Clinical Value Of CONUT Score In Predicting Short-term And Long-term Prognosis Of Patients Undergoing Colorectal Cancer Surgery

Objective CONUT(controlling nutritional status,CONUT)score is an index to evaluate the immune nutritional status of patients.At present,the CONUT score has been widely used.There have been relevant researches on the relationship between the CONUT score and the prognosis of cancer,such as gastric cancer,colorectal cancer,lung cancer,etc.The Research on the relationship between the postoperative complications of colorectal cancer and the CONUT score is still controversial.The relationship between the CONUT score and the short-term and long-term prognosis of colorectal cancer patients still needs to be explored.By analyzing the relationship between CONUT score and short-term prognosis(postoperative complications)and long-term prognosis of colorectal cancer patients,a nomogram based on CONUT score was constructed to predict the risk and survival rate of postoperative complications,and the clinical value of CONUT score in predicting the short-term prognosis and long-term prognosis of colorectal cancer patients was evaluated.Methods A retrospective study was conducted on the data of patients undergoing colorectal cancer surgery from October 2012 to September 2014.According to the CONUT score,the patients were divided into the following two groups: high CONUT group(CONUT score ≥ 2;n = 266),low CONUT group(CONUT score < 2;n = 246).Other clinicopathological data such as gender,age,BMI,TNM stage were collected.Chi square test and t-test were used to analyze the relationship between CONUT score and clinicopathological factors,as well as the relationship between CONUT score and postoperative complications.Kaplan-Meier survival analysis based on CONUT scores of different TNM stages was carried out;logistic regression model was used for single factor and multi factor analysis related to postoperative complications;DFS and OS Kaplan-Meier survival analysis based on CONUT scores;Cox proportional risk model was used for single factor and multi factor analysis of OS and DFS,followed by sub group and multi factor analysis;other immunity was carried out Kaplan-Meier survival analysis of nutritional indicators(PNI,NLR and PLR).The ability of CONUT score and other immune nutrition indexes(PNI,NLR and PLR)to predict the prognosis of colorectal cancer patients was compared by ROC curve analysis;the nomogram based on CONUT score to predict postoperative complications,OS and DFS was constructed,and the consistency between nomogram prediction and actual observation was evaluated by calibration curve.Result A total of 512 patients were included in the study,266 in the high CONUT group and 246 in the low CONUT group.The analysis of CONUT score and clinicopathological factors showed that the age of patients in the high CONUT group was significantly higher than that in the low CONUT group(P =0.010),and the BMI of patients in the high CONUT group was significantly higher than that in the low CONUT group(P < 0.001).There were significantly more colon cancer(P = 0.034),tumor ≥ 5cm(P < 0.001),CEA ≥ 5ng / ml(P =0.005)in high CONUT group.Moreover,patients in the high CONUT group had longer hospitalization time(P = 0.013).Further Kaplan-Meier survival analysis based on CONUT scores of different TNM stages showed that DFS and OS in high CONUT group were significantly lower than those in low CONUT group(P < 0.05),while in TNM III,there was no significant difference between the two groups(P > 0.05)There was a significant increase in postoperative complications in group A(P = 0.002,P = 0.036,P = 0.002,P = 0.036,P = 0.002,P = 0.036,P = 0.036,P = 0.001),but there was no significant correlation with complications in group II,III,IV and V;Logistic regression univariate analysis showed that age(≥ 60),operation mode(open type),intraoperative blood loss(≥100ml)and CONUT score was correlated with postoperative complications(P <0.05).The results of Kaplan-Meier survival analysis showed that the overall survival rate(OS)and disease-free survival rate(release free survival)of patients with high CONUT were the independent risk factors(HR = 1.792;95%CI(1.113-2.886);P = 0.016),DFS)is significantly lower than low CONUT Cox regression analysis showed that ASA grade(III-IV),CONUT score(high),PNI(low),Pt stage(T3-4),PN stage,perineural infiltration(positive),vascular infiltration(positive),histological type(low differentiation),CEA(high)and postoperative complications were correlated with DFS and OS in colorectal cancer patients(P < 0.05).Age(≥ 60 years old)was correlated with OS(P =0.021),but not with DFS(P = 0.065).Multivariate Cox regression analysis showed that CONUT score(high),PN stage,CEA(high)and postoperative complications were independent risk factors(P < 0.05),while age,CONUT score(high),PN stage and postoperative complications were independent risk factors(P < 0.05).The results of multivariate analysis of subgroups showed that CONUT score(high)was an independent risk factor for DFS and OS in most subgroups;Kaplan-Meier survival analysis of other immune nutrition indexes(PNI,NLR and PLR)showed that DFS and OS in patients with low PNI were significantly lower than those in patients with high PNI(DFS,P = 0.026,OS,P= 0.022).There was no significant difference between the low and high NLR groups(P > 0.05),nor between the low and high PLR groups(P > 0.05).The results of ROC curve showed that the ability of CONUT score to predict the prognosis of colorectal cancer patients was better than other immune nutrition indexes(PNI,NLR and PLR);the nomogram based on CONUT score to predict postoperative complications,OS and DFS showed good consistency between nomogram prediction and actual observation.Conclusion CONUT score was significantly correlated with age,BMI,tumor location,tumor size CEA,and length of stay of colorectal cancer patients.CONUT score and TNM I,TNM Stage II colorectal cancer patients are significantly related;CONUT score is significantly related to postoperative complications,which is an independent factor affecting postoperative complications;CONUT score is significantly related to DFS and OS of colorectal cancer patients,which is an independent factor affecting the long-term prognosis;CONUT score can well predict postoperative complications,DFS and OS of colorectal cancer patients,which is a reliable and effective prognostic indicator.CONUT score has good short-term prognosis and long-term prognosis.