Department of Oncology, the Suqian Clinical College of Xuzhou Medical University, Suqian, 223800, Jiangsu, China.
Department of Oncology, the affiliated hospital of Xuzhou Medical University, Jiangsu, 221000, Xuzhou, China.
BMC Cancer. 2023 Mar 9;23(1):225. doi: 10.1186/s12885-023-10682-z.
BACKGROUND: To investigate the prognostic impact of the controlling nutritional status (CONUT) score in non-small-cell lung cancer (NSCLC) patients receiving first-line chemotherapy. METHODS: We retrospectively reviewed 278 consecutive patients undergoing chemotherapy for stage III-IV NSCLC between May 2012 and July 2020. CONUT score was calculated by incorporating serum albumin, total cholesterol, and total lymphocyte count. The patients were divided into two groups: CONUT ≥ 3 and CONUT < 3, according to receiver operating characteristic (ROC) analysis. The associations of CONUT with clinicopathological factors and survival were evaluated. RESULTS: A high CONUT score was significantly associated with older age(P = 0.003), worse ECOG-PS(P = 0.018), advanced clinical stage(P = 0.006), higher systematic inflammation index (SII) (P < 0.001)and lower prognostic nutritional index (PNI) (P < 0.001).The high CONUT group had a significantly shorter progression-free survival(PFS) and overall survival(OS) than the low CONUT group. In the univariate analysis, higher SII, higher CONUT, advanced clinical stage and lower PNI were associated with worse PFS (P < 0.05). Worse ECOG-PS, higher SII, higher CONUT, advanced clinical stage and lower PNI were associated with worse OS (P < 0.05). In multivariate analysis, CONUT(HR, 2.487; 95%CI 1.818 ~ 3.403; P < 0.001) was independently associated with PFS, while PNI(HR, 0.676; 95%CI 0.494 ~ 0.927; P = 0.015) and CONUT(HR, 2.186; 95%CI 1.591 ~ 3.002; P < 0.001)were independently associated with OS. In ROC analysis, CONUT had a higher area under the ROC curve (AUC) for the prediction of 24-month PFS and OS than the SII or PNI. When the time-dependent AUC curve was used to predict PFS and OS, CONUT tended to maintain its predictive accuracy for long-term prognosis at a significantly higher level for an extended period after chemotherapy when compared with the other markers tested. The CONUT score showed better accuracy of predicting OS (C-index: 0.711) and PFS(C-index: 0.753). CONCLUSION: CONUT score is an independent prognostic indicator of poor outcomes for patients with stage III-IV NSCLC and is superior to the SII and PNI in terms of prognostic ability.
背景：本研究旨在探讨控制营养状况（CONUT）评分对接受一线化疗的非小细胞肺癌（NSCLC）患者预后的影响。
方法：我们回顾性分析了 2012 年 5 月至 2020 年 7 月期间接受化疗的 278 例 III-IV 期 NSCLC 患者的临床资料。通过血清白蛋白、总胆固醇和总淋巴细胞计数计算 CONUT 评分。根据受试者工作特征（ROC）分析，将患者分为 CONUT≥3 分和 CONUT<3 分两组。评估 CONUT 与临床病理因素和生存的关系。
结果：高 CONUT 评分与年龄较大（P=0.003）、ECOG-PS 评分较差（P=0.018）、临床分期较晚（P=0.006）、系统性炎症指数（SII）较高（P<0.001）和预后营养指数（PNI）较低（P<0.001）显著相关。高 CONUT 组的无进展生存期（PFS）和总生存期（OS）明显短于低 CONUT 组。单因素分析显示，较高的 SII、较高的 CONUT、较晚的临床分期和较低的 PNI 与较差的 PFS 相关（P<0.05）。较差的 ECOG-PS、较高的 SII、较高的 CONUT、较晚的临床分期和较低的 PNI 与较差的 OS 相关（P<0.05）。多因素分析显示，CONUT（HR，2.487；95%CI 1.8183.403；P<0.001）与 PFS 独立相关，而 PNI（HR，0.676；95%CI 0.4940.927；P=0.015）和 CONUT（HR，2.186；95%CI 1.591~3.002；P<0.001）与 OS 独立相关。在 ROC 分析中，CONUT 对 24 个月 PFS 和 OS 的预测具有更高的 ROC 曲线下面积（AUC），高于 SII 或 PNI。当使用时间依赖性 AUC 曲线预测 PFS 和 OS 时，与其他测试标志物相比，CONUT 在化疗后延长时间内，能够在更长时间内保持对预后的预测准确性，从而显著提高了对长期预后的预测能力。CONUT 评分在预测 OS（C 指数：0.711）和 PFS（C 指数：0.753）方面具有更好的准确性。
结论：CONUT 评分是 III-IV 期 NSCLC 患者预后不良的独立预测指标，在预测能力方面优于 SII 和 PNI。
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