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Controlling Nutritional Status (CONUT) Score is Associated with Overall Survival in Patients with Hepatocellular Carcinoma Treated with Conventional Transcatheter Arterial Chemoembolization: A Propensity Score Matched Analysis

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

This study aims to evaluate the prognostic value of controlling nutritional status (CONUT) score in determining the prognosis of patients with hepatocellular carcinoma (HCC) treated with conventional transcatheter arterial chemoembolization (cTACE).

Methods

This study retrospectively analyzed 936 patients who underwent cTACE for HCC between January 2012 and December 2018, and divided them into two groups based on their CONUT score. To balance the bias in baseline characteristics, propensity score matched (PSM) analysis was conducted. The Kaplan–Meier method was used to establish a cumulative survival curve, and the log-rank test was employed to determine differences in overall survival (OS) and progression-free survival (PFS) among the CONUT score groups. Furthermore, the Cox proportional hazard model was employed to assess the correlation between CONUT score and OS and PFS, whereby hazard ratios (HRs) and 95% confidence intervals (95% CIs) were computed.

Results

Before PSM, the median OS for the low (≤ 3) and high (≥ 4) CONUT group (558 vs. 378 patients) was 21.7 and 15.6 months, respectively, and the median PFS was 5.7 and 5 months. Following PSM, both the low and high CONUT score groups comprised 142 patients. The low CONUT score group exhibited a significantly longer OS compared to the high CONUT score group, as determined by the log-rank test (median OS 22.2 vs. 17.0 months, P = 0.014). No significant association was observed between CONUT group and PFS (median PFS 6.4 vs. 4.7 months, log-rank test, P = 0.121). Cox proportional hazard regression analysis revealed that a CONUT score of ≥ 4 was an independent risk factor for OS in patients with HCC who underwent cTACE (HR = 1.361; 95% CI: 1.047–1.771; P = 0.022). These findings were consistent across most subgroup analyses.

Conclusion

A high CONUT score has been found to be a prognostic factor for poorer OS in patients with HCC who underwent cTACE.

Level of Evidence

Level 3, Non-randomized controlled cohort.

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References

  1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49. https://doi.org/10.3322/caac.21660.

    Article  CAS  PubMed  Google Scholar 

  2. Yang JD, Heimbach JK. New advances in the diagnosis and management of hepatocellular carcinoma. BMJ. 2020. https://doi.org/10.1136/bmj.m3544.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul JL, Schirmacher P, Vilgrain V, European Assoc Study L. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69:182–236.

    Article  Google Scholar 

  4. Piscaglia F, Ogasawara S. Patient selection for transarterial chemoembolization in hepatocellular carcinoma: importance of benefit/risk assessment. Liver Cancer. 2018;7:104–19. https://doi.org/10.1159/000485471.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Golfieri R, Bargellini I, Spreafico C, et al. Patients with barcelona clinic liver cancer stages B and C hepatocellular carcinoma: time for a subclassification. Liver Cancer. 2019;8:78–91. https://doi.org/10.1159/000489791.

    Article  CAS  PubMed  Google Scholar 

  6. Lee IC, Hung YW, Liu CA, et al. A new ALBI-based model to predict survival after transarterial chemoembolization for BCLC stage B hepatocellular carcinoma. Liver Int. 2019;39:1704–12. https://doi.org/10.1111/liv.14194.

    Article  CAS  PubMed  Google Scholar 

  7. Kim JH, Shim JH, Lee HC, et al. New intermediate-stage subclassification for patients with hepatocellular carcinoma treated with transarterial chemoembolization. Liver Int. 2017;37:1861–8. https://doi.org/10.1111/liv.13487.

    Article  CAS  PubMed  Google Scholar 

  8. Hung YW, Lee IC, Chi CT, et al. Redefining tumor burden in patients with intermediate-stage hepatocellular carcinoma: the seven-eleven criteria. Liver Cancer. 2021;10:629–40. https://doi.org/10.1159/000517393.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Ignacio de Ulíbarri J, González-Madroño 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.

    PubMed  Google Scholar 

  10. 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. 2018;25:3316–23. https://doi.org/10.1245/s10434-018-6672-6.

    Article  PubMed  Google Scholar 

  11. 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. https://doi.org/10.1007/s10120-017-0744-3.

    Article  PubMed  Google Scholar 

  12. Okamoto S, Ureshino H, Kidoguchi K, et al. Clinical impact of the CONUT score in patients with multiple myeloma. Ann Hematol. 2020;99:113–9. https://doi.org/10.1007/s00277-019-03844-2.

    Article  CAS  PubMed  Google Scholar 

  13. Yılmaz A, Tekin SB, Bilici M, et al. The significance of controlling nutritional status (CONUT) score as a novel prognostic parameter in small cell lung cancer. Lung. 2020;198:695–704. https://doi.org/10.1007/s00408-020-00361-2.

