Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China.
Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China.
Eur J Surg Oncol. 2019 May;45(5):782-787. doi: 10.1016/j.ejso.2018.11.007. Epub 2018 Nov 10.
Postoperative hepatitis B virus (HBV) reactivation (PHR) is associated with resection-induced immunosuppression in patients with HBV-related hepatocellular carcinoma (HCC). Controlling Nutritional Status (CONUT) score is an effective index for evaluating immune-nutrition function. However, the value of COUNT in predicting PHR in HBV-HCC patients remains unknown.
Totally, 209 HCC patients were enrolled.
Preoperative immune function (CD3CD4, CD3CD8, IgG and IgM) in patients with high CONUT score was significantly worse than that in patients with low CONUT score (P<0.05). Blood test results on postoperative day 7 showed the same trend. In addition, patients with high CONUT score experienced a significantly larger decrease in the proportions of CD3CD4 and CD3CD8 than those with low CONUT score (P < 0.05). In patients with high CONUT score, the incidence of overall complications was also significantly higher (P = 0.029) and hospital-stay was significantly longer (P = 0.020). Besides, overall survival and recurrence free survival in patients with high CONUT score were significantly worse than those in patients with low CONUT score (48.32 vs. 38.12 months, P<0.001; 36.08 vs. 27.03 months, P = 0.001). The incidence of PHR was significantly higher in patients with high COUNT score (P<0.001), and CONUT score was strongly associated with PHR (P<0.001). Additionally, the fellow subgroup results also demonstrated that COUNT score was more effective in predicting PHR in patients with HBV-DNA level <500 copies/ml than patients with HBV-DNA 500-1000 copies/ml.
CONUT score is an effective indicator predicting survival and PHR in HBV-HCC patients, especially in those with HBV-DNA levels <500 copies/ml.
术后乙型肝炎病毒（HBV）再激活（PHR）与 HBV 相关肝细胞癌（HCC）患者的手术诱导免疫抑制有关。控制营养状况（CONUT）评分是评估免疫营养功能的有效指标。然而，CONUT 在预测 HBV-HCC 患者 PHR 中的价值尚不清楚。
共纳入 209 例 HCC 患者。
高 CONUT 评分患者的术前免疫功能（CD3CD4、CD3CD8、IgG 和 IgM）明显低于低 CONUT 评分患者（P<0.05）。术后第 7 天的血液检查结果也呈现出相同的趋势。此外，高 CONUT 评分患者 CD3CD4 和 CD3CD8 的比例下降幅度明显大于低 CONUT 评分患者（P<0.05）。在高 CONUT 评分患者中，总并发症发生率也明显更高（P=0.029），住院时间明显更长（P=0.020）。此外，高 CONUT 评分患者的总生存和无复发生存均明显差于低 CONUT 评分患者（48.32 与 38.12 个月，P<0.001；36.08 与 27.03 个月，P=0.001）。高 CONUT 评分患者的 PHR 发生率明显更高（P<0.001），CONUT 评分与 PHR 密切相关（P<0.001）。此外，亚组分析结果还表明，在 HBV-DNA 水平<500 拷贝/ml 的患者中，CONUT 评分在预测 PHR 方面比 HBV-DNA 500-1000 拷贝/ml 的患者更有效。
CONUT 评分是预测 HBV-HCC 患者生存和 PHR 的有效指标，尤其在 HBV-DNA 水平<500 拷贝/ml 的患者中。
