Determination of the predictive and prognostic value of the CONUT (Controlling Nutritional Status) score in the treatment process of metastatic colorectal cancer and its relationship with the clinicopathological features of the tumor

Abstract

BACKGROUND Studies have shown that the prognosis of various cancers is affected by factors such as inflammation, immunocompetence and nutrition, and the correlation between nutritional status and cancer prognosis is particularly striking. We aimed to evaluate the prognostic and predictive effect of The Controlling Nutritional Status (CONUT) score, calculated using serum albumin level (indicator of protein reserves), total cholesterol concentration (calorie consumption parameter) and total peripheral lymphocyte count (indicator of immunity), in patients with newly diagnosed metastatic colorectal cancer (mCRC). METHODS The prospectively designed study included 36 patients who were diagnosed with mCRC between June 2020 and December 2021 at the Department of Medical Oncology, Dokuz Eylul University Hospital, and were assessed according to the web-based software OpenEpi CONUT score was calculated using serum albumin level, total cholesterol concentration, and total peripheral lymphocyte count. Demographic, clinicopathological, and treatment-related characteristics of the patients, as well as CONUT values before treatment and at month 3, were recorded. The data obtained were analyzed in the SPSS statistical program according to appropriate analysis methods and the p value was < 0. 05 considered statistically significant. RESULTS The median age of the study population was 67.09 (Range: 37.37-88.30 years) years and 66.7% (n= 24) of the patients were male. The median follow-up period of the patients was 13.85 months (Range: 5.8-26.87 month) and 5.6% (n = 2) of the patients died during the follow-up period. The objective response rate (ORR) (complete and partial response) was higher in the group with low CONUT score than in the groups with medium and high CONUT scores (84.1% vs 73.3% vs 40%, respectively). When progression status was evaluated, the rate of patients progressing in the group with high CONUT score was higher than in the groups with medium and low CONUT scores (20% vs 13.3% vs 6.3% respectively). Patients with exitus were included in the CONUT high group, and the survival of these patients was shorter than in the CONUT low group. The median CONUT score value of the patients before treatment was 2 (0-11), and the median CONUT score at the 3rd month was 1 (0-10). When we looked at the correlation between the CONUT scores before treatment and at month 3, we saw that there was a statistically significant correlation between the baseline score and the 3rd month score (R: 0.36, p = 0.031). CONCLUSION Immunonutrition status is one of the factors affecting cancer prognosis, and the CONUT score, which reflects this status, has been shown to have a negative effect on prognosis if it is high at the beginning of treatment, as shown in our mCRC diagnosedpopulation of a small number of patients that we planned prospectively during the COVID period. In addition, it was thought that the decrease in the CONUT score was related to the increase in albumin values, which is a biomarker of improvement in nutritional status with systemic treatment.

Keywords

• CONUT score
• immunonutritional status
• metastatic colorectal cancer (mCRC)
• prognostic factor

References

1. 1. Global Cancer Observatory. International Agency for Research on Cancer. World Health Organization. Available at: https://gco.iarc.fr/ (Accessed on December 13, 2023).
2. 2. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024 [published correction appears in CA Cancer J Clin. 2024 Mar-Apr;74(2):203. doi: 10.3322/caac.21830]. CA Cancer J Clin. 2024;74(1):12-49. doi:10.3322/caac.21820.
3. 3. Cronin KA, Scott S, Firth AU, et al. Annual report to the nation on the status of cancer, part 1: National cancer statistics. Cancer. 2022;128(24):4251-4284. doi:10.1002/cncr.34479.
4. 4. Yamamoto M, Saito H, Uejima C, et al. Prognostic Value of Combined Tumor Marker and Controlling Nutritional Status (CONUT) Score in Colorectal Cancer Patients. Yonago Acta Med. 2019;62(1):124-130. Published 2019 Mar 28. doi:10.33160/yam.2019.03.017
5. 5. Li J, Zhu N, Wang C, et al. Preoperative albumin-to-globulin ratio and prognostic nutritional index predict the prognosis of colorectal cancer: a retrospective study. Sci Rep. 2023;13(1):17272. Published 2023 Oct 12. doi:10.1038/s41598-023-43391-5
6. 6. Misevic V, Mitrovic M, Krstić M, et al. Significance of the CONUT Score in the Prognosis of Colorectal Cancer Patients. Chirurgia (Bucur). 2023;118(4):391-398. doi:10.21614/chirurgia.2023.v.118.i.4.p.391
7. 7. Liang RF, Li JH, Li M, Yang Y, Liu YH. The prognostic role of controlling nutritional status scores in patients with solid tumors. Clin Chim Acta. 2017;474:155-158. doi:10.1016/j.cca.2017.09.021
8. 8. Okamoto A, Furukawa K, Ohkuma M, et al. Clinical Significance of Controlling Nutritional Status (CONUT) Score in Patients With Colorectal Liver Metastases After Hepatectomy. In Vivo. 2023;37(6):2678-2686. doi:10.21873/invivo.13377

9. 9. Misevic V, Mitrovic M, Krstić M, et al. Significance of the CONUT Score in the Prognosis of Colorectal Cancer Patients. Chirurgia (Bucur). 2023;118(4):391-398. doi:10.21614/chirurgia.2023.v.118.i.4.p.391
10. 10. Lu S, Chen Z, Peng R, et al. Prognostic effect of preoperative Controlling Nutritional Status score in patients with locally advanced rectal cancer: A two-center, retrospective study. Nutrition. 2023;112:112078. doi:10.1016/j.nut.2023.112078
11. 11. Takamizawa Y, Shida D, Boku N, et al. Nutritional and inflammatory measures predict survival of patients with stage IV colorectal cancer. BMC Cancer. 2020;20(1):1092. Published 2020 Nov 11. doi:10.1186/s12885-020-07560-3
12. 12. Pian G, Oh SY. Comparison of nutritional and immunological scoring systems predicting prognosis in T1-2N0 colorectal cancer. Int J Colorectal Dis. 2022;37(1):179-188. doi:10.1007/s00384-021-04043-0
13. 13. Yamamoto M, Saito H, Uejima C, et al. Prognostic Value of Combined Tumor Marker and Controlling Nutritional Status (CONUT) Score in Colorectal Cancer Patients. Yonago Acta Med. 2019;62(1):124-130. Published 2019 Mar 28. doi:10.33160/yam.2019.03.017