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Published in: Lung 4/2020

01-08-2020 | Lung Cancer | LUNG CANCER

The Significance of Controlling Nutritional Status (CONUT) Score as a Novel Prognostic Parameter in Small Cell Lung Cancer

Authors: Ali Yılmaz, Salim Başol Tekin, Mehmet Bilici, Hatice Yılmaz

Published in: Lung | Issue 4/2020

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Abstract

Purpose

The immuno-nutritional status is closely related to the prognosis in many cancers. Controlling nutritional status (CONUT) score is a new parameter that reflects the immuno-nutritional status and is prognostic in some cancers. However, the prognostic significance of the CONUT score in small cell lung cancer (SCLC) is unknown. We aimed to demonstrate the prognostic significance of the CONUT score in patients with SCLC.

Methods

Two hundred sixteen patients who were followed up with SCLC were included in the study retrospectively. According to the receiver operating characteristic (ROC) curve analysis, the optimal cutoff values were determined for the CONUT score, and the patients were divided into low (< 2) and high (≥ 2) CONUT groups. Neutrophil–lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and prognostic nutritional index (PNI) were grouped based on a cutoff point 2.84, 626, and 46.1, respectively. Cox regression analyses were used to assess their prognostic values for progression-free survival (PFS) and overall survival (OS).

Results

The high CONUT group had significantly worse PFS and OS than the low CONUT group (p < 0.001, p < 0.001). In univariate analysis, stage, prophylactic cranial irradiation, extrapulmonary lesion, PNI, body mass index, CONUT score were found to be significant for both PFS and OS. In multivariate analysis, only CONUT score and stage were found as independent prognostic factors for both PFS (p: 0.018, p: 0.046) and OS (p: 0.038, p: 0.006).

