Skip to main content

Advertisement

SpringerLink
Log in

Use of preoperative controlling nutritional status (CONUT) score as a better prognostic marker for distal cholangiocarcinoma after pancreatoduodenectomy

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

The controlling nutritional status (CONUT) score can be easily calculated from the serum albumin concentration, total cholesterol concentration, and total lymphocyte count. The study aim was to assess the preoperative prognostic factors for the overall survival (OS) of distal cholangiocarcinoma (DCC) following pancreatoduodenectomy (PD) and to demonstrate the utility of the CONUT score.

Methods

A total of 149 consecutive patients who underwent PD for DCC between September 2002 and December 2016 were divided into a low-CONUT (LC) group (CONUT scores ≤ 2) and a high-CONUT (HC) group (CONUT scores ≥ 3). The clinicopathological characteristics and OS of the patients were evaluated retrospectively. Prognostic factors of DCC were identified by multivariate analyses.

Results

The LC and HC groups included 113 and 36 patients, respectively. The OS was better in the LC group than in the HC group (median survival time and 5 year survival rate: 82 months and 56.8% vs. 38 months and 27.6%, P = 0.005). Multivariate analyses for the OS in all patients showed that the tumor differentiation, perineural invasion, residual tumor status, portal vein resection, blood transfusion, and preoperative CONUT score ≥ 3 were independently associated with a poor survival.

Conclusion

The CONUT score may be a useful preoperative factor for predicting the long-term survival in patients with DCC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1 
Fig. 2 
Fig. 3 

Similar content being viewed by others

References

  1. Bird NTE, McKenna A, Dodd J, Poston G, Jones R, Malik H. Meta-analysis of prognostic factors for overall survival in patients with resected hilar cholangiocarcinoma. Br J Surg. 2018;105:1408–16.

    CAS  PubMed  Google Scholar 

  2. van der Gaag NA, Kloek JJ, de Bakker JK, Musters B, Geskus RB, Busch OR, et al. Survival analysis and prognostic nomogram for patients undergoing resection of extrahepatic cholangiocarcinoma. Ann Oncol. 2012;23:2642–9.

    PubMed  Google Scholar 

  3. Courtin-Tanguy L, Rayar M, Bergeat D, Merdrignac A, Harnoy Y, Boudjema K, et al. The true prognosis of resected distal cholangiocarcinoma. J Surg Oncol. 2016;113(575):580.

    Google Scholar 

  4. Andrianello S, Paiella S, Allegrini V, Ramera M, Pulvirenti A, Malleo G, et al. Pancreaticoduodenectomy for distal cholangiocarcinoma: surgical results, prognostic factors, and long-term follow-up. Langenbecks Arch Surg. 2015;400:623–8.

    PubMed  Google Scholar 

  5. Ignacio de Ulibarri J, Gonzalez-Madrono A, de Villar NG, Gonzalez P, Gonzalez B, Mancha A, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20(1):38–45.

    CAS  PubMed  Google Scholar 

  6. Cabre M, Ferreiro C, Arus M, Roca M, Palomera E, Serra-Prat M. Evaluation of CONUT for clinical malnutrition detection and short-term prognostic assessment in hospitalized elderly people. J Nutr Health Aging. 2015;19:729–33.

    CAS  PubMed  Google Scholar 

  7. Toyokawa G, Kozuma Y, Matsubara T, Haratake N, Takamori S, Akamine T, et al. Prognostic impact of controlling nutritional status score in resected lung squamous cell carcinoma. J Thorac Dis. 2017;9:2942–51.

    PubMed  PubMed Central  Google Scholar 

  8. Toyokawa T, Kubo N, Tamura T, Sakurai K, Amano R, Tanaka H, et al. The pretreatment Controlling Nutritional Status (CONUT) score is an independent prognostic factor in patients with resectable thoracic esophageal squamous cell carcinoma: results from a retrospective study. BMC cancer. 2016;16:722.

    PubMed  PubMed Central  Google Scholar 

  9. Kuroda D, Sawayama H, Kurashige J, Iwatsuki M, Eto T, Tokunaga R, et al. Controlling Nutritional Status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection. Gastric Cancer. 2018;21:204–12.

    PubMed  Google Scholar 

  10. Harimoto N, Yoshizumi T, Inokuchi S, Itoh S, Adachi E, Ikeda Y, 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.

    PubMed  Google Scholar 

  11. Miyata T, Yamashita YI, Higashi T, Taki K, Izumi D, Kosumi K, et al. The prognostic impact of controlling nutritional status (CONUT) in intrahepatic cholangiocarcinoma following curative hepatectomy: a retrospective single institution study. World J Surg. 2018;42:1085–91.

