Controlling nutritional status (CONUT) score-based nomogram to predict overall survival of patients with HBV-associated hepatocellular carcinoma after curative hepatectomy

  • Z.-X. Lin
  • D.-Y. Ruan
  • C.-C. Jia
  • T.-T. Wang
  • J.-T. Cheng
  • H.-Q. HuangEmail author
  • X.-Y. WuEmail author
Research Article



As a novel immune-nutritional biomarker, the controlling nutritional status (CONUT) score has been reported to predict outcomes in cancer patients. We aimed to elucidate the prognostic value of preoperative CONUT score and construct a CONUT score-based nomogram to predict individual survival of patients with hepatitis B viral (HBV)-associated hepatocellular carcinoma (HCC) after curative hepatectomy.


Preoperative CONUT score was retrospectively calculated in 380 HBV-associated HCC patients undergoing radical resection between 2006 and 2012. Patients were assigned to two groups: CONUT-low ( < 2) and CONUT-high ( ≥ 2), according to the optimal cut-off value determined using receiver operating characteristic analysis. Associations of CONUT score with oncological outcomes were evaluated. The Cox proportional hazard model was used to identify predictors of survival and a new nomogram was developed based on the independent prognostic factors for overall survival (OS).


The CONUT score exhibited a higher area under the curve value than the other immune-nutritional parameters. The CONUT-high group had significant poorer OS and recurrence-free survival compared with CONUT-low group (P < 0.001 and P = 0.016, respectively). Multivariate analyses identified CONUT score, liver cirrhosis, tumor size and differentiation as independent prognostic factors for OS. And the nomogram based on these four variables had superior discriminative ability to predict survival compared with other conventional staging systems.


Preoperative CONUT score is an effective independent predictor of OS in patients with resected HBV-related HCC. This novel nomogram based on CONUT may provide accurate and individualized survival prediction for HCC patients undergoing surgical resection.


Controlling nutritional status Hepatocellular carcinoma Nomogram Prognosis Immune-nutritional marker 



The authors thank all the surgeons for treating patients in this study in The Third Affiliated Hospital of Sun Yat-sen University.


There was no specific funding for this study.

Compliance with ethical standards

Conflict of interest

The authors declare no potential conflicts of interest.

Ethical approval

The study protocol was approved by the Clinical Ethics Review Board of The Third Affiliated Hospital of Sun Yat-sen University. And it was conducted in accordance with the Declaration of Helsinki.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  1. 1.Department of Medical OncologySun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouChina
  2. 2.Department of Medical Oncology and Guangdong Key Laboratory of Liver DiseaseThe Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouChina
  3. 3.Department of Cell-Gene Therapy Translational Medicine Research CenterThe Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouChina

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