Controlling Nutritional Status (CONUT) Score is Associated with Overall Survival in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib: A Multicenter Cohort Study

Abstract

We aimed to investigate the impact of the controlling nutritional status (CONUT) score, an immuno-nutritional biomarker, on the prognosis of patients with hepatocellular carcinoma (HCC) treated with lenvatinib (LEN). This retrospective study enrolled 164 patients with HCC and treated with LEN (median age 73 years, Barcelona Clinic Liver Cancer (BCLC) stage B/C 93/71). Factors associated with overall survival (OS) were evaluated using multivariate and decision tree analyses. OS was calculated using the Kaplan-Meier method and analyzed using the log-rank test. Independent factors for OS were albumin-bilirubin grade 1, BCLC stage B, and CONUT score <5 (hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.58-5.31, p < 0.001). The CONUT score was the most important variable for OS, with OS rates of 70.0% and 29.0% in the low and high CONUT groups, respectively. Additionally, the median survival time was longer in the low CONUT group than in the high CONUT group (median survival time not reached vs. 11.3 months, p < 0.001). The CONUT score was the most important prognostic variable, rather than albumin-bilirubin grade and BCLC stage, in patients with HCC treated with LEN. Accordingly, immuno-nutritional status may be an important factor in the management of patients with HCC treated with LEN.

Keywords: controlling nutritional status; hepatoma; lenvatinib; prognosis.

Figure A1

Study design. A total of 177 patients with HCC were enrolled between 24 March 2018 and 28 February 2019. In the course of the study, 13 patients were excluded, and 164 patients with HCC were included in the analysis. Abbreviations: HCC, hepatocellular carcinoma; BCLC, Barcelona Clinic Liver Cancer.

Figure A2

Duration of treatment with lenvatinib according to CONUT score. Kaplan–Meier curves for the duration of treatment with Lenvatinib, according to CONUT score. The solid line represents the low CONUT group (CONUT score <5). The dotted line represents the high CONUT group (CONUT score ≥5). Abbreviations: CONUT, Controlling Nutritional Status.

Figure A3

The difference in the parameters of the CONUT score between the discontinuation and no discontinuation of LEN due to AE (adverse events). (a) total lymphocyte count, (b) total cholesterol level, and (c) serum albumin level.

Figure 1

Overall survival time in patients with HCC treated with lenvatinib. Kaplan–Meier curves for overall survival time in patients with HCC treated with lenvatinib. Abbreviations: HCC, hepatocellular carcinoma.

Figure 2

Profiles associated with survival in patients with HCC treated with lenvatinib. Decision tree algorithm for OS. Pie graphs indicate the percentages of alive (white)/deceased (black) patients in each group. Abbreviations: HCC, hepatocellular carcinoma; OS, overall survival.

Figure 3

Overall survival time in patients with HCC treated with lenvatinib. Kaplan–Meier survival analysis, showing overall survival time according to CONUT score (<5 or ≥5) in patients with HCC treated with lenvatinib. The solid line represents the low CONUT group (CONUT score <5). The dotted line represents the high CONUT group (CONUT score ≥5). Abbreviations: HCC, hepatocellular carcinoma; CONUT, Controlling Nutritional Status.

Figure 4

Correlations between CONUT score and total lymphocyte count, total cholesterol level, and albumin level. (a) Correlation between CONUT score and total lymphocyte count; (b) correlation between CONUT score and total cholesterol level; (c) correlation between CONUT score and albumin level. Abbreviations: CONUT, Controlling Nutritional Status.