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The Controlling Nutritional Status Score Serves as a Predictor of Short- and Long-Term Outcomes for Patients with Stage 2 or 3 Gastric Cancer: Analysis of a Multi-institutional Data Set

  • Song Ryo
  • Mitsuro Kanda
  • Seiji Ito
  • Yoshinari Mochizuki
  • Hitoshi Teramoto
  • Kiyoshi Ishigure
  • Toshifumi Murai
  • Takahiro Asada
  • Akiharu Ishiyama
  • Hidenobu Matsushita
  • Chie Tanaka
  • Daisuke Kobayashi
  • Michitaka Fujiwara
  • Kenta Murotani
  • Yasuhiro Kodera
Gastrointestinal Oncology
  • 91 Downloads

Abstract

Background

This study aimed to evaluate the predictive value of the preoperative Controlling Nutritional Status (CONUT) score, which comprehensively reflects protein and lipid metabolism as well as the immunocompetence among patients with stage 2 or 3 gastric cancer.

Methods

From a retrospective database of 3484 patients who underwent gastrectomy for gastric cancer at nine Japanese institutions between 2010 and 2014, data for 626 patients with stage 2 or 3 cancer were retrieved. The study evaluated the significance of the associations between the optimal CONUT score cutoff values with the prognosis and the incidence of postoperative complications.

Results

The study determined that 2 was the optimal CONUT score cutoff value for predicting mortality 2 years after surgery. The patients with a CONUT score of 2 or higher (CONUT-high group) were significantly older and had a worse Eastern Cooperative Oncology Group performance status, lower body mass index, and more advanced tumor-node-metastasis stage than the patients with a CONUT score lower than 2 (CONUT-low group). Overall, the survival time was significantly shorter in the CONUT-high group than in the CONUT-low group [hazard ratio (HR) 1.97; P < 0.0001]. A multivariable analysis showed that the CONUT score was an independent prognostic factor of overall survival. The CONUT score more significantly reflected the overall survival for patients who underwent postoperative adjuvant chemotherapy than for those who underwent surgery alone. Additionally, a high preoperative CONUT score was significantly associated with an increased incidence of postoperative pneumonia and prolonged hospitalization.

Conclusions

The study results suggest that the preoperative CONUT score may be a useful predictor of postoperative short- and long-term outcomes for patients with stage 2 or 3 gastric cancer.

Notes

Acknowledgements

We thank Jodi Smith, PhD, from the Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

DISCLOSURE

The author declares that they have no conflict of interest.

Supplementary material

10434_2018_7121_MOESM1_ESM.docx (11 kb)
Supplementary material 1 (DOCX 11 kb)
10434_2018_7121_MOESM2_ESM.pdf (175 kb)
Supplementary material 2 (PDF 175 kb)
10434_2018_7121_MOESM3_ESM.pdf (413 kb)
Supplementary material 3 (PDF 412 kb)

