Fang Pinhao, Zhou Jianfeng, Liang Zhiwen, Yang Yushang, Luan Siyuan, Xiao Xin, Li Xiaokun, Shang Qixin, Zhang Hanlu, Zeng Xiaoxi, Yuan Yong
Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China.
Biomedical Big Data Center of West China Hospital, Med+X Center for Informatics, Sichuan University, Chengdu, China.
J Thorac Dis. 2024 Jul 30;16(7):4460-4473. doi: 10.21037/jtd-24-187. Epub 2024 Jul 26.
A variety of nutritional evaluation parameters has been documented as prognostic indicators in some malignancies. However, the prognostic significance of the controlling nutritional status (CONUT) score, as one of these nutritional indices, in patients with esophageal squamous cell carcinoma (ESCC) remains unclear and warrants investigation. Our study sought to elucidate the prognostic value of this nutritional index in ESCC patients who underwent neoadjuvant therapy followed by esophagectomy.
This retrospective study encompassed 314 patients diagnosed with ESCC who underwent neoadjuvant therapy followed by esophagectomy at West China Hospital of Sichuan University between August 2016 and August 2021. CONUT scores were computed at two specific time points: prior to neoadjuvant therapy initiation and before surgery, utilizing serum albumin, total lymphocyte, and cholesterol levels of ESCC patients. Furthermore, the delta CONUT (ΔCONUT) score was derived by subtracting the preoperative CONUT score from the pretreatment CONUT score. The associations between CONUT scores and various survival outcomes were evaluated using Kaplan-Meier methods and Cox regression analysis.
Patients with a high preoperative CONUT score demonstrated a higher postoperative complication rate [odds ratio (OR) =2.009, 95% confidence interval (CI): 1.150-3.510, P=0.01] compared to those in the low CONUT group. Multivariate analysis revealed that a ΔCONUT score ≥0 served as an independent negative prognostic indicator for increased postoperative complications (OR =3.008, 95% CI: 1.509-5.999, P=0.002) and poorer overall survival [hazard ratio (HR) =2.388, 95% CI: 1.052-5.422, P=0.04] in ESCC patients who underwent neoadjuvant therapy combined with esophagectomy.
A high preoperative CONUT score and a ΔCONUT score ≥0 were indicative of a poor prognostic nutritional status in ESCC patients who had undergone neoadjuvant therapy followed by esophagectomy.
多种营养评估参数已被记录为某些恶性肿瘤的预后指标。然而，作为这些营养指标之一的控制营养状况（CONUT）评分在食管鳞状细胞癌（ESCC）患者中的预后意义仍不明确，值得研究。我们的研究旨在阐明该营养指标在接受新辅助治疗后行食管切除术的ESCC患者中的预后价值。
这项回顾性研究纳入了2016年8月至2021年8月期间在四川大学华西医院诊断为ESCC并接受新辅助治疗后行食管切除术的314例患者。CONUT评分在两个特定时间点计算：新辅助治疗开始前和手术前，利用ESCC患者的血清白蛋白、总淋巴细胞和胆固醇水平。此外，通过术前CONUT评分减去治疗前CONUT评分得出ΔCONUT评分。使用Kaplan-Meier方法和Cox回归分析评估CONUT评分与各种生存结局之间的关联。
与低CONUT组相比，术前CONUT评分高的患者术后并发症发生率更高[比值比（OR）=2.009，95%置信区间（CI）：1.150-3.510，P=0.01]。多变量分析显示，ΔCONUT评分≥0是接受新辅助治疗联合食管切除术的ESCC患者术后并发症增加（OR =3.008，95%CI：1.509-5.999，P=0.002）和总生存期较差[风险比（HR）=2.388，95%CI：1.052-5.422,P=0.04]的独立阴性预后指标。
术前CONUT评分高和ΔCONUT评分≥0表明接受新辅助治疗后行食管切除术的ESCC患者预后营养状况较差。
