Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 1088639, Japan.
BMC Cancer. 2020 Nov 11;20(1):1092. doi: 10.1186/s12885-020-07560-3.
This study aimed to evaluate the prognostic impact of nutritional and inflammatory measures (controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and modified Glasgow prognostic score (mGPS)) on overall survival (OS) in patients with stage IV colorectal cancer (CRC).
Subjects were 996 patients with stage IV CRC who were referred to the National Cancer Center Hospital between 2001 and 2015. We retrospectively investigated correlations between OS and CONUT score, PNI, and mGPS. Multivariate analyses were performed using Cox proportional hazards regression models.
After adjusting for known factors (age, gender, BMI, ECOG performance status, location of primary tumor, CEA levels, histological type, M category, and prior surgical treatment), all three measures were found to be independent prognostic factors for OS in patients with stage (CONUT score, p < 0.001; PNI, p < 0.001; mGPS, p < 0.001). Significant differences in OS were found between low CONUT score (0/1) (n = 614; 61%) and intermediate CONUT score (2/3) (n = 276; 28%) (hazard ratio (HR) = 1.20, 95% confidence interval (CI): 1.02-1.42, p = 0.032), and intermediate CONUT score and high CONUT score (≥4) (n = 106; 11%) (HR = 1.30, 95% CI: 1.01-1.67, p = 0.045). Significant differences in OS were found between mGPS = 0 (n = 633; 64%) and mGPS = 1 (n = 234; 23%) (HR = 1.84, 95% CI: 1.54-2.19, p < 0.001), but not between mGPS = 1 and mGPS = 2 (n = 129; 13%) (HR = 1.12, 95% CI: 0.88-1.41, p = 0.349). Patients with low PNI (< 48.0) (n = 443; 44%) showed a significantly lower OS rate than those with high PNI (≥48.0) (n = 553; 56%) (HR = 1.39, 95% CI: 1.19-1.62, p < 0.001).
CONUT score, PNI, and mGPS were found to be independent prognostic factors for OS in patients with stage IV CRC, suggesting that nutritional and inflammatory status is a useful host-related prognostic indicator in stage IV CRC.
本研究旨在评估营养和炎症指标（控制营养状况评分（CONUT）、预后营养指数（PNI）和改良格拉斯哥预后评分（mGPS））对 IV 期结直肠癌（CRC）患者总生存（OS）的预后影响。
本研究纳入了 2001 年至 2015 年期间在国立癌症中心医院就诊的 996 例 IV 期 CRC 患者。我们回顾性调查了 OS 与 CONUT 评分、PNI 和 mGPS 之间的相关性。使用 Cox 比例风险回归模型进行多变量分析。
在调整了已知因素（年龄、性别、BMI、ECOG 表现状态、原发肿瘤部位、CEA 水平、组织学类型、M 分期和既往手术治疗）后，所有三种测量方法均被发现是 IV 期 CRC 患者 OS 的独立预后因素（CONUT 评分，p<0.001；PNI，p<0.001；mGPS，p<0.001）。OS 在低 CONUT 评分（0/1）（n=614；61%）和中 CONUT 评分（2/3）（n=276；28%）之间存在显著差异（风险比（HR）=1.20，95%置信区间（CI）：1.02-1.42，p=0.032），中 CONUT 评分和高 CONUT 评分（≥4）（n=106；11%）之间也存在显著差异（HR=1.30，95% CI：1.01-1.67，p=0.045）。mGPS=0（n=633；64%）和 mGPS=1（n=234；23%）之间的 OS 存在显著差异（HR=1.84，95% CI：1.54-2.19，p<0.001），但 mGPS=1 和 mGPS=2（n=129；13%）之间没有差异（HR=1.12，95% CI：0.88-1.41，p=0.349）。低 PNI（<48.0）（n=443；44%）患者的 OS 率明显低于高 PNI（≥48.0）（n=553；56%）（HR=1.39，95% CI：1.19-1.62，p<0.001）。
CONUT 评分、PNI 和 mGPS 被发现是 IV 期 CRC 患者 OS 的独立预后因素，表明营养和炎症状态是 IV 期 CRC 患者有用的宿主相关预后指标。