Conclusion

The CONUT score at the time of diagnosis is an independent prognostic parameter that predicts recurrence and survival times in SCLC.
Literature
1.
go back to reference Wang D, Guo D, Shi F et al (2019) The predictive effect of the systemic immune-inflammation index for patients with small-cell lung cancer. Future Oncol 15(29):3367–3379PubMedCrossRef Wang D, Guo D, Shi F et al (2019) The predictive effect of the systemic immune-inflammation index for patients with small-cell lung cancer. Future Oncol 15(29):3367–3379PubMedCrossRef
2.
go back to reference Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424CrossRef Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424CrossRef
3.
go back to reference Horn L, Mansfield AS, Szczęsna A et al (2018) First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med 6 379(23):2220–2229CrossRef Horn L, Mansfield AS, Szczęsna A et al (2018) First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med 6 379(23):2220–2229CrossRef
5.
go back to reference Go SI, Jeon H, Park SW et al (2018) Low pre-treatment nutritional index is significantly related to poor outcomes in small cell lung cancer. Thorac Cancer 9(11):1483–1491PubMedPubMedCentralCrossRef Go SI, Jeon H, Park SW et al (2018) Low pre-treatment nutritional index is significantly related to poor outcomes in small cell lung cancer. Thorac Cancer 9(11):1483–1491PubMedPubMedCentralCrossRef
6.
go back to reference Alwarawrah Y, Kiernan K, MacIver NJ (2018) Changes in nutritional status impact immune cell metabolism and function. Front Immunol 16(9):1055CrossRef Alwarawrah Y, Kiernan K, MacIver NJ (2018) Changes in nutritional status impact immune cell metabolism and function. Front Immunol 16(9):1055CrossRef
7.
go back to reference Banks WA (2001) Anorectic effects of circulating cytokines: role of the vascular blood-brain barrier. Nutrition 17:434–437PubMedCrossRef Banks WA (2001) Anorectic effects of circulating cytokines: role of the vascular blood-brain barrier. Nutrition 17:434–437PubMedCrossRef
8.
go back to reference Zhu R, Liu Z, Jiao R et al (2019) Updates on the pathogenesis of advanced lung cancer-induced cachexia. Thorac Cancer 10(1):8–16PubMedCrossRef Zhu R, Liu Z, Jiao R et al (2019) Updates on the pathogenesis of advanced lung cancer-induced cachexia. Thorac Cancer 10(1):8–16PubMedCrossRef
9.
go back to reference Kamp CM, Langen RC, Snepvangers FJ et al (2013) Nuclear transcription factor kB activation and protein turnover adaptations in skeletal muscle of patients with progressive stages of lung cancer cachexia. Am J Clin Nutr 98:738–748CrossRef Kamp CM, Langen RC, Snepvangers FJ et al (2013) Nuclear transcription factor kB activation and protein turnover adaptations in skeletal muscle of patients with progressive stages of lung cancer cachexia. Am J Clin Nutr 98:738–748CrossRef
10.
go back to reference Fearon KC, Barber MD, Falconer JS et al (1999) Pancreatic cancer as a model: Inflammatory mediators, acute-phase response, and cancer cachexia. World J Surg 23:584–588PubMedCrossRef Fearon KC, Barber MD, Falconer JS et al (1999) Pancreatic cancer as a model: Inflammatory mediators, acute-phase response, and cancer cachexia. World J Surg 23:584–588PubMedCrossRef
12.
go back to reference Akamine T, Toyokawa G, Matsubara T et al (2017) Significance of the preoperative CONUT score in predicting postoperative disease-free and overall survival in patients with lung adenocarcinoma with obstructive lung disease. Anticancer Res 37(5):2735–2742PubMedCrossRef Akamine T, Toyokawa G, Matsubara T et al (2017) Significance of the preoperative CONUT score in predicting postoperative disease-free and overall survival in patients with lung adenocarcinoma with obstructive lung disease. Anticancer Res 37(5):2735–2742PubMedCrossRef
13.
go back to reference Sakin A, Sahin S, Yasar N et al (2019) The relation between hemogram parameters and survival in extensive-stage small cell lung cancer. Oncol Res Treat 42(10):506–515PubMedCrossRef Sakin A, Sahin S, Yasar N et al (2019) The relation between hemogram parameters and survival in extensive-stage small cell lung cancer. Oncol Res Treat 42(10):506–515PubMedCrossRef
14.
go back to reference Yang R, Chang Q, Meng X et al (2018) Prognostic value of systemic immune-inflammation index in cancer: a meta-analysis. J Cancer 7 9(18):3295–3302CrossRef Yang R, Chang Q, Meng X et al (2018) Prognostic value of systemic immune-inflammation index in cancer: a meta-analysis. J Cancer 7 9(18):3295–3302CrossRef
15.
16.
go back to reference Ignacio de Ulíbarri J, González-Madroño A, de Villar NG et al (2005) CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 20(1):38–45PubMed Ignacio de Ulíbarri J, González-Madroño A, de Villar NG et al (2005) CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 20(1):38–45PubMed
