Multicenter Study of Controlling Nutritional Status (CONUT) Score as a Prognostic Factor in Patients With HIV-Related Renal Cell Carcinoma.
In recent years, the controlled nutritional status (CONUT) score has been widely recognized as a new indicator for assessing survival in patients with urological neoplasms, including renal, ureteral, and bladder cancer. However, the CONUT score has not been analyzed in patients with HIV-related urological neoplasms. Therefore, we aimed to evaluate the prognostic significance of the CONUT score in patients with HIV-related renal cell carcinoma (RCC).
A total of 106 patients with HIV-related RCC were recruited from four hospitals between 2012 and 2021, and all included patients received radical nephrectomy or partial nephrectomy. The CONUT score was calculated by serum albumin, total lymphocyte counts, and total cholesterol concentrations. Patients with RCC were divided into two groups according to the optimal cutoff value of the CONUT score. Survival analysis of different CONUT groups was performed by the Kaplan-Meier method and a log rank test. A Cox proportional risk model was used to test for correlations between clinical variables and cancer-specific survival (CSS), overall survival (OS), and disease-free survival (DFS). Clinical variables included age, sex, hypertension, diabetes, tumor grade, Fuhrman grade, histology, surgery, and CD4+ T lymphocyte count.
The median age was 51 years, with 93 males and 13 females. At a median follow-up of 41 months, 25 patients (23.6%) had died or had tumor recurrence and metastasis. The optimal cutoff value for the CONUT score was 3, and a lower CONUT score was associated with the Fuhrman grade (P=0.024). Patients with lower CONUT scores had better CSS (HR 0.197, 95% CI 0.077-0.502, P=0.001), OS (HR 0.177, 95% CI 0.070-0.446, P<0.001) and DFS (HR 0.176, 95% CI 0.070-0.444, P<0.001). Multivariate Cox regression analysis indicated that a low CONUT score was an independent predictor of CSS, OS and DFS (CSS: HR=0.225, 95% CI 0.067-0.749, P=0.015; OS: HR=0.201, 95% CI 0.061-0.661, P=0.008; DFS: HR=0.227, 95% CI 0.078-0.664, P=0.007). In addition, a low Fuhrman grade was an independent predictor of CSS (HR 0.192, 95% CI 0.045-0.810, P=0.025), OS (HR 0.203, 95% CI 0.049-0.842, P=0.028), and DFS (HR 0.180, 95% CI 0.048-0.669, P=0.010), while other factors, such as age, sex, hypertension, diabetes, tumor grade, histology, surgery, and CD4+ T lymphocyte count, were not associated with survival outcome.
The CONUT score, an easily measurable immune-nutritional biomarker, may provide useful prognostic information in HIV-related RCC.
Xue W
，Zhang Y
，Wang H
，Zhang Y
，Hu X
... -
《Frontiers in Immunology》
Validation of the preoperative controlling nutritional status score as an independent predictor in a large Chinese cohort of patients with upper tract urothelial carcinoma.
Pretreatment controlling nutritional status (CONUT) score is a novel index which was used to predict outcomes in cancer patients. We aim to explore the prognostic significance of CONUT score in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).
A total of 662 UTUC patients between 2004 and 2016 were retrospectively analyzed. Patients were categorized into three groups based on CONUT score (Normal: 0-1; Light: 2-4; Moderate/severe: 5-12). Associations of CONUT score with oncological outcomes were analyzed using Logistic and Cox regression analysis. Harrell concordance index was used to assess the predictive accuracy of the multivariate models. Subgroup analyses were conducted according to tumor grade and stage.
The median follow-up duration was 41 months. Multivariate Logistic analysis showed that high CONUT score was independently associated with high-grade disease, high pT stage, lymphovascular invasion, sessile carcinoma, variant histology, and positive surgical margins (each P < 0.05). Multivariate analysis demonstrated that CONUT score 5-12 was an independent factor for worse cancer-specific survival (CSS, hazard ratio [HR]:2.39, 95% confidence interval [CI] 1.55-3.68, P < 0.0001), disease recurrence-free-survival (RFS, HR: 1.80, 95% CI 1.24-2.60, P = 0.002), and overall survival (OS, HR: 2.26, 95% CI 1.53-3.34, P < 0.0001). The estimated c-index of the multivariate models for CSS, RFS, and OS increased from 0.755, 0.715 and 0.745 to 0.772, 0.723, and 0.756 when CONUT score supplemented. Subgroup analyses showed that especially in patients with high-grade carcinoma and advanced stage (≥pT3), higher CONUT score predicts decreased CSS, RFS, and OS (all P < 0.05).
