Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Surg Oncol. 2020 Sep;34:261-269. doi: 10.1016/j.suronc.2020.05.008. Epub 2020 May 28.
The role of controlling nutritional status (CONUT) score in predicting cancer survival remains uncertain. This study aimed to investigate the predictive value of the CONUT score and to develop a more appropriate scoring system beyond CONUT for gastric cancer.
We retrospectively reviewed 1307 patients who underwent curative gastrectomy between 2009 and 2015. The CONUT and three modified scores with modified lipid components (L-CONUT: albumin/total lymphocyte count [TLC]/low density lipoprotein, H-CONUT: albumin/TLC/high density lipoprotein, and T-CONUT: albumin/TLC/triglyceride) were calculated. The predictive value of each scoring system on long-term survival was assessed.
The values of the four nutritional scores were categorized into four groups (normal, light, moderate, and severe). The CONUT (P < 0.001), L-CONUT (P < 0.001), H-CONUT (P < 0.001), and T-CONUT (P < 0.001) scores showed significant differences in overall survival in between groups. Survival analysis according to the pathological stage showed that advanced age, Eastern Cooperative Oncology Group performance status, male sex, and moderate H-CONUT score (HR, 3.970; 95% CI, 1.826-8.633; P = 0.001) were independent worse prognostic factors for overall survival in the stage I group. In the stage II group, light CONUT score (HR, 2.230; 95% CI, 1.067-4.664; P = 0.033) and moderate CONUT score (HR, 5.077; 95% CI, 1.647-15.650; P = 0.005) were significantly associated with poor prognosis. In the stage III group, no scoring system showed significant results.
In advanced gastric cancer (beyond stage II), the prognostic impact of the nutritional scoring system was uncertain. However, the H-CONUT score is a promising indicator of prognosis in stage I, and the CONUT score is useful for predicting long-term survival in stage II gastric cancer.
控制营养状况（CONUT）评分在预测癌症生存中的作用仍不确定。本研究旨在探讨 CONUT 评分的预测价值，并为胃癌开发一种超越 CONUT 的更合适的评分系统。
我们回顾性分析了 2009 年至 2015 年间接受根治性胃切除术的 1307 例患者。计算了 CONUT 和三个改良评分系统，包括改良脂质成分（L-CONUT：白蛋白/总淋巴细胞计数[TLC]/低密度脂蛋白，H-CONUT：白蛋白/TLC/高密度脂蛋白，和 T-CONUT：白蛋白/TLC/甘油三酯）。评估每个评分系统对长期生存的预测价值。
四个营养评分的分值分为四组（正常、轻度、中度和重度）。CONUT（P<0.001）、L-CONUT（P<0.001）、H-CONUT（P<0.001）和 T-CONUT（P<0.001）评分在总体生存方面存在显著差异。根据病理分期的生存分析显示，年龄较大、东部合作肿瘤学组体能状态、男性和中度 H-CONUT 评分（HR，3.970；95%CI，1.826-8.633；P=0.001）是 I 期组总体生存的独立预后不良因素。在 II 期组中，轻度 CONUT 评分（HR，2.230；95%CI，1.067-4.664；P=0.033）和中度 CONUT 评分（HR，5.077；95%CI，1.647-15.650；P=0.005）与预后不良显著相关。在 III 期组中，没有评分系统显示出显著结果。
在晚期胃癌（II 期以上）中，营养评分系统的预后影响不确定。然而，H-CONUT 评分是 I 期预后的一个有前途的指标，CONUT 评分对 II 期胃癌的长期生存预测有用。
