Surgical Endoscopy

, Volume 33, Issue 12, pp 4143–4152 | Cite as

Controlling Nutritional Status (CONUT) as a prognostic immunonutritional biomarker for gastric cancer after curative gastrectomy: a propensity score-matched analysis

  • Noriyuki HiraharaEmail author
  • Yoshitsugu Tajima
  • Yusuke Fujii
  • Shunsuke Kaji
  • Yasunari Kawabata
  • Ryoji Hyakudomi
  • Tetsu Yamamoto
  • Takahito Taniura



In clinical practice, it is not unusual to treat oncologic patients whose tumor markers are within normal range, even with advanced cancer. The Controlling Nutritional Status (CONUT) score could provide a useful nutritional and immunological prognostic biomarker for cancer patients. In this study, we assessed the prognostic value of the CONUT score for patients with gastric cancer, including a subgroup analysis with stratification based on serum carcinoembryonic antigen (CEA) level.


We retrospectively reviewed the medical records of 368 consecutive patients who underwent curative laparoscopy-assisted gastrectomy. The prognostic value of the CONUT score was compared between patients with a low (≤ 2) and high (≥ 3) score, with propensity score matching (PSM) used to control for biasing covariates (Depth of tumor, Lymph node metastasis, pathological TNM (pTNM) stage).


Overall survival (OS) among all patients was independently predicted by the tumor stage (hazard ratio (HR): 2.231, p = 0.001), the CONUT score (HR: 2.254, p = 0.001), and serum CEA level (HR: 1.821, p = 0.025). Among patients with a normal preoperative serum CEA level, tumor stage (HR: 2.350, p = 0.007), and the CONUT score (HR: 1.990, p = 0.028) were independent prognostic factors of OS. In the high serum CEA level group, tumor size (HR: 2.930, p = 0.015) and the CONUT score (HR: 3.707, p = 0.004) were independent prognostic factors of OS.


It is advantageous to use both CEA level and the CONUT score to assess the prognosis of patients with gastric cancer, which reflect both tumor-related factors and host-related factors, respectively.


Gastric cancer CONUT CEA Overall survival 



This study received no external sources of funding.

Compliance with ethical standards


Drs. Noriyuki Hirahara, Yoshitsugu Tajima, Yusuke Fujii, Shunsuke Kaji, Tetsu Yamamoto, Ryoji Hyakudomi, Takahito Taniura, and Yasunari Kawabata have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Noriyuki Hirahara
    • 1
    Email author
  • Yoshitsugu Tajima
    • 1
  • Yusuke Fujii
    • 1
  • Shunsuke Kaji
    • 1
  • Yasunari Kawabata
    • 1
  • Ryoji Hyakudomi
    • 1
  • Tetsu Yamamoto
    • 1
  • Takahito Taniura
    • 1
  1. 1.Department of Digestive and General SurgeryShimane University Faculty of MedicineIzumoJapan

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