    Article  CAS  PubMed  Google Scholar 

  14. Lin ZX, Ruan DY, Jia CC, et al. Controlling nutritional status (CONUT) score-based nomogram to predict overall survival of patients with HBV-associated hepatocellular carcinoma after curative hepatectomy. Clin Transl Oncol. 2020;22:370–80. https://doi.org/10.1007/s12094-019-02137-4.

    Article  CAS  PubMed  Google Scholar 

  15. Peng W, Yao M, Zou K, et al. Postoperative controlling nutritional status score is an independent risk factor of survival for patients with small hepatocellular carcinoma: a retrospective study. BMC Surg. 2021;21:338. https://doi.org/10.1186/s12893-021-01334-9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Chen Y, Zhao C, Yang Y, et al. Using the controlling nutritional status (CONUT) score for evaluating patients with early-stage hepatocellular carcinoma after radiofrequency ablation: a two-center retrospective study. Cardiovasc Intervent Radiol. 2020;43:1294–304. https://doi.org/10.1007/s00270-020-02519-0.

    Article  PubMed  Google Scholar 

  17. Müller L, Hahn F, Mähringer-Kunz A, et al. Immunonutritive scoring in patients with hepatocellular carcinoma undergoing transarterial chemoembolization: prognostic nutritional index or controlling nutritional status score? Front Oncol. 2021;11:696183. https://doi.org/10.3389/fonc.2021.696183.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67:358–80. https://doi.org/10.1002/hep.29086.

    Article  PubMed  Google Scholar 

  19. Tsunematsu M, Haruki K, Fujiwara Y, et al. Preoperative controlling nutritional status (CONUT) score predicts long-term outcomes in patients with non-B non-C hepatocellular carcinoma after curative hepatic resection. Langenbecks Arch Surg. 2021;406:99–107. https://doi.org/10.1007/s00423-020-01987-9.

    Article  PubMed  Google Scholar 

  20. Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol. 2022;76:681–93. https://doi.org/10.1016/j.jhep.2021.11.018.

    Article  PubMed  Google Scholar 

  21. Li SP, Cao D, He JH, et al. High platelet count predicts poor prognosis in HCC patients undergoing TACE: a propensity score-matched analysis. Expert Rev Gastroenterol Hepatol. 2022;16:193–9. https://doi.org/10.1080/17474124.2022.2031977.

    Article  CAS  PubMed  Google Scholar 

  22. Ryo S, Kanda M, Ito S, et al. 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. Ann Surg Oncol. 2019;26:456–64. https://doi.org/10.1245/s10434-018-07121-w.

    Article  PubMed  Google Scholar 

  23. Qian W, Xiao-Jian J, Jun H, et al. Comparison of the value of multiple preoperative objective nutritional indices for the evaluation of prognosis after hepatectomy for hepatocellular carcinoma. Nutr Cancer. 2022;74:3217–27. https://doi.org/10.1080/01635581.2022.2069276.

    Article  CAS  PubMed  Google Scholar 

  24. Huang TH, Hsieh CC, Kuo LM, et al. Malnutrition associated with an increased risk of postoperative complications following hepatectomy in patients with hepatocellular carcinoma. HPB (Oxford). 2019;21:1150–5. https://doi.org/10.1016/j.hpb.2019.01.003.

    Article  PubMed  Google Scholar 

  25. Loftus TJ, Brown MP, Slish JH, et al. Serum levels of prealbumin and albumin for preoperative risk stratification. Nutr Clin Pract. 2019;34:340–8. https://doi.org/10.1002/ncp.10271.

    Article  PubMed  Google Scholar 

  26. Núñez KG, Sandow T, Patel J, et al. Hypoalbuminemia is a hepatocellular carcinoma independent risk factor for tumor progression in low-risk bridge to transplant candidates. Cancers (Basel). 2022. https://doi.org/10.3390/cancers14071684.

    Article  PubMed  Google Scholar 

  27. Qu Z, Lu YJ, Feng JW, et al. Preoperative prognostic nutritional index and neutrophil-to-lymphocyte ratio predict survival outcomes of patients with hepatocellular carcinoma after curative resection. Front Oncol. 2021;11:823054. https://doi.org/10.3389/fonc.2021.823054.

    Article  CAS  PubMed  Google Scholar 

  28. de Ulíbarri Pérez JI, Fernández G, Rodríguez Salvanés F, et al. Nutritional screening; control of clinical undernutrition with analytical parameters. Nutr Hosp. 2014;29:797–811. https://doi.org/10.3305/nh.2014.29.4.7275.

