COUNT Score Predicts Postoperative HBV Reactivation In HCC Patients With HBV-DNA Low-Copy

Background Controlling Nutritional Status(CONUT)score is an effective index for evaluating preoperative immune-nutrition function.It has been widely used in different disease,such as inflammatory disease,chronic heart failure,chronic liver disease and so on.However,its role in predicting the prognosis in hepatocellular carcinoma(HCC)patients with malnutrition is still unknown.Thus we enrolled HCC patients with hepatitis B virus(HBV)-DNA level less than 10~3copies/ml and without previous treatments in this study.And analysis the relationship between immune-functional status and prognosis.We aim to find out the value of CONUT score in predicting prognosis in HCC patients with low HBV-DNA levels.Moreover,we next investigate the role of CONUT score in predicting the incidence of postoperative HBV reactivation(PHR)in HCC patients with low HBV-DNA levels.Methods A retrospective analysis of 209 patients with primary hepatocellular carcinoma who underwent radical surgery between 2012 and2013 in our hospital.The CONUT score was calculated according to the patient's serum albumin(ALB),total cholesterol concentration(TC)and total lymphocyte count(TLC).Below 3 is a low value,and 3 or more is a high value.The CONUT score low value group and the CONUT score high value group were used to analyze the relationship between preoperative nutritional status and prognosis by Kaplan-Meier method according to their prognosis and survival status,and the survival rate was compared by log-rank test.The difference in the curve was analyzed by COX proportional hazard regression model to analyze the prognosis of patients and its influencing factors.To analyze the relationship between CONUT score and prognosis and HBV reactivation in patients with preoperative HBV-DNA low-copy HCC.Results Preoperative immune function(CD3+CD4+,CD3+CD8+,IgG and IgM)in patients with high CONUT score was significantly worse than that in patients with low CONUT score(P<0.05).Blood test results on postoperative day 7 showed the same trend.In addition,patients with high CONUT score experienced a significantly larger decrease in the proportions of CD3+CD4+and CD3+CD8+than those with low CONUT score(P<0.05).In patients with high CONUT score,the incidence of complications was also significantly higher(P=0.029)and hospital-stay was significantly longer(P=0.020).Besides,overall survival and recurrence free survival in patients with high CONUT score were significantly worse than those in patients with low CONUT score(48.32 vs.38.12 months,P<0.001;36.08 vs.27.03 months,P=0.001).The incidence of PHR was significantly higher in patients with high COUNT score(P<0.001),and CONUT score was strongly associated with PHR(HR=9.18,P<0.001).Additionally,the fellow subgroup results also demonstrated that COUNT score was more effective in predicting PHR in patients with HBV-DNA level<500copies/ml than patients with HBV-DNA 500-1000 copies/ml.Conclusion For HBV-HCC patients with preoperative low-copy HBV-DNA,high CONUT scores were independent risk factors of OS,RFS and PHR after HCC resection.