Suzuki Satoshi, Kanaji Shingo, Yamamoto Masashi, Oshikiri Taro, Nakamura Tetsu, Kakeji Yoshihiro
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Hyogo, Kobe, 650-0017, Japan.
World J Surg. 2019 Apr;43(4):1076-1084. doi: 10.1007/s00268-018-04889-6.
Preoperative nutritional status is considered to affect the short-term and long-term outcomes of cancer patients. The clinical value of the controlling nutritional status (CONUT) score in elderly patients undergoing gastrectomy for gastric cancer remains unknown.
This study reviewed 211 elderly patients aged 75 years or over who underwent curative resection for gastric cancer from 2000 to 2015. Patients were grouped according to the preoperative CONUT score into those with normal nutrition (75 patients), light malnutrition (100 patients) and moderate or severe malnutrition (36 patients). The predictive value of the CONUT score for postoperative morbidity and survival was assessed.
Impaired nutrition was associated with cardiovascular disease (P = 0.012) and chronic kidney disease (P = 0.014), and worsened malnutrition was linked to advanced age (P = 0.004), decreased body mass index (P = 0.008) and advanced disease stage (P = 0.01). Multivariate analysis showed the CONUT score as an independent predictor of procedure-unrelated infectious morbidity (odds ratio, 2.36; 95% confidence interval [CI], 0.99-5.40; P = 0.046). Patients with a higher CONUT score had significantly shorter overall survival in both stage I and stage II/III gastric cancer (P = 0.044 and P = 0.007, respectively) and reduced cancer-specific survival in stage II/III (P = 0.003) The CONUT score was a strong predictors of overall survival (hazard ratio [HR], 2.12; 95% CI, 1.18-3.69; P = 0.012) and cancer-specific survival (HR, 3.75; 95% CI, 1.30-10.43; P = 0.015) independent of disease stage.
The preoperative CONUT score is a simple and promising predictor of postoperative procedure-unrelated infectious morbidity and prognosis in elderly gastric cancer patients.
术前营养状况被认为会影响癌症患者的短期和长期预后。控制营养状况（CONUT）评分在老年胃癌患者胃切除术中的临床价值尚不清楚。
本研究回顾了2000年至2015年间接受胃癌根治性切除术的211名75岁及以上的老年患者。根据术前CONUT评分将患者分为营养正常组（75例）、轻度营养不良组（100例）和中度或重度营养不良组（36例）。评估CONUT评分对术后发病率和生存率的预测价值。
营养受损与心血管疾病（P = 0.012）和慢性肾病（P = 0.014）相关，营养不良加重与高龄（P = 0.004）、体重指数降低（P = 0.008）和疾病晚期（P = 0.01）有关。多因素分析显示CONUT评分是与手术无关的感染性发病率的独立预测因素（比值比，2.36；95%置信区间[CI]，0.99 - 5.40；P = 0.046）。CONUT评分较高的患者在I期和II/III期胃癌中的总生存期均显著缩短（分别为P = 0.044和P = 0.007）；在II/III期患者中，癌症特异性生存期降低（P = 0.003）。CONUT评分是总生存期（风险比[HR]，2.12；95%CI，1.18 - 3.69；P = 0.012）和癌症特异性生存期（HR，3.75；95%CI，1.30 - 10.43；P = 0.015）的有力预测因素，与疾病分期无关。
术前CONUT评分是老年胃癌患者术后与手术无关的感染性发病率和预后的一个简单且有前景的预测指标。