References

  1. 1.
    Van Cutsem E, Sagaert X, Topal B, Haustermans K, Prenen H. Gastric cancer. Lancet. 2016;388:2654–64.CrossRefGoogle Scholar
  2. 2.
    Kanda M, Shimizu D, Tanaka H, et al. Significance of SYT8 for the detection, prediction, and treatment of peritoneal metastasis from gastric cancer. Ann Surg. 2018;267:495–503.CrossRefGoogle Scholar
  3. 3.
    Heys SD, Park KG, Garlick PJ, Eremin O. Nutrition and malignant disease: implications for surgical practice. Br J Surg. 1992;79:614–23.CrossRefGoogle Scholar
  4. 4.
    Miyata H, Yano M, Yasuda T, et al. Randomized study of clinical effect of enteral nutrition support during neoadjuvant chemotherapy on chemotherapy-related toxicity in patients with esophageal cancer. Clin Nutr. 2012;31:330–36.CrossRefGoogle Scholar
  5. 5.
    Andreyev J, Ross P, Donnellan C, et al. Guidance on the management of diarrhoea during cancer chemotherapy. Lancet Oncol. 2014;15:e447–60.CrossRefGoogle Scholar
  6. 6.
    Kanda M, Mizuno A, Tanaka C, et al. Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer. Med Baltim. 2016;95:e3781.CrossRefGoogle Scholar
  7. 7.
    Iseki Y, Shibutani M, Maeda K, et al. Impact of the preoperative Controlling Nutritional Status (CONUT) score on the survival after curative surgery for colorectal cancer. PLoS ONE. 2015;10:e0132488.CrossRefGoogle Scholar
  8. 8.
    Nakagomi A, Kohashi K, Morisawa T, et al. Nutritional status is associated with inflammation and predicts a poor outcome in patients with chronic heart failure. J Atheroscler Thromb. 2016;23:713–27.CrossRefGoogle Scholar
  9. 9.
    Toyokawa T, Kubo N, Tamura T, et al. 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. 2016;16:722.CrossRefGoogle Scholar
  10. 10.
    Formiga F, Chivite D, Corbella X. Utility of the Controlling Nutritional Status (CONUT) score in patients admitted due to acute heart failure. Int J Cardiol. 2017;235:203.CrossRefGoogle Scholar
  11. 11.
    Ishihara H, Kondo T, Yoshida K, et al. Preoperative Controlling Nutritional Status (CONUT) score as a novel predictive biomarker of survival in patients with localized urothelial carcinoma of the upper urinary tract treated with radical nephroureterectomy. Urol Oncol. 2017;35:539.Google Scholar
  12. 12.
    Kuroda D, Sawayama H, Kurashige J, et al. Controlling Nutritional Status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection. Gastric Cancer. 2018;21:204–12.CrossRefGoogle Scholar
  13. 13.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20:1–19.CrossRefGoogle Scholar
  14. 14.
    Liu JY, Peng CW, Yang XJ, Huang CQ, Li Y. The prognosis role of AJCC/UICC 8th edition staging system in gastric cancer, a retrospective analysis. Am J Transl Res. 2018;10:292–303.Google Scholar
  15. 15.
    Kanda M, Kobayashi D, Tanaka C, et al. Adverse prognostic impact of perioperative allogeneic transfusion on patients with stage II/III gastric cancer. Gastric Cancer. 2016;19:255–63.CrossRefGoogle Scholar
  16. 16.
    Sasako M, Sakuramoto S, Katai H, et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol. 2011;29:4387–93.CrossRefGoogle Scholar
  17. 17.
    Kanda M, Murotani K, Kobayashi D, et al. Postoperative adjuvant chemotherapy with S-1 alters recurrence patterns and prognostic factors among patients with stage II/III gastric cancer: a propensity-score-matching analysis. Surgery. 2015;158:1573–80.CrossRefGoogle Scholar
  18. 18.
    Kanda M, Tanaka C, Kobayashi D, et al. Preoperative albumin-bilirubin grade predicts recurrences after radical gastrectomy in patients with pT2-4 gastric cancer. World J Surg. 2018;42:773–81.CrossRefGoogle Scholar
  19. 19.
    Inaoka K, Kanda M, Uda H, et al. Clinical utility of the platelet-lymphocyte ratio as a predictor of postoperative complications after radical gastrectomy for clinical T2-4 gastric cancer. World J Gastroenterol. 2017;23:2519–26.CrossRefGoogle Scholar
  20. 20.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRefGoogle Scholar
