Miyazaki Ryohei, Tamura Masaya, Sakai Takashi, Furukawa Naoki, Yamamoto Marino, Okada Hironobu
Department of Thoracic Surgery, Kochi Medical School, Nankoku, Kochi, Japan.
J Thorac Dis. 2024 Jul 30;16(7):4400-4408. doi: 10.21037/jtd-24-435. Epub 2024 Jul 22.
We found that conventional controlling nutritional status (CONUT) score can serve as a sensitive prognostic marker. Some prognostic indicators do include C-reactive protein (CRP), such as the CRP-lymphocyte ratio (CLR), CRP-albumin-lymphocyte index (CALLY), and CRP-albumin ratio (CAR). However, CRP has not been combined with the CONUT score, which we believe could result in a more sensitive marker. This study evaluated the combined use of the CONUT score and CRP to predict prognostic outcomes in elderly non-small cell lung cancer (NSCLC) patients undergoing surgical resection.
This study involved the retrospective analysis of 114 NSCLC patients who were over 80 years old and underwent curative resection. The summation of the CRP score and CONUT score was defined as the combined CRP and controlling nutritional status (C-CONUT) score. The capacity of CRP, CONUT score, and C-CONUT score to predict overall survival (OS) was evaluated via receiver operating characteristics (ROC) curves. Prognostic markers for OS were then identified using the Cox proportional hazards regression model.
The ROC curves identified the C-CONUT score as the most reliable marker of prognosis (area under the curve =0.745). Forty-seven patients were included in the high C-CONUT (≥3) group, while 67 patients were included in the low C-CONUT (0 to 2) group. Worse prognosis rates were observed in the high C-CONUT group in comparison to the low C-CONUT group in terms of OS (five-year OS: 39.8% versus 87.4%, P<0.001). Lymphatic invasion (P<0.001), histological findings (P=0.02), and C-CONUT score [hazard ratio (HR): 5.07, 95% confidence interval (CI): 2.39-10.8, P<0.001] were identified as exclusive markers for OS prognosis in the multivariate analysis.
Our current findings indicate that C-CONUT score may serve as an innovative prognostic marker in the elderly NSCLC population.
我们发现传统控制营养状态（CONUT）评分可作为一种敏感的预后标志物。一些预后指标确实包括C反应蛋白（CRP），如CRP-淋巴细胞比值（CLR）、CRP-白蛋白-淋巴细胞指数（CALLY）和CRP-白蛋白比值（CAR）。然而，CRP尚未与CONUT评分相结合，我们认为这可能会产生一个更敏感的标志物。本研究评估了CONUT评分与CRP联合使用对接受手术切除的老年非小细胞肺癌（NSCLC）患者预后结果的预测价值。
本研究对114例年龄超过80岁且接受根治性切除的NSCLC患者进行回顾性分析。CRP评分与CONUT评分之和定义为联合CRP与控制营养状态（C-CONUT）评分。通过受试者工作特征（ROC）曲线评估CRP、CONUT评分和C-CONUT评分预测总生存期（OS）的能力。然后使用Cox比例风险回归模型确定OS的预后标志物。
ROC曲线确定C-CONUT评分为最可靠的预后标志物（曲线下面积=0.745）。高C-CONUT（≥3）组纳入47例患者，低C-CONUT（0至2）组纳入67例患者。在OS方面，高C-CONUT组的预后率低于低C-CONUT组（五年OS：39.8%对87.4%，P<0.001）。多因素分析确定淋巴浸润（P<0.001）、组织学结果（P=0.02）和C-CONUT评分[风险比（HR）：5.07，95%置信区间（CI）：2.39-10.8，P<0.001]为OS预后的独立标志物。
我们目前的研究结果表明，C-CONUT评分可能是老年NSCLC人群中的一种创新预后标志物。
