Annals of Surgical Oncology

, Volume 26, Issue 2, pp 456–464 | Cite as

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 KandaEmail author
  • 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



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.


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.


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.


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.



We thank Jodi Smith, PhD, from the Edanz Group ( for editing a draft of this manuscript.


The author declares that they have no conflict of interest.

Supplementary material

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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)


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Song Ryo
    • 1
    • 2
  • Mitsuro Kanda
    • 3
    Email author
  • 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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