The pretreatment Controlling Nutritional Status (CONUT) score is an independent prognostic factor in patients with resectable thoracic esophageal squamous cell carcinoma: results from a retrospective study

Abstract

Background: The purpose of this study was to investigate the impact of the Controlling Nutritional Status (CONUT) score on survival compared with the platelet to lymphocyte ratio (PLR), the neutrophil to lymphocyte ratio (NLR), and the Glasgow Prognostic Score (GPS) in patients with resectable thoracic esophageal squamous cell carcinoma (ESCC).

Methods: One hundred eighty-five consecutive patients who underwent subtotal esophagectomy with curative intent for resectable thoracic ESCC were retrospectively reviewed. Time-dependent receiver operating characteristic curve analyses for 3-year overall survival (OS) as the endpoint were performed, and the maximal Youden indices were calculated to assess discrimination ability and to determine the appropriate cut-off values of CONUT, PLR, and NLR. The patients were then classified into high and low groups based on these cut-off values. Correlations between CONUT and other clinicopathological characteristics were analyzed. Prognostic factors predicting overall survival (OS) and relapse-free survival (RFS) were analyzed using Cox proportional hazards models.

Results: The areas under the curve predicting 3-year OS were 0.603 for CONUT, 0.561 for PLR, 0.564 for NLR, and 0.563 for GPS. The optimal cut-off values were two for the CONUT score, 193 for PLR, and 3.612 for NLR. The high-CONUT group was significantly associated with lower BMI, high-PLR, high-NLR, and GPS1/2 groups. On univariate analysis, high-CONUT, high-PLR, high-NLR, and GPS 1/2 groups were significantly associated with poorer OS and RFS. Of these factors, multivariate analysis revealed that only the CONUT score was an independent prognostic factor for OS (HR 2.303, 95 % CI 1.191-4.455; p = 0.013) and RFS (HR 2.163, 95 % CI 1.139-4.109; p = 0.018).

Conclusions: The CONUT score was an independent predictor of OS and RFS before treatment and was superior to PLR, NLR, and GPS in terms of predictive ability for prognosis in patients with resectable thoracic ESCC.

Keywords: Controlling nutritional status; Esophageal cancer; Esophagectomy; Nutrition; Prognostic factor.

Fig. 1

Kaplan-Meier survival curves of overall survival (OS) and relapse-free survival (RFS) in patients with resectable thoracic ESCC. a The 3- and 5-year OS rates are 72.0 % and 63.6 % in the low-CONUT group and 35.3 and 35.3 % in the high-CONUT group. b The 3- and 5-year RFS rates are 65.3 and 59.5 % in the low-CONUT group and 35.3 and 35.3 % in the high-CONUT group. c The 3- and 5-year OS rates are 72.1 and 62.6 % in the low-PLR group and 52.1 and 52.1 % in the high-PLR group. d The 3- and 5-year RFS rates are 65.4 and 59.5 % in the low-PLR group and 49.3 and 45.5 % in the high-PLR group. e The 3- and 5-year OS rates are 72.1 and 63.3 % in the low-NLR group and 43.5 and 43.5 % in the high-NLR group. f The 3- and 5-year RFS rates are 65.0 and 59.6 % in the low-NLR group and 44.6 and 39.0 % in the high-NLR group. g The 3- and 5-year OS rates are 71.4 and 63.9 % in the GPS 0 group and 32.7 and 16.3 % in the GPS 1/2 group. h The 3- and 5-year RFS rates are 64.8 and 59.8 % in the GPS 0 group and 34.3 and 17.1 % in the GPS 1/2 group

Fig. 2

Kaplan-Meier survival curves of overall survival (OS) and relapse-free survival (RFS) according to the CONUT score in patients with preoperative treatment (a OS, p = 0.008; b RFS, p = 0.010) and in patients without preoperative treatment (c OS, p = 0.002; d RFS, p = 0.009)