17.
go back to reference Okamoto S, Ureshino H, Kidoguchi K et al (2020) Clinical impact of the CONUT score in patients with multiple myeloma. Ann Hematol 99(1):113–119PubMedCrossRef Okamoto S, Ureshino H, Kidoguchi K et al (2020) Clinical impact of the CONUT score in patients with multiple myeloma. Ann Hematol 99(1):113–119PubMedCrossRef
18.
go back to reference Takagi K, Domagala P, Polak WG et al (2019) Prognostic significance of the controlling nutritional status (CONUT) score in patients undergoing gastrectomy for gastric cancer: a systematic review and meta-analysis. BMC Surg 5 19(1):129CrossRef Takagi K, Domagala P, Polak WG et al (2019) Prognostic significance of the controlling nutritional status (CONUT) score in patients undergoing gastrectomy for gastric cancer: a systematic review and meta-analysis. BMC Surg 5 19(1):129CrossRef
19.
go back to reference Elghiaty A, Kim J, Jang WS et al (2019) Preoperative controlling nutritional status (CONUT) score as a novel immune-nutritional predictor of survival in non-metastatic clear cell renal cell carcinoma of ≤ 7 cm on preoperative imaging. J Cancer Res Clin Oncol 145(4):957–965PubMedCrossRef Elghiaty A, Kim J, Jang WS et al (2019) Preoperative controlling nutritional status (CONUT) score as a novel immune-nutritional predictor of survival in non-metastatic clear cell renal cell carcinoma of ≤ 7 cm on preoperative imaging. J Cancer Res Clin Oncol 145(4):957–965PubMedCrossRef
21.
go back to reference Toyokawa G, Kozuma Y, Matsubara T et al (2017) Prognostic impact of controlling nutritional status score in resected lung squamous cell carcinoma. J Thorac Dis 9(9):2942–2951PubMedPubMedCentralCrossRef Toyokawa G, Kozuma Y, Matsubara T et al (2017) Prognostic impact of controlling nutritional status score in resected lung squamous cell carcinoma. J Thorac Dis 9(9):2942–2951PubMedPubMedCentralCrossRef
22.
go back to reference Shoji F, Haratake N, Akamine T et al (2017) The preoperative controlling nutritional status score predicts survival after curative surgery in patients with pathological Stage I non-small cell lung cancer. Anticancer Res 37(2):741–747PubMedCrossRef Shoji F, Haratake N, Akamine T et al (2017) The preoperative controlling nutritional status score predicts survival after curative surgery in patients with pathological Stage I non-small cell lung cancer. Anticancer Res 37(2):741–747PubMedCrossRef
23.
go back to reference Amin MB, Greene FL, Byrd DR et al (2016) AJCC cancer staging manuel, 8th edn. Springer International Publishing, Berlin, pp 1–1024 Amin MB, Greene FL, Byrd DR et al (2016) AJCC cancer staging manuel, 8th edn. Springer International Publishing, Berlin, pp 1–1024
25.
go back to reference Bernhardt D, Aufderstrasse S, König L et al (2018) Impact of inflammatory markers on survival in patients with limited disease small-cell lung cancer undergoing chemoradiotherapy. Cancer Manag Res 30(10):6563–6569CrossRef Bernhardt D, Aufderstrasse S, König L et al (2018) Impact of inflammatory markers on survival in patients with limited disease small-cell lung cancer undergoing chemoradiotherapy. Cancer Manag Res 30(10):6563–6569CrossRef
27.
go back to reference Vartolomei MD, Porav-Hodade D, Ferro M et al (2018) Prognostic role of pretreatment neutrophil-to-lymphocyte ratio (NLR) in patients with non-muscle-invasive bladder cancer (NMIBC): a systematic review and meta-analysis. Urol Oncol 36(9):389–399PubMedCrossRef Vartolomei MD, Porav-Hodade D, Ferro M et al (2018) Prognostic role of pretreatment neutrophil-to-lymphocyte ratio (NLR) in patients with non-muscle-invasive bladder cancer (NMIBC): a systematic review and meta-analysis. Urol Oncol 36(9):389–399PubMedCrossRef
28.
go back to reference Yu Y, Qian L, Cui J (2017) Value of neutrophil-to-lymphocyte ratio for predicting lung cancer prognosis: a meta-analysis of 7,219 patients. Mol Clin Oncol 7(3):498–506PubMedPubMedCentralCrossRef Yu Y, Qian L, Cui J (2017) Value of neutrophil-to-lymphocyte ratio for predicting lung cancer prognosis: a meta-analysis of 7,219 patients. Mol Clin Oncol 7(3):498–506PubMedPubMedCentralCrossRef
31.
go back to reference Hong X, Cui B, Wang M et al (2015) Systemic ımmune-inflammation ındex, based on platelet counts and neutrophil-lymphocyte ratio, ıs useful for predicting prognosis in small cell lung cancer. Tohoku J Exp Med 236(4):297–304PubMedCrossRef Hong X, Cui B, Wang M et al (2015) Systemic ımmune-inflammation ındex, based on platelet counts and neutrophil-lymphocyte ratio, ıs useful for predicting prognosis in small cell lung cancer. Tohoku J Exp Med 236(4):297–304PubMedCrossRef
32.