Preoperative CONUT score is a negative independent prognostic indicator for both pathologic and survival outcomes in UTUC, especially in those with high-grade carcinoma and advanced stage. Adding this parameter into our clinical prediction model is appropriate so as to improve its predictive accuracy.
Xu H
，Tan P
，Jin X
，Ai J
，Lin T
，Lei H
，Yang L
，Wei Q
... -
《-》
High Preoperative Controlling Nutritional Status Score Predicts a Poor Prognosis in Patients with Localized Upper Tract Urothelial Cancer: A Propensity Score Matching Study in a Large Chinese Center.
The aim of this study was to elucidate the prognostic value of the preoperative controlling nutritional status (CONUT) score, a new index based on the total lymphocyte count, serum albumin concentration and total cholesterol concentration, in patients with localized upper tract urothelial cancer (UTUC) after radical nephroureterectomy (RNU) using propensity score matching (PSM) analysis.
We retrospectively reviewed 908 consecutive patients with localized UTUC who underwent RNU between 1999 and 2015. Patients were divided into two groups according to the optimal cutoff value of the preoperative CONUT score. Relationships between the CONUT score with clinicopathological characteristics, overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were analyzed before and after 1:1 PSM.
A high preoperative CONUT score was significantly correlated with older age, low body mass index (BMI), poor American Statistical Association (ASA) score, advanced pathological T stage, and tumor squamous or glandular differentiation (all p<0.05). Kaplan-Meier curves showed poor OS, CSS, and DFS for patients with a high CONUT score before and after PSM (all p<0.001). Furthermore, multivariate analyses revealed that a high preoperative CONUT score was an independent risk factor for poor DFS (hazard ratio [HR] 1.418, 95% confidence interval [CI] 1.132-1.776, p=0.002) before PSM and an independent risk factor for poor DFS (HR 1.333, 95% CI 1.010-1.760, p=0.042) and OS (HR 1.459, 95% CI 1.010-2.107, p=0.044) after PSM.
A high preoperative CONUT score is an independent prognostic factor for poor outcomes in patients with localized UTUC after RNU.
Bao Z
，Li Y
，Guan B
，Xiong G
，Zhang L
，Tang Q
，Wang T
，Li X
，Fang D
，Zhou L
... -
《-》
The prognostic significance of controlling nutritional status (CONUT) score for surgically treated renal cell cancer and upper urinary tract urothelial cancer: a systematic review and meta-analysis.
In order to evaluate the predictive effect of the controlled nutritional status (CONUT) score on the prognosis of patients with renal cell carcinoma (RCC) and upper urinary tract urothelial carcinoma (UTUC), a meta-analysis was performed. This systematic review has been registered on PROSPERO, the registration ID is CRD42021251879. A systematic search of the published literature using PubMed, Web of Science, Cochrane Library, EMBASE, and MEDLINE was performed. The fields of "renal cell cancer," "upper tract urothelial cancer," and "controlling nutritional status" and other fields were used as search terms. STATA 16 software was used to carry out data merging and statistical analysis of binary variables, Q test and χ2 tests were used to verify the heterogeneity between the included works of studies. Subgroup analysis and sensitivity analysis were used to explain the sources of heterogeneity between studies. Begg's test was used to assess publication bias between studies. From the first 542 studies retrieved, through strict inclusion and exclusion criteria, 7 studies finally met the requirements and were included in the meta-analysis. Pooled results indicated that high CONUT indicates worse over survival (OS) [HR = 1.70, 95% CI (1.43-2.03), P = 0.02], cancer-specific survival (CSS) [HR = 1.84, 95% CI (1.52-2.23), P = 0.01], recurrence-free survival (RFS) [HR = 1.60, 95% CI (1.26-2.03), P = 0.116], and disease-free survival (DFS) [HR = 1.47, 95% CI (1.20-1.81), P = 0.03]. Based on cancer type, cutoff value, region, and sample size, a subgroup analysis was performed. The results showed that OS and CSS were not affected by the above factors, and the high CONUT score before surgery predicted worse OS and CSS. In conclusion, this meta-analysis revealed that the preoperative CONUT score is a potential independent predictor of the postoperative prognosis of RCC/UTUC patients. A high CONUT predicts worse OS/CSS/DFS and RFS in patients.
Peng L
，Meng C
，Li J
，You C
，Du Y
，Xiong W
，Xia Z
，Cao D
，Li Y
... -
《-》
ResearchGate
(全网免费下载)
钛学术
(全网免费下载)
