High Preoperative Controlling Nutritional Status Score Predicts a Poor Prognosis in Patients with Localized Upper Tract Urothelial Cancer: A Propensity Score Matching Study in a Large Chinese Center

Impact of a novel immune and nutritional score on prognosis in patients with upper urinary tract urothelial carcinoma following radical nephroureterectomy

BACKGROUND

This study aimed to evaluate the clinical significance of a novel immune and nutritional score combining prognostic values of the controlling nutritional status (CONUT) score and prognostic immune and nutritional index (PINI) on long-term outcomes in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).

METHODS

This study analyzed 437 consecutive patients with UTUC treated by RNU. Restricted cubic splines were used to visualize the relation of PINI with Survival in patients with UTUC. The PINI was stratified into low- (1) and high-PINI (0) categories. The CONUT score was divided into three groups: Normal (1), Light (2), and Moderate/severe (3). Subsequently, patients were grouped according to CONUT-PINI score (CPS) (CPS group 1; CPS group 2; CPS group 3; and CPS group 4). Survival curves were plotted using the Kaplan-Meier method and log-rank test. The Cox proportional hazards regression model was used to determine the risk factors associated with overall Survival (OS) and cancer-specific Survival (CSS). By comprising independent prognostic factors, a predictive nomogram was constructed.

RESULTS

PINI and CONUT score were identified as independent prognostic factors for OS and CSS. Kaplan-Meier survival analysis showed that the high CPS group was associated with worse OS and CSS than the low CPS group. Multivariate Cox regression and competing risk analyses showed that CPS, LVI, T stage, margin, and pN were independent factors associated with OS and CSS. Based on these five significant factors, we constructed a prognostic model for predicting clinical outcomes. The receiver operating characteristic curve indicated that the model had excellent predictive abilities for survival. The C-index of this model for OS and CSS were 0.773, and 0.789, respectively. The nomogram for OS and CSS showed good discrimination and calibration. Decision curve analysis (DCA) showed that this nomogram has a higher net benefit.

CONCLUSION

The CPS combined the prognostic capacity of PINI and CONUT score and was able to predict patient outcomes in our cohort of UTUC patients. We have developed a nomogram to facilitate the clinical use of the CPS and provide accurate estimates of survival for individuals.

The effect of nutritional scores on mortality in COVID-19 patients

OBJECTIVES:

While studies on the treatment for the coronavirus disease 2019 (COVID-19) pandemic continue all over the world, factors that increase the risk of severe disease have also been the subject of research. Malnutrition has been considered an independent risk factor. Therefore, we aimed to investigate the clinical effect of dietary habits and evaluate the prognostic value of the Controlling Nutritional Status score in the COVID-19 patients we followed up.

METHODS:

A total of 2760 patients hospitalized for COVID-19 were examined. Patients were retrospectively screened from three different centers between September 1 and November 30, 2020. A total of 1488 (53.9%) patients who met the criteria were included in the study. Risk classifications were made according to the calculation methods of prognostic nutritional index and Controlling Nutritional Status scores and total scores. The primary outcome of the study was in-hospital mortality.

RESULTS:

The groups with severe Controlling Nutritional Status and prognostic nutritional index scores had a significantly higher mortality rate than those with mild scores. In the multivariable regression analysis performed to determine in-hospital mortality, the parameters, such as age (OR 1.04; 95%CI 1.02–1.06, p<0.001), admission oxygen saturation value (SaO₂) (OR 0.85; 95%CI 0.83–0.87, p<0.001), and Controlling Nutritional Status score (OR 1.34; 95%CI 1.23–1.45, p<0.001), were independent predictors. The patient groups with a low Controlling Nutritional Status score had a higher rate of discharge with recovery (p<0.001).

CONCLUSIONS:

Higher Controlling Nutritional Status scores may be effective in determining in-hospital mortality in patients with COVID-19. Nutrition scores can be used as a useful and effective parameter to determine prognosis in patients with COVID-19.

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

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.

The Controlling Nutritional Status (CONUT) Score and Prognosis in Malignant Tumors: A Systematic Review and Meta-Analysis

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.

Multicenter Study of Controlling Nutritional Status (CONUT) Score as a Prognostic Factor in Patients With HIV-Related Renal Cell Carcinoma

Objective

In recent years, the controlled nutritional status (CONUT) score has been widely recognized as a new indicator for assessing survival in patients with urological neoplasms, including renal, ureteral, and bladder cancer. However, the CONUT score has not been analyzed in patients with HIV-related urological neoplasms. Therefore, we aimed to evaluate the prognostic significance of the CONUT score in patients with HIV-related renal cell carcinoma (RCC).

