were extracted to assess the correlation between the CONUT score and the overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS), as well as the cancer-specific survival. RESULTS A total of 11 studies with 3029 patients were included in the analysis. Pooled results indicated that a high CONUT score was positively correlated with poor OS (HR: 1.63, 95%CI: 1.40-1.88, P < .001) and shortened DFS/RFS (HR: 1.65, 95%CI: 1.35-2.01, P < .001), but no significant relationship with the cancer-specific survival (HR: 1.28, 95%CI: 0.60-2.73, P = .517) was identified. The negative effect of high CONUT score on the OS and DFS/RFS was detected in every subgroup with varying treatment methods, cancer stage, CONUT cut-off values, sample size, and analysis methods of HR. Additionally, preoperative high CONUT score was an independent predictor of postoperative complications (odds ratio: 1.58, 95%CI: 1.21-2.06, P = .001) in NSCLC. Last but not least, high CONUT score was not significantly correlated with the patients' sex, smoking status, cancer stage, lymphatic invasion, vascular invasion, pleural invasion, and pathological cancer type. CONCLUSION These results demonstrate that high CONUT score is positively related to poor prognoses. The CONUT score may therefore be considered as an effective prognostic marker in NSCLC patients.
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Affiliation(s)
- Jing Peng
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University
| | - Yan Hao
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
| | - Bihua Rao
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University
| | - Yunxia Cao
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
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19
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Niu X, Zhu Z, Bao J. Prognostic significance of pretreatment controlling nutritional status score in urological cancers: a systematic review and meta-analysis. Cancer Cell Int 2021; 21:126. [PMID: 33608012 PMCID: PMC7893866 DOI: 10.1186/s12935-021-01813-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/06/2021] [Indexed: 02/08/2023] Open
Abstract
Background Controlling Nutritional Status (CONUT) score is a novel nutrition-based biomarker that has been reported for predicting survival in various cancers. However, the relationship between CONUT score and prognosis of urological cancers remains unclear. Hence, we performed this meta-analysis to evaluate the prognostic significance of CONUT score for patients with urological cancers. Methods PubMed, Embase, the Cochrane Library and National Knowledge Infrastructure (CNKI) were systematically searched up to October 2020. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate the association of CONUT score with overall survival (OS), cancer-specific survival (CSS) and recurrence/disease/progress-free survival (RFS/DFS/PFS) in urological cancers. Results A total of 12 articles with 13 studies were included in the analysis. Pooled results indicated that increased CONUT score predicted poor OS (HR: 1.78, 95% CI 1.51–2.09, p < 0.001), CSS (HR: 2.14, 95% CI 1.55–2.97, p < 0.001) and RFS/DFS/PFS (HR: 1.57, 95% CI 1.35–1.84, p < 0.001). Subgroup analysis by cancer type revealed that high CONUT score associated with worse OS in renal cell carcinoma (RCC) and urothelial cancer (UC) (HR: 3.05, 95% CI 2.07–4.50, p < 0.001; HR: 1.58, 95% CI 1.32–1.89, p < 0.001). Similar results could be found in CSS (RCC HR: 2.67, 95% CI 1.87–3.81, p < 0.011; UC HR: 1.68, 95% CI 1.09–2.59, p = 0.011) and in RFS/DFS/PFS (RCC HR: 1.96, 95% CI 1.44–2.66, p < 0.001; UC HR: 1.42, 95% CI 1.18–1.71, p < 0.001). Conclusions These results illustrated that the high CONUT score may predict worse survival for patients suffering from urological cancers. Therefore, the CONUT score may represent an effective prognostic indicator in urological cancers.
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Affiliation(s)
- Xinhao Niu
- Department of Urinary Surgery, Shanghai Public Health Clinical Center, Fudan University, No. 2901 Caolang Road, 201508, Shanghai, China
| | - Zhe Zhu
- Department of Urinary Surgery, Shanghai Public Health Clinical Center, Fudan University, No. 2901 Caolang Road, 201508, Shanghai, China
| | - Juan Bao
- Department of Urinary Surgery, Shanghai Public Health Clinical Center, Fudan University, No. 2901 Caolang Road, 201508, Shanghai, China.