  21. 21.
    de Ulibarri IJ, Gonzalez-Madrono A, de Villar NG, et al. CONUT: a tool for Controlling Nutritional Status. first validation in a hospital population. Nutr Hosp. 2005;20:38–45.Google Scholar
  22. 22.
    Miyata T, Yamashita YI, Higashi T, et al. The prognostic impact of Controlling Nutritional Status (CONUT) in intrahepatic cholangiocarcinoma following curative hepatectomy: a retrospective single institution study. World J Surg. 2018;42:1085–91.CrossRefGoogle Scholar
  23. 23.
    Takagi K, Umeda Y, Yoshida R, et al. Preoperative Controlling Nutritional Status score predicts mortality after hepatectomy for hepatocellular carcinoma. Dig Surg. 2018.  https://doi.org/10.1159/000488215.
  24. 24.
    O’Hara LM, Thom KA, Preas MA. Update to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infection (2017): a summary, review, and strategies for implementation. Am J Infect Control. 2018;46:602–9.CrossRefGoogle Scholar
  25. 25.
    Giger U, Buchler M, Farhadi J, et al. Preoperative immunonutrition suppresses perioperative inflammatory response in patients with major abdominal surgery-a randomized controlled pilot study. Ann Surg Oncol. 2007;14:2798–806.CrossRefGoogle Scholar
  26. 26.
    Balkwill F. Tumour necrosis factor and cancer. Nat Rev Cancer. 2009;9:361–71.CrossRefGoogle Scholar
  27. 27.
    Ryan AM, Reynolds JV, Healy L, et al. Enteral nutrition enriched with eicosapentaenoic acid (EPA) preserves lean body mass following esophageal cancer surgery: results of a double-blinded randomized controlled trial. Ann Surg. 2009;249:355–63.CrossRefGoogle Scholar
  28. 28.
    Nakamura I, Shibata M, Gonda K, et al. Serum levels of vascular endothelial growth factor are increased and correlate with malnutrition, immunosuppression involving MDSCs and systemic inflammation in patients with cancer of the digestive system. Oncol Lett. 2013;5:1682–6.CrossRefGoogle Scholar
  29. 29.
    Watanabe T, Shibata M, Nishiyama H, et al. Elevated serum levels of vascular endothelial growth factor is effective as a marker for malnutrition and inflammation in patients with ovarian cancer. Biomed Rep. 2013;1:197–201.CrossRefGoogle Scholar
  30. 30.
    Braumuller H, Wieder T, Brenner E, et al. T-helper-1-cell cytokines drive cancer into senescence. Nature. 2013;494:361–5.CrossRefGoogle Scholar
  31. 31.
    Brenner D, Blaser H, Mak TW. Regulation of tumour necrosis factor signalling: live or let die. Nat Rev Immunol. 2015;15:362–74.CrossRefGoogle Scholar
  32. 32.
    Kanda M, Tanaka C, Kobayashi D, et al. Proposal of the coagulation score as a predictor for short-term and long-term outcomes of patients with resectable gastric cancer. Ann Surg Oncol. 2017;24:502–9.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Song Ryo
    • 1
    • 2
  • Mitsuro Kanda
    • 3
  • Seiji Ito
    • 4
  • Yoshinari Mochizuki
    • 5
  • Hitoshi Teramoto
    • 6
  • Kiyoshi Ishigure
    • 1
  • Toshifumi Murai
    • 7
  • Takahiro Asada
    • 2
  • Akiharu Ishiyama
    • 8
  • Hidenobu Matsushita
    • 9
  • Chie Tanaka
    • 3
  • Daisuke Kobayashi
    • 3
  • Michitaka Fujiwara
    • 3
  • Kenta Murotani
    • 10
  • Yasuhiro Kodera
    • 3
  1. 1.Department of SurgeryKonan Kosei HospitalKonanJapan
  2. 2.Department of SurgeryGifu Prefectural Tajimi HospitalTajimiJapan
  3. 3.Department of Gastroenterological Surgery (Surgery II)Nagoya University Graduate School of MedicineNagoyaJapan
  4. 4.Department of Gastroenterological SurgeryAichi Cancer CenterNagoyaJapan
  5. 5.Department of SurgeryKomaki Municipal HospitalKomakiJapan
  6. 6.Department of SurgeryYokkaichi Municipal HospitalYokkaichiJapan
  7. 7.Department of SurgeryIchinomiya Municipal HospitalIchinomiyaJapan
  8. 8.Department of SurgeryOkazaki City HospitalOkazakiJapan
  9. 9.Department of SurgeryTosei General HospitalSetoJapan
  10. 10.Biostatistics Center, Graduate School of MedicineKurume UniversityKurumeJapan

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