Langenbeck's Archives of Surgery

, Volume 402, Issue 2, pp 333–341 | Cite as

Preoperative controlling nutritional status (CONUT) is useful to estimate the prognosis after esophagectomy for esophageal cancer

  • Naoya Yoshida
  • Kazuto Harada
  • Yoshifumi Baba
  • Keisuke Kosumi
  • Masaaki Iwatsuki
  • Koichi Kinoshita
  • Kenichi Nakamura
  • Yasuo Sakamoto
  • Yuji Miyamoto
  • Ryuichi Karashima
  • Kosuke Mima
  • Hiroshi Sawayama
  • Mayuko Ohuchi
  • Akira Chikamoto
  • Yu Imamura
  • Masayuki Watanabe
  • Hideo Baba
ORIGINAL ARTICLE

Abstract

Purpose

The aim of this study is to confirm the predictive value of controlling nutritional status (CONUT), as a postoperative prognostic marker for esophageal cancer patients undergoing esophagectomy.

Methods

We retrospectively analyzed 373 patients who underwent three-incision esophagectomy with 2- or 3-field lymphadenectomy for esophageal cancer between April 2005 and March 2016. The patients were divided into three groups based on the degree of preoperative malnutrition as assessed by CONUT: normal, light malnutrition, and moderate or severe malnutrition.

Results

The patients with moderate or severe malnutrition experienced a significantly higher frequency of reoperation (normal or light malnutrition, 6.3%; moderate or severe malnutrition, 18.2%; P = 0.033) and a higher tendency for respiratory morbidities (normal or light malnutrition, 14.0%; moderate or severe malnutrition, 27.3%; P = 0.088). Cox regression analysis identified a significantly poor prognosis, in both overall survival (hazard ratio (HR), 3.56; 95% confidence interval (CI), 1.714–7.390; P < 0.001) and cancer-specific survival (HR, 3.41; 95% CI, 1.790–6.516; P = 0.046).

Conclusions

CONUT is convenient and useful for preoperatively assessing malnutrition and prognosis of esophageal cancer patients who underwent surgery.