Methods

A total of 106 patients with HIV-related RCC were recruited from four hospitals between 2012 and 2021, and all included patients received radical nephrectomy or partial nephrectomy. The CONUT score was calculated by serum albumin, total lymphocyte counts, and total cholesterol concentrations. Patients with RCC were divided into two groups according to the optimal cutoff value of the CONUT score. Survival analysis of different CONUT groups was performed by the Kaplan–Meier method and a log rank test. A Cox proportional risk model was used to test for correlations between clinical variables and cancer-specific survival (CSS), overall survival (OS), and disease-free survival (DFS). Clinical variables included age, sex, hypertension, diabetes, tumor grade, Fuhrman grade, histology, surgery, and CD4+ T lymphocyte count.

Result

The median age was 51 years, with 93 males and 13 females. At a median follow-up of 41 months, 25 patients (23.6%) had died or had tumor recurrence and metastasis. The optimal cutoff value for the CONUT score was 3, and a lower CONUT score was associated with the Fuhrman grade (P=0.024). Patients with lower CONUT scores had better CSS (HR 0.197, 95% CI 0.077-0.502, P=0.001), OS (HR 0.177, 95% CI 0.070-0.446, P<0.001) and DFS (HR 0.176, 95% CI 0.070-0.444, P<0.001). Multivariate Cox regression analysis indicated that a low CONUT score was an independent predictor of CSS, OS and DFS (CSS: HR=0.225, 95% CI 0.067-0.749, P=0.015; OS: HR=0.201, 95% CI 0.061-0.661, P=0.008; DFS: HR=0.227, 95% CI 0.078-0.664, P=0.007). In addition, a low Fuhrman grade was an independent predictor of CSS (HR 0.192, 95% CI 0.045-0.810, P=0.025), OS (HR 0.203, 95% CI 0.049-0.842, P=0.028), and DFS (HR 0.180, 95% CI 0.048-0.669, P=0.010), while other factors, such as age, sex, hypertension, diabetes, tumor grade, histology, surgery, and CD4+ T lymphocyte count, were not associated with survival outcome.

Conclusion

The CONUT score, an easily measurable immune-nutritional biomarker, may provide useful prognostic information in HIV-related RCC.

The prognostic significance of controlling nutritional status (CONUT) score for surgically treated renal cell cancer and upper urinary tract urothelial cancer: a systematic review and meta-analysis

In order to evaluate the predictive effect of the controlled nutritional status (CONUT) score on the prognosis of patients with renal cell carcinoma (RCC) and upper urinary tract urothelial carcinoma (UTUC), a meta-analysis was performed. This systematic review has been registered on PROSPERO, the registration ID is CRD42021251879. A systematic search of the published literature using PubMed, Web of Science, Cochrane Library, EMBASE, and MEDLINE was performed. The fields of "renal cell cancer," "upper tract urothelial cancer," and "controlling nutritional status" and other fields were used as search terms. STATA 16 software was used to carry out data merging and statistical analysis of binary variables, Q test and χ² tests were used to verify the heterogeneity between the included works of studies. Subgroup analysis and sensitivity analysis were used to explain the sources of heterogeneity between studies. Begg's test was used to assess publication bias between studies. From the first 542 studies retrieved, through strict inclusion and exclusion criteria, 7 studies finally met the requirements and were included in the meta-analysis. Pooled results indicated that high CONUT indicates worse over survival (OS) [HR = 1.70, 95% CI (1.43-2.03), P = 0.02], cancer-specific survival (CSS) [HR = 1.84, 95% CI (1.52-2.23), P = 0.01], recurrence-free survival (RFS) [HR = 1.60, 95% CI (1.26-2.03), P = 0.116], and disease-free survival (DFS) [HR = 1.47, 95% CI (1.20-1.81), P = 0.03]. Based on cancer type, cutoff value, region, and sample size, a subgroup analysis was performed. The results showed that OS and CSS were not affected by the above factors, and the high CONUT score before surgery predicted worse OS and CSS. In conclusion, this meta-analysis revealed that the preoperative CONUT score is a potential independent predictor of the postoperative prognosis of RCC/UTUC patients. A high CONUT predicts worse OS/CSS/DFS and RFS in patients.

The Impact of Diabetes on the Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

Background

Studies have reported that diabetes is related to the prognosis of upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU), but this conclusion is still controversial. Here, we performed a meta-analysis to comprehensively explore the association between diabetes and UTUC prognosis.

Methods

In November 2020, we searched PubMed, Web of science and the Cochrane Library to find relevant studies that evaluated the effect of diabetes on the prognosis of UTUC. The Newcastle Ottawa Scale was used to assess the quality of the literature. Review Manager 5.3 was used to pool cancer-specific survival (CSS), overall survival (OS), recurrence-free survival (RFS) and intravesical recurrence (IVR).

