Department of Surgery, Konan Kosei Hospital, Konan, Japan.
Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
Ann Surg Oncol. 2019 Feb;26(2):456-464. doi: 10.1245/s10434-018-07121-w. Epub 2018 Dec 18.
This study aimed to evaluate the predictive value of the preoperative Controlling Nutritional Status (CONUT) score, which comprehensively reflects protein and lipid metabolism as well as the immunocompetence among patients with stage 2 or 3 gastric cancer.
From a retrospective database of 3484 patients who underwent gastrectomy for gastric cancer at nine Japanese institutions between 2010 and 2014, data for 626 patients with stage 2 or 3 cancer were retrieved. The study evaluated the significance of the associations between the optimal CONUT score cutoff values with the prognosis and the incidence of postoperative complications.
The study determined that 2 was the optimal CONUT score cutoff value for predicting mortality 2 years after surgery. The patients with a CONUT score of 2 or higher (CONUT-high group) were significantly older and had a worse Eastern Cooperative Oncology Group performance status, lower body mass index, and more advanced tumor-node-metastasis stage than the patients with a CONUT score lower than 2 (CONUT-low group). Overall, the survival time was significantly shorter in the CONUT-high group than in the CONUT-low group [hazard ratio (HR) 1.97; P < 0.0001]. A multivariable analysis showed that the CONUT score was an independent prognostic factor of overall survival. The CONUT score more significantly reflected the overall survival for patients who underwent postoperative adjuvant chemotherapy than for those who underwent surgery alone. Additionally, a high preoperative CONUT score was significantly associated with an increased incidence of postoperative pneumonia and prolonged hospitalization.
The study results suggest that the preoperative CONUT score may be a useful predictor of postoperative short- and long-term outcomes for patients with stage 2 or 3 gastric cancer.
本研究旨在评估术前控制营养状况（CONUT）评分的预测价值，该评分综合反映了 2 或 3 期胃癌患者的蛋白质和脂质代谢以及免疫功能。
从 2010 年至 2014 年在日本 9 家机构接受胃癌胃切除术的 3484 例患者的回顾性数据库中，检索了 626 例 2 或 3 期癌症患者的数据。该研究评估了最佳 CONUT 评分截断值与预后和术后并发症发生率之间关联的意义。
该研究确定 2 是预测术后 2 年死亡率的最佳 CONUT 评分截断值。CONUT 评分≥2（CONUT 高组）的患者明显较年长，东部合作肿瘤学组表现状态较差，体重指数较低，肿瘤-淋巴结-转移分期较高，CONUT 评分低于 2（CONUT 低组）。总体而言，CONUT 高组的生存时间明显短于 CONUT 低组[风险比（HR）1.97；P<0.0001]。多变量分析表明，CONUT 评分是总生存的独立预后因素。CONUT 评分更能反映接受术后辅助化疗患者的总生存情况，而不是单独接受手术的患者。此外，术前高 CONUT 评分与术后肺炎发生率增加和住院时间延长显著相关。
研究结果表明，术前 CONUT 评分可能是 2 或 3 期胃癌患者术后短期和长期结局的有用预测指标。