    PubMed  Google Scholar 

  12. Kato Y, Yamada S, Suenaga M, Takami H, Niwa Y, Hayashi M, et al. Impact of the controlling nutritional status score on the prognosis after curative resection of pancreatic ductal adenocarcinoma. Pancreas. 2018;47:823–9.

    PubMed  Google Scholar 

  13. Terasaki F, Sugiura T, Okamura Y, Ito T, Yamamoto Y, Ashida R, et al. The preoperative controlling nutritional status (CONUT) score is an independent prognostic marker for pancreatic ductal adenocarcinoma. Updates Surg. 2020. https://doi.org/10.1007/s13304-020-00792-9.

    Article  PubMed  Google Scholar 

  14. Kumamoto Y, Kaizu T, Tajima H, Nishizawa N, Ei S, Igarashi K, et al. Neutrophil-to-lymphocyte ratio as a predictor of postoperative morbidity in patients with distal cholangiocarcinoma. Molecular and clinical oncology. 2018;9:362–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Fujii T, Sugimoto H, Yamada S, Kanda M, Suenaga M, Takami H, et al. Modified blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. J Gastrointest Surg. 2014;18:1108–15.

    PubMed  Google Scholar 

  16. Ebata T, Hirano S, Konishi M, Uesaka K, Tsuchiya Y, Ohtsuka M, et al. Randomized clinical trial of adjuvant gemcitabine chemotherapy versus observation in resected bile duct cancer. Br J surg. 2018;105:192–202.

    CAS  PubMed  Google Scholar 

  17. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    PubMed  Google Scholar 

  18. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017;161:584–91.

    PubMed  Google Scholar 

  19. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study group of pancreatic surgery (ISGPS). Surgery. 2007;142:761–8.

    PubMed  Google Scholar 

  20. Lin Y. Robust inference for responder analysis: innovative clinical trial design using a minimum p-value approach. Contemp Clin Trials Commun. 2016;3:65–9.

    PubMed  PubMed Central  Google Scholar 

  21. Vanniyasingam T, Rodseth RN, Lurati Buse GA, Bolliger D, Burkhart CS, Cuthbertson BH, et al. Predicting the occurrence of major adverse cardiac events within 30 days of a vascular surgery: an empirical comparison of the minimum p value method and ROC curve approach using individual patient data meta-analysis. Springerplus. 2016;5:304.

    PubMed  PubMed Central  Google Scholar 

  22. McMillan DC, Elahi MM, Sattar N, Angerson WJ, Johnstone J, McArdle CS. Measurement of the systemic inflammatory response predicts cancer-specific and non-cancer survival in patients with cancer. Nutr Cancer. 2001;41:64–9.

    CAS  PubMed  Google Scholar 

  23. Wu N, Chen G, Hu H, Pang L, Chen Z. Low pretherapeutic serum albumin as a risk factor for poor outcome in esophageal squamous cell carcinomas. Nutr Cancer. 2015;67:481–5.

    CAS  PubMed  Google Scholar 

  24. Cengiz O, Kocer B, Surmeli S, Santicky MJ, Soran A. Are pretreatment serum albumin and cholesterol levels prognostic tools in patients with colorectal carcinoma? Med Sci Monit. 2006;12(6):CR240–CR247.

    CAS  PubMed  Google Scholar 

  25. Onate-Ocana LF, Aiello-Crocifoglio V, Gallardo-Rincon D, Herrera-Goepfert R, Brom-Valladares R, Carrillo JF, et al. Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Ann Surg Oncol. 2007;14:381–9.

    PubMed  Google Scholar 

  26. Peters SJ, Vanhaecke T, Papeleu P, Rogiers V, Haagsman HP, van Norren K. Co-culture of primary rat hepatocytes with rat liver epithelial cells enhances interleukin-6-induced acute-phase protein response. Cell Tissue Res. 2010;340:451–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Honda H, Qureshi AR, Heimburger O, Barany P, Wang K, Pecoits-Filho R, et al. Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD. Am J Kidney Dis. 2006;47:139–48.

    CAS  PubMed  Google Scholar 

  28. Shen J, Wen T, Li C, Yan L, Li B, Yang J. The prognostic prediction role of preoperative serum albumin level in patients with intahepatic cholangiocarcinoma following hepatectomy. Dig Dis. 2018;36:306–13.

    PubMed  Google Scholar 

  29. Waghray A, Sobotka A, Marrero CR, Estfan B, Aucejo F, Narayanan Menon KV. Serum albumin predicts survival in patients with hilar cholangiocarcinoma. Gastroenterology report. 2017;5:62–6.