Results

A total of 10 studies with 11,303 patients were included in this meta-analysis. Our pooled results showed that diabetes did not affect the survival outcome of UTUC, including CSS (HR: 1.33, 95% CI: 0.89-1.98; P = 0.16), OS (HR: 1.18, 95% CI: 0.77-1.80; P = 0.45) and RFS (HR: 1.37, 95% CI: 0.91-2.05; P = 0.13). However, diabetes increased the risk of IVR of UTUC patients (HR: 1.26, 95% CI: 1.11-1.43; P = 0.0004).

Conclusion

Although diabetes has no significant impact on the survival outcomes of UTUC after RNU, it increases the risk of IVR. Therefore, special attention should be paid to monitoring the IVR for UTUC patients with diabetes and the necessity of appropriate intravesical adjuvant treatment when needed.

Controlling Nutritional Status Score Before Receiving Treatment as a Prognostic Indicator for Patients With Urothelial Cancer: An Exploration Evaluation Methods

Introduction

This meta-analysis aims to assess whether the Controlling nutritional status (CONUT) score before treatment can be an independent predictor of the prognosis of patients with urothelial cancer (UC).

Methods

The system searches Web of Science, PubMed, MEDLINE, China National Knowledge Infrastructure (CNKI), and Cochrane Library, and the search time is up to April 2021. Use STATA 16.0 and Engauge Digitizer 4.1 software for data processing and statistical analysis.

Results

A total of 8 studies were included in this meta-analysis. The meta-analysis results show that compared with the low CONUT group, the high CONUT group has worse over survival (OS) [HR=1.58, 95%CI (1.34, 1.86), P=0.001], cancer-specific survival (CSS) [HR=2.03, 95%CI (1.25-3.29), P=0.04] and recurrence-free survival (RFS) [HR=1.97, 95%CI (1.15, 3.40), P=0.014]; for progression-free survival (PFS), or disease-free survival (DFS), the difference between the two groups was not statistically significant [HR=2.30, 95%CI (0.72, 7.32), P=0.158]. According to different carcinoma types, cut-off value, and region, subgroup analysis of OS was performed, and similar results were obtained.

Conclusions

Based on current evidence, this meta-analysis proves that the CONUT score of UC patients before treatment is an independent prognostic predictor. It performs well on OS, CSS, and RFS, but the conclusions on DFS/PFS need to be treated with caution.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021251890, identifier CRD42021251890.

The Association of Controlling Nutritional Status (CONUT) Score with Survival in Patients with Surgically Treated Renal Cell Carcinoma and Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-Analysis

In recent years, Controlling Nutritional Status (CONUT) Score has become widely recognized as a novel index to evaluate the survival in urological neoplasms patients, especially with renal cell carcinoma (RCC) and upper tract urothelial carcinoma (UTUC). The aim of this meta-analysis is to evaluate the prognostic value of CONUT score in patients with RCC and UTUC. PubMed, Web of Science and Embase were searched for data on the association between CONUT score and RCC/UTUC prognosis up to July 29, 2021. Duplicates were excluded, and inclusion/exclusion criteria were applied to all abstracts. We sorted out relevant studies and extracted the risk ratios (RRs) and its 95% confidence interval (CI) for recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). The relationship between gender and survival outcomes was analyzed using univariate cox regression. We analyzed seven studies including 5410 patients in the meta-analysis. A high CONUT score was associated with poor 5-year RFS (RR = 1.27, 95% CI = 1.13-1.43, P = 0.0001), CSS (RR = 1.22, 95% CI = 1.07-1.39, P = 0.003) and OS (RR = 1.24, 95% CI = 1.10-1.41, P = 0.0005). As a result, the association between CONUT score and survival was statistically significant. In addition, gender was not related to survival outcomes. Our results show that the CONUT score is associated with RCC and UTUC outcomes and can serve as a readily available biomarker for managing this disease.

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

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.

Evaluation of the nutritional status in patients with COVID-19

COVID-19 has been a global health threat. We aimed to investigate the nutrition status of COVID-19 patients and evaluate the prognostic value of the controlling nutritional status (CONUT) score in these patients. 348 severe patients with COVID-19 were collected. Based on the CONUT score, 161 (46.3%) patients had mild malnutrition while 139 (39.9%) patients had moderate-severe malnutrition. Compared to the patients in normal and mild groups, the patients in moderate-severe group were older, more male, had higher counts of white blood cell and neutrophil as well as higher serum levels of C-reactive protein. Nearly half of patients (44.6%) in moderate-severe group developed acute cardiac injury, while 6.3% and 15.5% patients in normal and mild group, respectively. Patients with moderate-severe malnutrition exhibited a higher mortality than those patients with normal and mild malnutrition. Multivariate regression analysis showed the CONUT score was the independent predictor of death in patients with COVID-19 (odds ratio: 1.410; 95%CI: 1.089–1.825; p = 0.009). Malnutrition is significantly associated with poor outcome of COVID-19, while the prognosis of patients with normal nutrition status is relative favorable. The CONUT score independently predicts the prognosis of COVID-19 patients, which can help physicians to clarify patients with poor prognosis.