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Takahashi T, Watanabe T, Otaki Y, Kato S, Tamura H, Nishiyama S, Arimoto T, Takahashi H, Shishido T, Watanabe M. Prognostic significance of the controlling nutritional (CONUT) score in patients with acute coronary syndrome. Heart Vessels 2021; 36:1109-1116. [PMID: 33538856 DOI: 10.1007/s00380-021-01792-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Malnutrition is an independent predictor of adverse outcomes in patients with acute coronary syndrome. The controlling nutritional (CONUT) score has been applied to assess nutritional status, and has been reported to be associated with poor prognosis in patients with heart failure. However, the prognostic impact of the CONUT score in patients with acute coronary syndrome (ACS) remains to be elucidated. METHODS We evaluated the CONUT score in 196 patients with ACS who underwent percutaneous coronary intervention. We divided the patients into four groups according to CONUT score (undernutrition degree: normal, CONUT 0-1 (reference); mild, CONUT 2-4; moderate, CONUT 5-8; severe, CONUT 9-12). The endpoint of the present study was composite events including all-cause death, acute coronary syndrome, target vessel revascularization, and stroke. RESULTS The median CONUT score was significantly higher in patients with composite events than in those without events (P = 0.0058). Kaplan-Meier analysis revealed that a significantly higher event rate in patients with severe malnutrition (log-rank test, P = 0.0222). In the multivariate Cox proportional hazards analysis, CONUT score was independently associated with composite events after adjustment for confounding factors (adjusted hazard ratio 1.284, 95% confidence interval 1.126-1.457, P = 0.0003). CONCLUSION Higher CONUT scores were associated with unfavorable outcomes in patients with ACS. Malnutrition assessed by the CONUT score may provide valuable prognostic information in patients with ACS.
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Affiliation(s)
- Tetsuya Takahashi
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Tetsu Watanabe
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Yoichiro Otaki
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Shigehiko Kato
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Harutoshi Tamura
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Satoshi Nishiyama
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Takanori Arimoto
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Hiroki Takahashi
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Tetsuro Shishido
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Masafumi Watanabe
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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21
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Postoperative Trends and Prognostic Values of Inflammatory and Nutritional Biomarkers after Liver Transplantation for Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13030513. [PMID: 33572776 PMCID: PMC7866292 DOI: 10.3390/cancers13030513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 02/08/2023] Open
Abstract
Simple Summary Inflammatory biomarkers have a strong prognostic value in surgically treated patients with hepatocellular carcinoma (HCC), but the underlying pathogenic mechanism has not been completely clarified. Conversely, nutritional biomarkers predict the outcomes after hepatic resection for HCC but not after liver transplantation (LT). Indeed, the impact of LT on the recipient’s nutritional status is heterogeneous, while the data on the patient’s outcome after LT in terms of inflammatory status are limited. Therefore, to address these unsolved questions, we conducted a retrospective analysis on 324 HCC patients treated with LT, exploring the postoperative trend up to 1 year post-LT and the prognostic value of the Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Lymphocyte Ratio (NLR), Controlling Nutritional Status (CONUT), Prognostic Nutritional Index (PNI). It was found that at 1 year post-LT, the nutritional status of liver-transplanted HCC patients significantly improved while their inflammatory state tended to persist. Consequently, post-LT PLR and NLR maintained a prognostic value for LT outcome while post-LT CONUT and PNI acquired it. Abstract Preoperative inflammatory biomarkers such as the Platelet-to-Lymphocyte Ratio (PLR) and the Neutrophil-to-Lymphocyte Ratio (NLR) strongly predict the outcome in surgically treated patients with hepatocellular carcinoma (HCC), while nutritional biomarkers such as the Controlling Nutritional Status (CONUT) and the Prognostic Nutritional Index (PNI) show an analogue prognostic value in hepatic resection (HR) but not in liver transplant (LT) cases. Data on the impact of LT on the inflammatory and nutritional/metabolic function are heterogeneous. Therefore, we investigated the post-LT trend of these biomarkers up to postoperative month (POM) 12 in 324 HCC patients treated with LT. Inflammatory biomarkers peaked in the early post-LT period but at POM 3 leveled off at values similar (NLR) or higher (PLR) than pre-LT ones. CONUT and PNI worsened in the early post-LT period, but at POM 3 they stabilized at significantly better values than pre-LT. In LT recipients with an overall survival >1 year and no evidence of early HCC recurrence, 1 year post-LT NLR and PNI independently predicted patient overall survival, while 1 year post-LT PLR independently predicted late tumor recurrence. In conclusion, at 1 year post-LT, the nutritional status of liver-transplanted HCC patients significantly improved while their inflammatory state tended to persist. Consequently, post-LT PLR and NLR maintained a prognostic value for LT outcome while post-LT CONUT and PNI acquired it.