    PubMed  Google Scholar 

  30. Okuyama H, Ichikawa Y, Sun Y, Hamazaki T, Lands WE. Cancer and all-cause mortalities are lower in the higher total cholesterol groups among general populations. World Rev Nutr Diet. 2007;96:37–54.

    PubMed  Google Scholar 

  31. Roch AM, House MG, Cioffi J, Ceppa EP, Zyromski NJ, Nakeeb A, et al. Significance of portal vein invasion and extent of invasion in patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma. J Gastrointest Surg. 2016;20(3):479–87.

    PubMed  Google Scholar 

  32. Li JR, Zhang Y, Zheng JL. Decreased pretreatment serum cholesterol level is related with poor prognosis in resectable non-small cell lung cancer. Int J Clin Exp Pathol. 2015;8:11877–83.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Wang J, Wang WJ, Zhai L, Zhang DF. Association of cholesterol with risk of pancreatic cancer: a meta-analysis. World J Gastroenterol. 2015;21:3711–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Kang R, Li P, Wang T, Li X, Wei Z, Zhang Z, et al. Apolipoprotein E epsilon 2 allele and low serum cholesterol as risk factors for gastric cancer in a Chinese Han population. Sci Rep. 2016;6:19930.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Niendorf A, Nagele H, Gerding D, Meyer-Pannwitt U, Gebhardt A. Increased LDL receptor mRNA expression in colon cancer is correlated with a rise in plasma cholesterol levels after curative surgery. Int J Cancer. 1995;61:461–4.

    CAS  PubMed  Google Scholar 

  36. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420:860–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454:436–44.

    CAS  PubMed  Google Scholar 

  38. Chiba T, Ohtani H, Mizoi T, Naito Y, Sato E, Nagura H, et al. Intraepithelial CD8+ T-cell-count becomes a prognostic factor after a longer follow-up period in human colorectal carcinoma: possible association with suppression of micrometastasis. Br J Cancer. 2004;91:1711–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Liang L, Zhu J, Jia H, Huang L, Li D, Li Q, et al. Predictive value of pretreatment lymphocyte count in stage II colorectal cancer and in high-risk patients treated with adjuvant chemotherapy. Oncotarget. 2016;7:1014–28.

    PubMed  Google Scholar 

  40. Yamada M, Sugiura T, Okamura Y, Ito T, Yamamoto Y, Ashida R, et al. Microscopic venous invasion in pancreatic cancer. Ann Surg Oncol. 2018;25:1043–51.

    PubMed  Google Scholar 

  41. Hu LS, Weiss M, Popescu I, Marques HP, Aldrighetti L, Maithel SK, et al. Impact of microvascular invasion on clinical outcomes after curative-intent resection for intrahepatic cholangiocarcinoma. J Surg Oncol. 2019;119:21–9.

    PubMed  Google Scholar 

  42. Martin D, Joliat GR, Halkic N, Demartines N, Schafer M. Perioperative nutritional management of patients undergoing pancreatoduodenectomy: an international survey among surgeons. HPB (Oxford). 2019;22(1):75–82.

    Google Scholar 

  43. Adiamah A, Skorepa P, Weimann A, Lobo DN. The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer: a systematic review and meta-analysis. Ann Surg. 2019;270:247–56.

    PubMed  Google Scholar 

  44. Ebata T, Ercolani G, Alvaro D, Ribero D, Di Tommaso L, Valle JW. Current status on cholangiocarcinoma and gallbladder cancer. Liver Cancer. 2016;6:59–655.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Hepato–Biliary–Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, Sunto-gun, 411–8777, Japan

    Fumihiro Terasaki, Teiichi Sugiura, Yukiyasu Okamura, Takaaki Ito, Yusuke Yamamoto, Ryo Ashida, Katsuhisa Ohgi & Katsuhiko Uesaka

Authors
  1. Fumihiro Terasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Teiichi Sugiura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yukiyasu Okamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takaaki Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yusuke Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryo Ashida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Katsuhisa Ohgi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Katsuhiko Uesaka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Teiichi Sugiura.

Ethics declarations

Conflict of interest

Fumihiro Terasaki and the other co-authors have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Terasaki, F., Sugiura, T., Okamura, Y. et al. Use of preoperative controlling nutritional status (CONUT) score as a better prognostic marker for distal cholangiocarcinoma after pancreatoduodenectomy. Surg Today 51, 358–365 (2021). https://doi.org/10.1007/s00595-020-02098-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-020-02098-0

Keywords

Search

Navigation