go back to reference Nazha B, Moussaly E, Zaarour M et al (2015) Hypoalbuminemia in colorectal cancer prognosis: nutritional marker or inflammatory surrogate? World J Gastrointest Surg 27 7(12):370–377CrossRef Nazha B, Moussaly E, Zaarour M et al (2015) Hypoalbuminemia in colorectal cancer prognosis: nutritional marker or inflammatory surrogate? World J Gastrointest Surg 27 7(12):370–377CrossRef
33.
go back to reference Saito H, Kono Y, Murakami Y et al (2017) Influence of prognostic nutritional index and tumor markers on survival in gastric cancer surgery patients. Langenbecks Arch Surg 402(3):501–507PubMedCrossRef Saito H, Kono Y, Murakami Y et al (2017) Influence of prognostic nutritional index and tumor markers on survival in gastric cancer surgery patients. Langenbecks Arch Surg 402(3):501–507PubMedCrossRef
34.
go back to reference Zhang W, Ye B, Liang W et al (2017) Preoperative prognostic nutritional index is a powerful predictor of prognosis in patients with stage III ovarian cancer. Sci Rep 25 7(1):9548CrossRef Zhang W, Ye B, Liang W et al (2017) Preoperative prognostic nutritional index is a powerful predictor of prognosis in patients with stage III ovarian cancer. Sci Rep 25 7(1):9548CrossRef
35.
go back to reference Wang Z, Wang Y, Zhang X et al (2018) Pretreatment prognostic nutritional index as a prognostic factor in lung cancer: review and meta-analysis. Clin Chim Acta 486:303–310PubMedCrossRef Wang Z, Wang Y, Zhang X et al (2018) Pretreatment prognostic nutritional index as a prognostic factor in lung cancer: review and meta-analysis. Clin Chim Acta 486:303–310PubMedCrossRef
36.
go back to reference Lipschitz DA (1988) Protein-energy malnutrition. Hosp Pract (Off Ed) 15 23(11):87–99CrossRef Lipschitz DA (1988) Protein-energy malnutrition. Hosp Pract (Off Ed) 15 23(11):87–99CrossRef
37.
go back to reference Harimoto N, Yoshizumi T, Sakata K et al (2017) Prognostic significance of preoperative controlling nutritional status (CONUT) score in patients undergoing hepatic resection for hepatocellular carcinoma. World J Surg 41(11):2805–2812PubMedCrossRef Harimoto N, Yoshizumi T, Sakata K et al (2017) Prognostic significance of preoperative controlling nutritional status (CONUT) score in patients undergoing hepatic resection for hepatocellular carcinoma. World J Surg 41(11):2805–2812PubMedCrossRef
38.
go back to reference Lin ZX, Ruan DY, Li Y et al (2015) Lymphocyte-to-monocyte ratio predicts survival of patients with hepatocellular carcinoma after curative resection. World J Gastroenterol 21(38):10898–10906PubMedPubMedCentralCrossRef Lin ZX, Ruan DY, Li Y et al (2015) Lymphocyte-to-monocyte ratio predicts survival of patients with hepatocellular carcinoma after curative resection. World J Gastroenterol 21(38):10898–10906PubMedPubMedCentralCrossRef
39.
go back to reference Khan AUH, Allende-Vega N, Gitenay D et al (2017) The PDK1 ınhibitor dichloroacetate controls cholesterol homeostasis through the ERK5/MEF2 pathway. Sci Rep 6 7(1):10654CrossRef Khan AUH, Allende-Vega N, Gitenay D et al (2017) The PDK1 ınhibitor dichloroacetate controls cholesterol homeostasis through the ERK5/MEF2 pathway. Sci Rep 6 7(1):10654CrossRef
40.
go back to reference Toyokawa T, Kubo N, Tamura T et al (2016) 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. BMC Cancer 6(16):722CrossRef Toyokawa T, Kubo N, Tamura T et al (2016) 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. BMC Cancer 6(16):722CrossRef
41.
go back to reference Kuroda D, Sawayama H, Kurashige J et al (2018) Controlling nutritional status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection. Gastric Cancer 21(2):204–212PubMedCrossRef Kuroda D, Sawayama H, Kurashige J et al (2018) Controlling nutritional status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection. Gastric Cancer 21(2):204–212PubMedCrossRef
42.
go back to reference Ohba T, Takamori S, Toyozawa R et al (2019) Prognostic impact of the controlling nutritional status score in patients with non-small cell lung cancer treated with pembrolizumab. J Thorac Dis 11(9):3757–3768PubMedPubMedCentralCrossRef Ohba T, Takamori S, Toyozawa R et al (2019) Prognostic impact of the controlling nutritional status score in patients with non-small cell lung cancer treated with pembrolizumab. J Thorac Dis 11(9):3757–3768PubMedPubMedCentralCrossRef
Metadata
Title
The Significance of Controlling Nutritional Status (CONUT) Score as a Novel Prognostic Parameter in Small Cell Lung Cancer
Authors
Ali Yılmaz
Salim Başol Tekin
Mehmet Bilici
Hatice Yılmaz
Publication date
01-08-2020
Publisher
Springer US
Published in
Lung / Issue 4/2020
Print ISSN: 0341-2040
Electronic ISSN: 1432-1750
DOI
https://doi.org/10.1007/s00408-020-00361-2

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