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22
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Donahue BS. Commentary: Preoperative nutritional status and mortality from cardiac surgery: Do we have your attention yet? J Thorac Cardiovasc Surg 2021; 164:1150-1151. [PMID: 34561101 DOI: 10.1016/j.jtcvs.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Brian S Donahue
- Division of Pediatric Cardiac Anesthesia, Departments of Anesthesiology and Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn.
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Wang A, He Z, Cong P, Qu Y, Hu T, Cai Y, Sun B, Chen H, Fu W, Peng Y. 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. Front Oncol 2021; 10:593452. [PMID: 33505910 PMCID: PMC7829909 DOI: 10.3389/fonc.2020.593452] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/30/2020] [Indexed: 12/27/2022] Open
Abstract
Background Currently, 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). Methods Preoperative 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. Results CONUThigh 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). Conclusion CONUT score may be of some clinical reference value in evaluating postoperative prognosis of HCCA patients.
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Affiliation(s)
- Ankang Wang
- Department of General Surgery, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China.,Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhenxing He
- Department of General Surgery, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China
| | - Peng Cong
- Department of General Surgery, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China
| | - Yueyu Qu
- Department of General Surgery, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China
| | - Tao Hu
- Department of General Surgery, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China
| | - Yu Cai
- Department of General Surgery, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China
| | - Bo Sun
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hao Chen
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wenguang Fu
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yong Peng
- Department of General Surgery, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China
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24
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Shao J, Li J, Zhang XL, Wang G. Prognostic Significance of the Preoperative Controlled Nutritional Status Score in Lung Cancer Patients Undergoing Surgical Resection. Nutr Cancer 2020; 73:2211-2218. [PMID: 33319623 DOI: 10.1080/01635581.2020.1850814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jingjing Shao
- Key Laboratory of Cancer Research Center Nantong, Nantong Tumor Hospital, Nantong University, Nantong, China
| | - Jing Li
- Key Laboratory of Cancer Research Center Nantong, Nantong Tumor Hospital, Nantong University, Nantong, China
| | - Xun Lei Zhang
- Department of Radiotherapy, Nantong Tumor Hospital, Nantong University, Nantong, China
| | - Gaoren Wang
- Department of Radiology, Nantong Tumor Hospital, Nantong University, Nantong, China
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25
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Takagi K, de Wilde RF, Polak WG, IJzermans JN. The effect of donor body mass index on graft function in liver transplantation: A systematic review. Transplant Rev (Orlando) 2020; 34:100571. [DOI: 10.1016/j.trre.2020.100571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/21/2020] [Accepted: 09/05/2020] [Indexed: 12/12/2022]
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26
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Chen Y, Zhao C, Yang Y, Xin YJ, Wang YN, Li X, Zhou X, Feng DP. Using the Controlling Nutritional Status (CONUT) Score for Evaluating Patients with Early-Stage Hepatocellular Carcinoma After Radiofrequency Ablation: A Two-Center Retrospective Study. Cardiovasc Intervent Radiol 2020; 43:1294-1304. [PMID: 32435833 DOI: 10.1007/s00270-020-02519-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To estimate the prognostic significance of the controlling nutritional status (CONUT) in patients with BCLC stage A hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). MATERIALS AND METHODS From January 2013 to December 2016, 325 patients with BCLC stage A HCC who underwent RFA at the National Cancer Center and First Hospital of Shanxi Medical University were retrospectively studied. The patients were divided into low (≤ 4) and high (≥ 5) CONUT scores for assessment of overall survival (OS) and recurrence-free survival (RFS). Several covariates, including age, sex, the diameter and number of lesions, lesion differentiation, Child-Pugh class, hepatitis B virus infection, along with blood levels of AFP, AST, ALT, γ-GT, and TBIL, were assessed using univariate and multivariate analyses. RESULTS The mortality rate was 17.49% (46/263) and 35.48% (22/62) in the low and high CONUT groups, respectively, with the difference being statistically significant (P = 0.033). In addition, disease recurrence was significantly higher in the high CONUT group at 70.97%, as compared to the low CONUT group at 43.35% (P = 0.041). The predictive factors were used to build the nomogram to estimate 1-, 3- and 5-year OS and RFS rates. CONCLUSIONS CONUT scores were found to be associated with the prognosis of patients with early-stage HCC who underwent RFA. Higher CONUT scores were associated with poor survival outcomes.