    Article  PubMed  Google Scholar 

  29. Jiang SS, Weng DS, Jiang L, et al. The clinical significance of preoperative serum cholesterol and high-density lipoprotein-cholesterol levels in hepatocellular carcinoma. J Cancer. 2016;7:626–32. https://doi.org/10.7150/jca.13837.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Chew V, Tow C, Teo M, et al. Inflammatory tumour microenvironment is associated with superior survival in hepatocellular carcinoma patients. J Hepatol. 2010;52:370–9. https://doi.org/10.1016/j.jhep.2009.07.013.

    Article  CAS  PubMed  Google Scholar 

  31. Refolo MG, Messa C, Guerra V, et al. Inflammatory mechanisms of HCC development. Cancers (Basel). 2020. https://doi.org/10.3390/cancers12030641.

    Article  PubMed  Google Scholar 

  32. Mano Y, Shirabe K, Yamashita Y, et al. Preoperative neutrophil-to-lymphocyte ratio is a predictor of survival after hepatectomy for hepatocellular carcinoma: a retrospective analysis. Ann Surg. 2013;258:301–5. https://doi.org/10.1097/SLA.0b013e318297ad6b.

    Article  PubMed  Google Scholar 

  33. Nagai S, Abouljoud MS, Kazimi M, et al. Peritransplant lymphopenia is a novel prognostic factor in recurrence of hepatocellular carcinoma after liver transplantation. Transplantation. 2014;97:694–701. https://doi.org/10.1097/01.TP.0000437426.15890.1d.

    Article  PubMed  Google Scholar 

  34. Ding W, Xu X, Qian Y, et al. Prognostic value of tumor-infiltrating lymphocytes in hepatocellular carcinoma: A meta-analysis. Medicine (Baltimore). 2018;97:e13301. https://doi.org/10.1097/md.0000000000013301.

    Article  PubMed  Google Scholar 

  35. Takagi K, Yagi T, Umeda Y, et al. Preoperative controlling nutritional status (CONUT) score for assessment of prognosis following hepatectomy for hepatocellular carcinoma. World J Surg. 2017;41:2353–60. https://doi.org/10.1007/s00268-017-3985-8.

    Article  PubMed  Google Scholar 

  36. Harimoto N, Yoshizumi T, Sakata K, et al. Prognostic significance of preoperative controlling nutritional status (CONUT) score in patients undergoing hepatic resection for hepatocellular carcinoma. World J Surg. 2017;41:2805–12. https://doi.org/10.1007/s00268-017-4097-1.

    Article  PubMed  Google Scholar 

  37. Yang Y, Ye F, Xin Y, et al. Prognostic significance of controlling nutritional status score-based nomogram for hepatocellular carcinoma within Milan criteria after radiofrequency ablation. J Gastrointest Oncol. 2020;11:1024–39. https://doi.org/10.21037/jgo-20-225.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Shimose S, Kawaguchi T, Iwamoto H, et al. Controlling nutritional status (CONUT) score is associated with overall survival in patients with unresectable hepatocellular carcinoma treated with lenvatinib: a multicenter cohort study. Nutrients. 2020. https://doi.org/10.3390/nu12041076.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Chen Y, Xu WJ, Yang Y, et al. Nomograms including the controlling nutritional status score in patients with hepatocellular carcinoma undergoing transarterial chemoembolisation for prediction survival: a retrospective analysis. Br J Nutr. 2022;128:1966–74. https://doi.org/10.1017/s000711452100492x.

    Article  CAS  PubMed  Google Scholar 

  40. Müller L, Hahn F, Auer TA, et al. Tumor burden in patients with hepatocellular carcinoma undergoing transarterial chemoembolization: head-to-head comparison of current scoring systems. Front Oncol. 2022;12:850454. https://doi.org/10.3389/fonc.2022.850454.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Wang ZX, Wang EX, Bai W, et al. Validation and evaluation of clinical prediction systems for first and repeated transarterial chemoembolization in unresectable hepatocellular carcinoma: a Chinese multicenter retrospective study. World J Gastroenterol. 2020;26:657–69. https://doi.org/10.3748/wjg.v26.i6.657.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Author notes

  1. Zhuofan Deng and Wenfeng Zhang have contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Zhuofan Deng, Wenfeng Zhang, Linxiao Gao, Chunyu Zhang, Kai Lei, Jianping Gong & Bin Xiong

  2. Department of Pediatric Surgical Oncology, Children’s Hospital of Chongqing Medical University, Chongqing, China

    Junwei Peng

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Deng, Z., Zhang, W., Peng, J. et al. Controlling Nutritional Status (CONUT) Score is Associated with Overall Survival in Patients with Hepatocellular Carcinoma Treated with Conventional Transcatheter Arterial Chemoembolization: A Propensity Score Matched Analysis. Cardiovasc Intervent Radiol (2024). https://doi.org/10.1007/s00270-024-03712-1

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