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. 2022 Mar 4:13:836958.
doi: 10.3389/fphar.2022.836958. eCollection 2022.

Controlling Nutritional Status (CONUT) Predicts Survival in Gastric Cancer Patients With Immune Checkpoint Inhibitor (PD-1/PD-L1) Outcomes

Li Chen  1   2 , Hao Sun  2 , Ruihu Zhao  2 , Rong Huang  2 , Hongming Pan  2 , Yanjiao Zuo  2 , Lele Zhang  2 , Yingwei Xue  2 , Hongjiang Song  2 , Xingrui Li  1
Affiliations

Controlling Nutritional Status (CONUT) Predicts Survival in Gastric Cancer Patients With Immune Checkpoint Inhibitor (PD-1/PD-L1) Outcomes

Li Chen et al. Front Pharmacol. .

Erratum in

Abstract

Objective: The controlling nutritional status (CONUT), based on total lymphocyte count (TL), total cholesterol level (T-CHOL), and serum albumin (ALB), can provide a useful immunological prognostic biomarker for cancer patients. The present study aims to investigate the correlation between CONUT and prognosis in gastric cancer patients receiving immune checkpoint inhibitor (ICI) treatment. Methods: We retrospectively enrolled 146 patients with gastric cancer treated with ICIs (PD-1/PD-L1 inhibitors) from August 2016 to December 2020. The clinicopathologic characteristics were analyzed by Chi-square test or Fisher's exact test. The Kaplan-Meier and log-rank test were used to calculate and compare progression-free survival (PFS) and overall survival (OS). The prognostic and predictive factors of PFS and OS were identified by univariate and multivariate analyses. A nomogram was developed to estimate 1-, 3-, and 5-year PFS and OS probability. Results: Through the CONUT score, there were 75 (51.37%) patients in the low CONUT group and 71 (48.63%) patients in the high CONUT group. There was a correlation between the CONUT score and age (p = 0.005), pathology (p = 0.043), ALB (p = 0.020), PALB (p = 0.032), and Hb (p = 0.001). The CA724, TNM stage, and treatment (ICIs vs. chemotherapy) were the independent prognostic factors for PFS and OS by multivariate analyses. Patients with high CONUT score had poorer PFS and OS (χ2 = 3.238, p = 0.072, and χ2 = 4.298, p = 0.038). In the subgroup analysis, the patients with high CONUT score were associated with shorter PFS and OS with ICIs or chemotherapy. With the PD-1/PD-L1 positive expression, the patients with high CONUT score had shorter PFS and OS than those with low CONUT score. Furthermore, the patients with high CA724 value were associated with shorter PFS and OS. The toxicity assessment in ICIs or chemotherapy was significantly associated with anemia. The nomograms were constructed to predict the probability of 1-, 3-, and 5-year PFS, and 1-, 3-, and 5-year OS with C-indices of 0.749 and 0.769, respectively. Conclusion: The CONUT, as a novel immuno-nutritional biomarker, may be useful in identifying gastric cancer patients who are unlikely to benefit from ICI treatment.

Keywords: PD-1; PD-L1; controlling nutritional status; gastric cancer; immune checkpoint inhibitors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Survival according to the ALB, TL, and CONUT groups for (A) progression-free survival (PFS) by ALB; (B) overall survival (OS) by ALB; (C) PFS by TL; (D) OS by TL; (E) PFS by CONUT; (F) OS by CONUT. ALB, serum albumin; TL, total lymphocyte count; CONUT, Controlling Nutritional Status.
FIGURE 2
FIGURE 2
Survival according to the ICIs and Chemotherapy groups for (A) progression-free survival (PFS) by ICIs; (B) overall survival (OS) by ICIs; (C) PFS by Chemotherapy; (D) OS by Chemotherapy. ICIs, immune checkpoint inhibitors.
FIGURE 3
FIGURE 3
Survival according to the Surgery groups for (A) progression-free survival (PFS) by Surgery for all patients; (B) overall survival (OS) by Surgery for all patients; (C) PFS by Surgery; (D) OS by Surgery; (E) PFS by Non-surgery; and (F) OS by Non-surgery.
FIGURE 4
FIGURE 4
Survival according to PD-1/PD-L1 positive expression groups for (A) progression-free survival (PFS); (B) overall survival (OS).
FIGURE 5
FIGURE 5
Survival according to carbohydrate antigen 724 (CA724) groups for (A) progression-free survival (PFS) by CA724; (B) overall survival (OS) by CA724; (C) PFS by low CA724; (D) OS by low CA724; (E) PFS by high CA724; (F) OS by high CA724.
FIGURE 6
FIGURE 6
Nomogram for predicting (A) progression-free survival (PFS) and (B) overall survival (OS).
See this image and copyright information in PMC

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