Prognostic value of the controlling nutritional status (CONUT) score in intrahepatic cholangiocarcinoma patients especially who had long-time alcohol consumption

Abstract

Our study is to investigate the preoperative prognostic value of the Controlling Nutritional Status score in intrahepatic cholangiocarcinoma patients after curative resection. One hundred and sixty-seven patients admitted to our hospital between January 2012 and December 2018 were included retrospectively. Time-dependent receiver operating characteristic (ROC) curve analysis was conducted to evaluate the ability of the Controlling Nutritional Status score to predict recurrence and survival. Patients with high Controlling Nutritional Status score (≥3) had significantly poorer RFS compared to those with low Controlling Nutritional Status score (low: <3) (p = 0.000) in Kaplan-Meier survival curve. Multivariate analyses identified Controlling Nutritional Status score, lymph node metastasis, tumor numbers and preoperative CEA as independent prognostic factors for RFS. Lymph node metastasis was the independent risk factor of OS. The Cox regression model with Controlling Nutritional Status score had better prognostic value for recurrence than the Cox regression model without Controlling Nutritional Status score in long-time alcohol consumption intrahepatic cholangiocarcinoma patients (AUC: 0.760 vs 0.706, p = 0.036). CONUT score may be a more powerful prognostic biomarker, which is tightly associated with other tumor characteristics, to predict recurrence but not survival, especially in long-time alcohol consumption intrahepatic cholangiocarcinoma patients after curative-intent surgery.

Keywords: CONUT score; alcoholic; intrahepatic cholangiocarcinoma; nutritional state.

Fig. 1

A flow diagram for the selection of ICC patients.

Fig. 2

The receiver operating curve (ROC) for postoperative recurrence was plotted to verify the optimum cut-off value of CONUT score (A)/tumor size (B)/CA199 (C) for RFS, and comparison of the AUC between CONUT score/tumor size/CA199/CEA for RFS (D).

Fig. 3

Kaplan–Meier analysis of CONUT groups (low: <3 and high: ≥3) for RFS (A) and OS (B).

Fig. 4

Kaplan–Meier analysis of CONUT groups (low: <3 and high: ≥3) for RFS in negative and positive lymph node metastasis group (A, B), in small and large tumor size group (small: <6.2 cm and large: ≥6.2 cm) (C, D), in low and high CA199 group (low: <793.8 U/ml and high ≥793.8 U/ml) (E, F), and in negative and positive perineural invasion group (G, H).

Fig. 5

Comparison of the AUC between the Cox regression model with CONUT score and without CONUT score for RFS (A), and in patients who had long-time alcohol consumption history for RFS (B).