Controlling Nutritional Status score: A new prognostic indicator for patients with oligometastatic prostate cancer
Introduction
Prostate cancer is one of the most common malignancies in men. In 2016, prostate cancer ranked first in the incidence of male cancer in the United States. Moreover, its mortality is second only to lung cancer.1 Due to changes in lifestyle and dietary structure, the incidence and mortality of prostate cancer have increased significantly in China.2 However, most newly diagnosed patients in China are diagnosed with advanced or distant metastases with a poor prognosis and have lost the opportunity to undergo early radical surgery.
In recent years, Hellman et al3 proposed the concept of oligometastasis. The oligotransfer state is a period of mild tumor invasiveness. It is a transitional phase between localized disease and extensive metastasis. The number of metastases is limited, and the transferred organs are specific but do not yet have a tendency to spread throughout the body. At the present, there is no clear definition of the oligometastasis status in prostate cancer. Singh et al4 retrospectively analyzed the number and type of metastases in patients with metastatic prostate cancer and found that the survival rate of patients with metastatic lesions ≤5 was significantly better than those with >5 metastases. Oligometastatic cancer can achieve long-term survival through local treatment of the primary tumor. Systemic treatment and the removal of primary tumors can significantly increase the overall survival of patients with gastric cancer5 and colorectal cancer.6 In recent years, a number of studies7 have also found that cytoreductive surgery by primary resection can benefit patients with oligometastatic prostate cancer.
However, there are still significant differences in the prognosis of patients undergoing oligometastasis cytoreductive surgery. Fossati and Löppenberg et al8, 9 analyzed data from 81,971 patients with metastatic prostate cancer in the SEER database from 2004 to 2011 and established a 3-year specificity death risk model based on age, PSA level, Gleason score, and TNM staging. The analysis found that when the 3-year overall risk of death in patients with metastatic prostate cancer was >72%, local treatment of primary tumors did not benefit patients. Therefore, it is imperative to find biomarkers that can stratify oligometastatic patients to determine treatment decisions and predict prognosis. The long-term prognosis of patients with malignant tumors is closely related to systemic nutritional status and immune-inflammatory response.10 The development, metastasis, and prognosis of oncological diseases depend not only on the type of tumor cells but also on nutrition and immunity, which play an important role in these processes. A variety of nutritional and inflammation-related biomarkers have been used to assess tumor prognosis, such as neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). The CONUT (Controlling Nutritional Status) score is presented as an emerging concept, which is calculated from serum albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration, and is used to pre-assess the patient's preoperative nutritional status.11 The use of the CONUT score has the advantages of simplicity of operation and low cost. In recent years, a number of studies have shown that the CONUT score is a new predictor of prognosis for patients with malignant tumors and has been shown to correlate with the prognosis of patients with gastric cancer, colorectal cancer, lung cancer, and liver cancer.
In this study, we aimed to investigate whether the CONUT score is an independent prognostic factor compared to NLR and PLR in oligometastatic prostate cancer and to assess its clinical value in prognosis.
Section snippets
Study patients
A retrospective analysis of 94 patients diagnosed with metastatic prostate cancer (metastasis ≤5) between January 2015 and December 2017 in Shanghai Tenth People's Hospital was conducted. Case inclusion criteria were set as follows: (1) Patients were diagnosed with prostate cancer by prostate biopsy or transurethral resection of the prostate, and after a rigorous assessment of imaging studies (including CT, MRI, Bone Scan, and 68-Ga-PSMA-ligand PET/CT), a multidisciplinary team at the Shanghai
The optimal cut-off value for the CONUT score, NLR, and PLR
The serum albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration were used to obtain the CONUT score. Blood samples were obtained within 1 week before surgery to calculate the CONUT score. The CONUT scoring system was normal (0-1), mild (2-4), moderate (5-8), and severe (Table 1). Using the X-tile software12 as a PSA-PFS state variable, the cutoff for the CONUT score was determined (Fig 1A). The best CONUT cutoff was found to be 3. Therefore, 94 patients
Discussion
In the present study, we evaluated the ability of the CONUT score to predict prognosis in patients undergoing oligometastasis cytoreductive surgery. From the data, it can be concluded that the CONUT score is an independent risk factor for the prognosis of oligometastatic prostate cancer surgery. A high CONUT score is significantly associated with tumor progression. Simultaneously, for the comparison between CONUT scores and clinical parameters, we found that there were differences between the
Conclusion
In conclusion, the CONUT score is a new serum biomarker to evaluate the prognosis of oligometastasis cytoreductive surgery and is simple, convenient, fast, and economical. We suggest that the CONUT score should be calculated before the initial treatment and be used as an assessment tool and reliable indicator of metastatic prostate cancer and immune inflammation. There are several limitations to this study. First, this is a retrospective study conducted in a single center, and there may be a
Acknowledgments
This work was supported by the National Natural Science Foundation of China (No. 81472389).
Disclosure
The author reports no conflicts of interest in this work.
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Authors contributed equally.