Keywords

Esophageal cancer Esophagectomy Nutrition Prognosis 

References

  1. 1.
    Vashist YK, Loos J, Dedow J et al (2011) Glasgow prognostic score is a predictor of perioperative and long-term outcome in patients with only surgically treated esophageal cancer. Ann Surg Oncol 18:1130–1138CrossRefPubMedGoogle Scholar
  2. 2.
    Kosumi K, Baba Y, Ishimoto T et al (2016) Neutrophil/lymphocyte ratio predicts the prognosis in esophageal squamous cell carcinoma patients. Surg Today 46:405–413CrossRefPubMedGoogle Scholar
  3. 3.
    Feng JF, Huang Y, Chen QX (2014) Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil lymphocyte ratio (NLR) as a predictive factor in patients with esophageal squamous cell carcinoma. World J Surg Oncol 12:58CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Huang Y, Feng JF (2015) Low preoperative lymphocyte to monocyte ratio predicts poor cancer-specific survival in patients with esophageal squamous cell carcinoma. Onco Targets Ther 8:137–145PubMedPubMedCentralGoogle Scholar
  5. 5.
    Harada K, Ida S, Baba Y, Ishimoto T et al (2015) Prognostic and clinical impact of sarcopenia in esophageal squamous cell carcinoma. Dis Esophagus. doi:10.1111/dote.12381 Google Scholar
  6. 6.
    Watanabe M, Ishimoto T, Baba Y, Nagai Y, Yoshida N, Yamanaka T, Baba H (2013) Prognostic impact of body mass index in patients with squamous cell carcinoma of the esophagus. Ann Surg Oncol 20:3984–3991CrossRefPubMedGoogle Scholar
  7. 7.
    Scarpa M, Filip B, Cavallin F, Alfieri R, Saadeh L, Cagol M, Castoro C (2015) Esophagectomy in elderly patients: which is the best prognostic score? Dis Esophagus. doi:10.1111/dote.12358 Google Scholar
  8. 8.
    Ignacio de Ulíbarri J, González-Madroño A, de Villar NG et al (2005) CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 20:38–45PubMedGoogle Scholar
  9. 9.
    Yoshida N, Baba Y, Shigaki H et al (2016) Preoperative nutritional assessment by controlling nutritional status (CONUT) is useful to estimate postoperative morbidity after esophagectomy for esophageal cancer. World J Surg 40:1910–1917CrossRefPubMedGoogle Scholar
  10. 10.
    Edge S, Byrd DR, Compton CC, Fritz AG, Green FL, Trotti A (2009) AJCC cancer staging manual, seventh edn. Springer, New YorkGoogle Scholar
  11. 11.
    Society of Thoracic Surgeons (2013) Risk-adjusted morbidity and mortality for esophagectomy for cancer. Available: http://www.sts.org/quality-research-patient-safety/quality/quality-performance-measures Accessed 24 Aug 2016
  12. 12.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Wu N, Chen G, Hu H, Pang L, Chen Z (2015) Low pretherapeutic serum albumin as a risk factor for poor outcome in esophageal squamous cell carcinomas. Nutr Cancer 67:481–485CrossRefPubMedGoogle Scholar
  14. 14.
    de Martino M, Leitner CV, Seemann C et al (2015) Preoperative serum cholesterol is an independent prognostic factor for patients with renal cell carcinoma (RCC). BJU Int 115:397–404CrossRefPubMedGoogle Scholar
  15. 15.
    Tomita M, Ayabe T, Shimizu T, Nakamura K (2012) Preoperative total serum cholesterol and patients’ survival in resected nonsmall cell lung cancer. Lung Cancer Int. doi:10.1155/2012/463520 PubMedPubMedCentralGoogle Scholar
  16. 16.
    Kotani K, Sekine Y, Ishikawa S, Ikpot IZ, Suzuki K, Remaley AT (2013) High-density lipoprotein and prostate cancer: an overview. J Epidemiol 23:313–319CrossRefPubMedGoogle Scholar
  17. 17.
    Kuroda K, Nakashima J, Kanao K et al (2007) Interleukin 6 is associated with cachexia in patients with prostate cancer. Urology 69:113–117CrossRefPubMedGoogle Scholar
  18. 18.
    Kumari N, Dwarakanath BS, Das A, Bhatt AN (2016) Role of interleukin-6 in cancer progression and therapeutic resistance. Tumour Biol. doi:10.1007/s13277–016–5098–7 PubMedGoogle Scholar
  19. 19.
    Feng JF, Liu JS, Huang Y (2014) Lymphopenia predicts poor prognosis in patients with esophageal squamous cell carcinoma. Medicine (Baltimore) 93:e257CrossRefGoogle Scholar
  20. 20.
    Balmanoukian A, Ye X, Herman J, Laheru D, Grossman SA (2012) The association between treatment-related lymphopenia and survival in newly diagnosed patients with resected adenocarcinoma of the pancreas. Cancer Investig 30:571–576CrossRefGoogle Scholar
  21. 21.
    Campian JL, Sarai G, Ye X, Marur S, Grossman SA (2014) Association between severe treatment-related lymphopenia and progression-free survival in patients with newly diagnosed squamous cell head and neck cancer. Head Neck 36:1747–1753CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Aggarwal S, Gollapudi S, Gupta SJ (1999) Increased TNF-alpha-induced apoptosis in lymphocytes from aged humans: changes in TNF-alpha receptor expression and activation of caspases. Immunol 162:2154–2161Google Scholar
