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Prognostic Significance of Preoperative Controlling Nutritional Status (CONUT) Score in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma: A Multi-institutional Study

  • Hepatobiliary Tumors
  • Published:
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Abstract

Background

The Controlling Nutritional Status (CONUT) score is an objective tool that is widely used to assess the nutritional status in patients, including those with cancer. The relationship between the CONUT score and prognosis in patients who have undergone hepatic resection has not been evaluated in a multi-institutional study.

Methods

Data were retrospectively collected for 2461 consecutive patients with hepatocellular carcinoma (HCC) who had undergone hepatic resection with curative intent at 13 institutions between January 2004 and December 2015. Patients were assigned to two groups: preoperative CONUT scores ≤ 3 (low CONUT score) and ≥ 4 (high CONUT score). Clinicopathological characteristics, surgical outcomes, and long-term survival were compared using propensity score matching analysis.

Results

Of the 2461 patients, 540 (21.9%) had high (≥ 4) and 1921 (78.1%) had low (≤ 3) preoperative CONUT scores. Overall, a high CONUT score was significantly associated with older age, female sex, low body mass index, low serum albumin, high serum total bilirubin, low lymphocyte count, low serum cholesterol, shorter prothrombin time, higher indocyanine green retention test at 15 min, Child–Pugh B (vs. A), liver cirrhosis, minor resection, shorter operation time, massive blood loss, blood transfusion, and postoperative complications. After propensity score matching, a higher CONUT score was significantly associated with poor overall survival (OS) and recurrence-free survival (RFS) using multivariate analysis.

Conclusions

This retrospective, multi-institutional analysis showed that, in patients who undergo curative hepatectomy for HCC, the preoperative CONUT score is predictive of worse OS and RFS, even after propensity score matching analysis.

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Acknowledgment

The authors thank Jodi Smith, Ph.D., from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan

    Norifumi Harimoto MD, PhD & Ken Shirabe MD

  2. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Norifumi Harimoto MD, PhD, Tomoharu Yoshizumi MD, Shoichi Inokuchi MD, Shinji Itoh MD & Yoshihiko Maehara MD

  3. Department of Surgery, Kyushu Central Hospital, Fukuoka, Japan

    Eisuke Adachi MD

  4. Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan

    Yasuharu Ikeda MD

  5. Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan

    Hideaki Uchiyama MD

  6. Department of Surgery, Oita Prefectural Hospital, Oita, Japan

    Tohru Utsunomiya MD

  7. Department of Surgery, Iizuka Hospital, Fukuoka, Japan

    Kiyoshi Kajiyama MD

  8. Department of Surgery, Munakata Medical Association Hospital, Fukuoka, Japan

    Koichi Kimura MD

  9. Department of Gastroenterological Surgery, Steel Memorial Yawata Hospital, Fukuoka, Japan

    Fumiaki Kishihara MD

  10. Department of Hepato-Biliary-Pancreatic Surgery, National Kyushu Cancer Center, Fukuoka, Japan

    Keishi Sugimachi MD & Eiji Tsujita MD

  11. Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan

    Mizuki Ninomiya MD

  12. Department of Surgery, Oita Red Cross Hospital, Oita, Japan

    Kengo Fukuzawa MD

  13. Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan

    Takashi Maeda MD

Authors
  1. Norifumi Harimoto MD, PhD
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  2. Tomoharu Yoshizumi MD
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  3. Shoichi Inokuchi MD
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  4. Shinji Itoh MD
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  5. Eisuke Adachi MD
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  7. Hideaki Uchiyama MD
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  8. Tohru Utsunomiya MD
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  9. Kiyoshi Kajiyama MD
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  10. Koichi Kimura MD
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  11. Fumiaki Kishihara MD
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  13. Eiji Tsujita MD
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  14. Mizuki Ninomiya MD
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  15. Kengo Fukuzawa MD
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  16. Takashi Maeda MD
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  17. Ken Shirabe MD
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  18. Yoshihiko Maehara MD
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Corresponding author

Correspondence to Norifumi Harimoto MD, PhD.

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Disclosure

Norifumi Harimoto, Tomoharu Yoshizumi, Shoichi Inokuchi, Shinji Itoh, Eisuke Adachi, Yasuharu Ikeda, Hideaki Uchiyama, Tohru Utsunomiya, Kiyoshi Kajiyama, Koichi Kimura, Fumiaki Kishihara, Keishi Sugimachi, Eiji Tsujita, Mizuki Ninomiya, Kengo Fukuzawa, Takashi Maeda, Ken Shirabe, and Yoshihiko Maehara have no conflicts of interest or financial support to declare.

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Electronic Supplementary Fig.

 1 Receiver operating characteristics (ROC) curves of the preoperative CONUT score were analyzed, with (a) overall survival (OS), (b) cancer-specific survival (CSS), and (c) recurrence-free survival (RFS) predicted by comparing the areas under the curve (AUCs). Electronic Supplementary Fig. 2 Histograms of the area of CONUT scores for all patients. The histograms of all populations were normally distributed. Electronic Supplementary Fig. 3 Kaplan–Meier analysis of (a) overall survival and (b) recurrence-free survival curves in patients with CONUT scores ≥ 4 (thick black lines) and ≤ 3 (thin black lines). Both overall and recurrence-free survival were significantly poorer in patients with CONUT score ≥ 4. Electronic Supplementary Fig. 4 Kaplan–Meier analysis of (a) overall survival and (b) recurrence-free survival curves in patients with CONUT scores ≥ 4 (thick black lines) and ≤ 3 (thin black lines). Both overall and recurrence-free survival were significantly poorer in patients with CONUT score ≥ 4. Electronic Supplementary Fig. 5 Kaplan–Meier analysis of (a) overall survival and (b) recurrence-free survival curves in patients with CONUT scores ≥ 4 (thick black lines) and ≤ 3 (thin black lines) in the low-risk subgroups, meaning thepatients with no liver cirrhosis, a single tumor, and tumor size less than 5 cm. Both overall and recurrence-free survival were significantly poorer in patients with CONUT score ≥ 4. (PPTX 146 kb)

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Harimoto, N., Yoshizumi, T., Inokuchi, S. et al. Prognostic Significance of Preoperative Controlling Nutritional Status (CONUT) Score in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma: A Multi-institutional Study. Ann Surg Oncol 25, 3316–3323 (2018). https://doi.org/10.1245/s10434-018-6672-6

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  • DOI: https://doi.org/10.1245/s10434-018-6672-6

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