Takagi Kosei, Yagi Takahito, Umeda Yuzo, Shinoura Susumu, Yoshida Ryuichi, Nobuoka Daisuke, Kuise Takashi, Araki Hiroyuki, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
World J Surg. 2017 Sep;41(9):2353-2360. doi: 10.1007/s00268-017-3985-8.
Immune-nutritional status has been recently reported as a prognostic factor in hepatocellular carcinoma (HCC). The controlling nutritional status (CONUT) score has been established as a useful tool to evaluate immune-nutritional status. This study aimed to investigate the efficacy of the CONUT score as a prognostic factor in patients undergoing hepatectomy for HCC.
A total of 295 patients who underwent curative hepatectomy for HCC between January 2007 and December 2014 were retrospectively analyzed. Patients were divided into two groups according to the CONUT score. The impact of the CONUT score on clinicopathological, surgical, and long-term outcomes was evaluated. Subsequently, the impact of prognostic factors, including the CONUT score, associated with outcomes was assessed using multivariate analyses.
Of 295 patients, 118 (40%) belonged to the high CONUT group (CONUT score ≥ 3). The high CONUT group had a significantly lower 5-year recurrence-free survival rate than the low CONUT group (27.9 vs. 41.4%, p = 0.011) and a significantly lower 5-year overall survival rate (61.9 vs. 74.9%, p = 0.006). In multivariate analyses of prognostic factors, the CONUT score was an independent predictor of recurrence-free survival (hazard ratio = 1.64, p = 0.006) and overall survival (hazard ratio = 2.50, p = 0.001).
The CONUT score is a valuable preoperative predictor of survival in patients undergoing hepatectomy for HCC.
免疫营养状态最近被报道为肝细胞癌（HCC）的一个预后因素。控制营养状态（CONUT）评分已被确立为评估免疫营养状态的一个有用工具。本研究旨在探讨CONUT评分作为HCC肝切除患者预后因素的有效性。
回顾性分析2007年1月至2014年12月期间接受根治性肝切除治疗HCC的295例患者。根据CONUT评分将患者分为两组。评估CONUT评分对临床病理、手术及长期预后的影响。随后，使用多因素分析评估包括CONUT评分在内的与预后相关的预后因素的影响。
在295例患者中，118例（40%）属于高CONUT组（CONUT评分≥3）。高CONUT组的5年无复发生存率显著低于低CONUT组（27.9%对41.4%，p = 0.011），5年总生存率也显著较低（61.9%对74.9%，p = 0.006）。在预后因素的多因素分析中，CONUT评分是无复发生存（风险比 = 1.64，p = 0.006）和总生存（风险比 = 2.50，p = 0.001）的独立预测因素。
CONUT评分是HCC肝切除患者生存的一个有价值的术前预测指标。
