Abstract
Background
The Controlling Nutritional Status (CONUT) score is an objective tool that is widely used to assess the nutritional status in patients, including those with cancer. The relationship between the CONUT score and prognosis in patients who have undergone hepatic resection has not been evaluated in a multi-institutional study.
Methods
Data were retrospectively collected for 2461 consecutive patients with hepatocellular carcinoma (HCC) who had undergone hepatic resection with curative intent at 13 institutions between January 2004 and December 2015. Patients were assigned to two groups: preoperative CONUT scores ≤ 3 (low CONUT score) and ≥ 4 (high CONUT score). Clinicopathological characteristics, surgical outcomes, and long-term survival were compared using propensity score matching analysis.
Results
Of the 2461 patients, 540 (21.9%) had high (≥ 4) and 1921 (78.1%) had low (≤ 3) preoperative CONUT scores. Overall, a high CONUT score was significantly associated with older age, female sex, low body mass index, low serum albumin, high serum total bilirubin, low lymphocyte count, low serum cholesterol, shorter prothrombin time, higher indocyanine green retention test at 15 min, Child–Pugh B (vs. A), liver cirrhosis, minor resection, shorter operation time, massive blood loss, blood transfusion, and postoperative complications. After propensity score matching, a higher CONUT score was significantly associated with poor overall survival (OS) and recurrence-free survival (RFS) using multivariate analysis.
Conclusions
This retrospective, multi-institutional analysis showed that, in patients who undergo curative hepatectomy for HCC, the preoperative CONUT score is predictive of worse OS and RFS, even after propensity score matching analysis.
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Acknowledgment
The authors thank Jodi Smith, Ph.D., from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.
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Norifumi Harimoto, Tomoharu Yoshizumi, Shoichi Inokuchi, Shinji Itoh, Eisuke Adachi, Yasuharu Ikeda, Hideaki Uchiyama, Tohru Utsunomiya, Kiyoshi Kajiyama, Koichi Kimura, Fumiaki Kishihara, Keishi Sugimachi, Eiji Tsujita, Mizuki Ninomiya, Kengo Fukuzawa, Takashi Maeda, Ken Shirabe, and Yoshihiko Maehara have no conflicts of interest or financial support to declare.
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Electronic Supplementary Fig.
1 Receiver operating characteristics (ROC) curves of the preoperative CONUT score were analyzed, with (a) overall survival (OS), (b) cancer-specific survival (CSS), and (c) recurrence-free survival (RFS) predicted by comparing the areas under the curve (AUCs). Electronic Supplementary Fig. 2 Histograms of the area of CONUT scores for all patients. The histograms of all populations were normally distributed. Electronic Supplementary Fig. 3 Kaplan–Meier analysis of (a) overall survival and (b) recurrence-free survival curves in patients with CONUT scores ≥ 4 (thick black lines) and ≤ 3 (thin black lines). Both overall and recurrence-free survival were significantly poorer in patients with CONUT score ≥ 4. Electronic Supplementary Fig. 4 Kaplan–Meier analysis of (a) overall survival and (b) recurrence-free survival curves in patients with CONUT scores ≥ 4 (thick black lines) and ≤ 3 (thin black lines). Both overall and recurrence-free survival were significantly poorer in patients with CONUT score ≥ 4. Electronic Supplementary Fig. 5 Kaplan–Meier analysis of (a) overall survival and (b) recurrence-free survival curves in patients with CONUT scores ≥ 4 (thick black lines) and ≤ 3 (thin black lines) in the low-risk subgroups, meaning thepatients with no liver cirrhosis, a single tumor, and tumor size less than 5 cm. Both overall and recurrence-free survival were significantly poorer in patients with CONUT score ≥ 4. (PPTX 146 kb)
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Harimoto, N., Yoshizumi, T., Inokuchi, S. et al. Prognostic Significance of Preoperative Controlling Nutritional Status (CONUT) Score in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma: A Multi-institutional Study. Ann Surg Oncol 25, 3316–3323 (2018). https://doi.org/10.1245/s10434-018-6672-6
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DOI: https://doi.org/10.1245/s10434-018-6672-6