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Affiliation(s)
- Yi Chen
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.,Department of Interventional Radiology, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi Province, China
| | - Chao Zhao
- Department of Interventional Radiology, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi Province, China
| | - Yi Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yu-Jing Xin
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ya-Nan Wang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiang Zhou
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Dui-Ping Feng
- Department of Interventional Radiology, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi Province, China.
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27
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Takagi K, Buettner S, Ijzermans JNM. Prognostic significance of the controlling nutritional status (CONUT) score in patients with colorectal cancer: A systematic review and meta-analysis. Int J Surg 2020; 78:91-96. [PMID: 32335238 DOI: 10.1016/j.ijsu.2020.04.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The clinical evidence of the controlling nutritional status (CONUT) score for outcomes has increased in gastroenterological surgical oncology. The aim of this study was to investigate the impact of the CONUT score on outcomes in patients with colorectal cancer (CRC). METHODS A literature review was systematically conducted to evaluate the significance of the CONUT score in CRC patients. Meta-analyses of survival were performed to investigate the effects of the CONUT score in CRC patients. RESULTS Nine studies met the inclusion criteria, and six studies with 2601 patients were included in the present meta-analyses. High CONUT score was associated with poor overall survival (HR 1.97, 95%CI = 1.40-2.77, P < 0.001), cancer-specific survival (HR 3.64, 95%CI = 1.96-6.75, P < 0.001), and recurrence/relapse-free survival (HR 1.68, 95%CI = 1.23-2.29, P = 0.001) after CRC surgery. CONCLUSIONS The CONUT score is a practical prognostic factor associated with prognosis of CRC. Further studies are needed to clarify the significance of the CONUT score in CRC patients.
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Affiliation(s)
- Kosei Takagi
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Stefan Buettner
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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28
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Controlling Nutritional Status (CONUT) Score is Associated with Overall Survival in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib: A Multicenter Cohort Study. Nutrients 2020; 12:nu12041076. [PMID: 32295043 PMCID: PMC7231015 DOI: 10.3390/nu12041076] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 01/10/2023] Open
Abstract
We aimed to investigate the impact of the controlling nutritional status (CONUT) score, an immuno-nutritional biomarker, on the prognosis of patients with hepatocellular carcinoma (HCC) treated with lenvatinib (LEN). This retrospective study enrolled 164 patients with HCC and treated with LEN (median age 73 years, Barcelona Clinic Liver Cancer (BCLC) stage B/C 93/71). Factors associated with overall survival (OS) were evaluated using multivariate and decision tree analyses. OS was calculated using the Kaplan–Meier method and analyzed using the log–rank test. Independent factors for OS were albumin–bilirubin grade 1, BCLC stage B, and CONUT score <5 (hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.58–5.31, p < 0.001). The CONUT score was the most important variable for OS, with OS rates of 70.0% and 29.0% in the low and high CONUT groups, respectively. Additionally, the median survival time was longer in the low CONUT group than in the high CONUT group (median survival time not reached vs. 11.3 months, p < 0.001). The CONUT score was the most important prognostic variable, rather than albumin–bilirubin grade and BCLC stage, in patients with HCC treated with LEN. Accordingly, immuno-nutritional status may be an important factor in the management of patients with HCC treated with LEN.
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