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

ABSTRACT

BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.