  23. 23.
    Kou F, Lu Z, Li J et al (2016) Pretreatment lymphopenia is an easily detectable predictive and prognostic marker in patients with metastatic esophagus squamous cell carcinoma receiving first-line chemotherapy. Cancer Med 5:778–586CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Ray-Coquard I, Cropet C, Van Glabbeke M et al (2009) Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res 69:5383–5391CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Cézé N, Thibault G, Goujon G, Viguier J, Watier H, Dorval E, Lecomte T (2011) Pre-treatment lymphopenia as a prognostic biomarker in colorectal cancer patients receiving chemotherapy. Cancer Chemother Pharmacol 68:1305–1313CrossRefPubMedGoogle Scholar
  26. 26.
    Grossman SA, Ye X, Lesser G, Sloan A, Carraway H, Desideri S, Piantadosi S, NABTT CNS Consortium (2011) Immunosuppression in patients with high-grade gliomas treated with radiation and temozolomide. Clin Cancer Res 17:5473–5480CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    He JR, Shen GP, Ren ZF et al (2012) Pretreatment levels of peripheral neutrophils and lymphocytes as independent prognostic factors in patients with nasopharyngeal carcinoma. Head Neck 34:1769–1776CrossRefPubMedGoogle Scholar
  28. 28.
    Kobayashi N, Usui S, Kikuchi S, Goto Y, Sakai M, Onizuka M, Sato Y (2012) Preoperative lymphocyte count is an independent prognostic factor in node-negative non-small cell lung cancer. Lung Cancer 75:223–227CrossRefPubMedGoogle Scholar
  29. 29.
    Fuhrman MP (2002) The albumin-nutrition connection: separating myth from fact. Nutrition 18:199–200CrossRefPubMedGoogle Scholar
  30. 30.
    Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321–336CrossRefPubMedGoogle Scholar
  31. 31.
    Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11:8–13CrossRefPubMedGoogle Scholar
  32. 32.
    Kataoka K, Takeuchi H, Mizusawa J et al (2016) Prognostic impact of postoperative morbidity after esophagectomy for esophageal cancer: exploratory analysis of JCOG9907. Ann Surg. doi:10.1097/SLA.0000000000001828 Google Scholar
  33. 33.
    Yamashita K, Makino T, Miyata H et al (2016) Postoperative infectious complications are associated with adverse oncologic outcomes in esophageal cancer patients undergoing preoperative chemotherapy. Ann Surg Oncol 23:2106–2114CrossRefPubMedGoogle Scholar
  34. 34.
    Baba Y, Yoshida N, Shigaki H et al (2016) Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single institution study. Ann Surg 264:305–311CrossRefPubMedGoogle Scholar
  35. 35.
    Markar S, Gronnier C, Duhamel A et al (2015) The impact of severe anastomotic leak on long-term survival and cancer recurrence after surgical resection for esophageal malignancy. Ann Surg 262:972–980CrossRefPubMedGoogle Scholar
  36. 36.
    van der Schaaf M, Derogar M, Johar A et al (2014) Reoperation after oesophageal cancer surgery in relation to long-term survival: a population-based cohort study. BMJ Open 4:e004648CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Fukuda T, Seto Y, Yamada K, Hiki N, Fukunaga T, Oyama S, Yamaguchi T (2008) Can immune-enhancing nutrients reduce postoperative complications in patients undergoing esophageal surgery? Dis Esophagus 21:708–711CrossRefPubMedGoogle Scholar
  38. 38.
    Mazaki T, Ishii Y, Murai I (2015) Immunoenhancing enteral and parenteral nutrition for gastrointestinal surgery: a multiple-treatments meta-analysis. Ann Surg 261:662–669CrossRefPubMedGoogle Scholar
  39. 39.
    Kojima S, Sakakibara H, Motani S et al (2007) Incidence of chronic obstructive pulmonary disease, and the relationship between age and smoking in a Japanese population. J Epidemiol 17:54–60CrossRefPubMedGoogle Scholar
  40. 40.
    Yoshida N, Watanabe M, Baba Y et al (2014) Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today 44:526–532CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Naoya Yoshida
    • 1
  • Kazuto Harada
    • 1
  • Yoshifumi Baba
    • 1
  • Keisuke Kosumi
    • 1
  • Masaaki Iwatsuki
    • 1
  • Koichi Kinoshita
    • 1
  • Kenichi Nakamura
    • 1
  • Yasuo Sakamoto
    • 1
  • Yuji Miyamoto
    • 1
  • Ryuichi Karashima
    • 1
  • Kosuke Mima
    • 1
  • Hiroshi Sawayama
    • 1
  • Mayuko Ohuchi
    • 1
  • Akira Chikamoto
    • 1
  • Yu Imamura
    • 2
  • Masayuki Watanabe
    • 2
  • Hideo Baba
    • 1
  1. 1.Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
  2. 2.Department of Gastroenterological SurgeryCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan

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