Mikozis fungoideste nutrisyonel durum kontrolü (CONUT) ve Prognostik Nutrisyonel İndeks (PNI) skorlarının prognostik değeri

Abstract

Giriş: Mikozis fungoides (MF), indolent ancak potansiyel olarak progresyon gösterebilen seyriyle en yaygın kutanöz T hücreli lenfomadır. Tümör–nod–metastaz–kan (TNMB) sistemi standart prognostik araç olmakla birlikte, aynı evredeki hastalarda sağkalım sonuçları değişkenlik gösterebilmekte ve tamamlayıcı biyobelirteçlere ihtiyaç duyulmaktadır. Nutrisyonel Durum Kontrolü (CONUT) skoru ve Prognostik Nutrisyonel İndeks (PNI), sistemik beslenme ve immün durumu yansıtan bileşik göstergelerdir. Hematolojik malignitelerde prognostik değerleri gösterilmiş olmakla birlikte, MF’ deki rolleri net değildir. Amaç: MF' de CONUT ve PNI skorlarının prognostik önemini değerlendirmek ve bu skorların hastalık evresi, inflamatuvar belirteçler ve klinik progresyon ile ilişkilerini incelemek. Yöntemler: Bu retrospektif çalışmaya histolojik olarak doğrulanmış 130 MF hastası dahil edildi. Başlangıçta demografik, klinik ve laboratuvar parametreleri kaydedildi. CONUT ve PNI, serum albümin, total kolesterol ve lenfosit sayısı kullanılarak hesaplandı. Hastalar ISCL/EORTC kriterlerine göre erken (IA–IIA) ve ileri (≥IIB) evre olarak sınıflandırıldı. İleri hastalığı öngören faktörleri belirlemek için karşılaştırmalı analizler, Spearman korelasyonu, ROC eğrisi analizleri ve çok değişkenli lojistik regresyonlar uygulandı (p < 0.05). Bulgular: İleri evre hastalar ( %19.2 ), daha düşük albümin (p = 0.009), kolesterol (p = 0.018) ve lenfosit düzeylerine (p = 0.028) sahipti; buna eşlik eden daha yüksek CRP (p = 0.004), LDH (p = 0.012) ve β₂-mikroglobulin (B2M) değerleri (p < 0.001) saptandı. Her iki indeks de sistemik inflamasyonla güçlü ilişkiler gösterdi: CONUT, β2M ile pozitif koreleydi (r = 0.621, p < 0.001), PNI ise hastalık evresi ile ters ilişkiliydi (r = −0.201, p = 0.032). ROC analizinde ileri evre MF' i belirlemede yüksek ayırt edicilik saptandı (CONUT için AUC = 0.812, PNI için AUC = 0.835); optimal kesim değerleri sırasıyla 2.5 ve 45.5 idi. Çok değişkenli modellerde artmış CONUT (OR = 2.23, p = 0.008) ve düşük PNI (OR = 0.88, p = 0.004), artmış β2M ile birlikte ileri evreyi bağımsız olarak öngördü. Sonuçlar: CONUT ve PNI skorları, MF'de malnütrisyon, inflamasyon ve immün dengesizliğin bütünleşik etkilerini yansıtmaktadır. Bu skorların ileri evre ve sistemik hastalık yükü ile güçlü ilişkisi, onları erken risk sınıflamasında erişilebilir ve düşük maliyetli biyobelirteç adayları haline getirmektedir. Bulguların doğrulanması ve klinik olarak anlamlı kesim değerlerinin belirlenmesi için prospektif çok merkezli çalışmalara ihtiyaç vardır.

Keywords

• mikozis fungoides
• nutrisyonel durum kontrolü
• prognostik nutrisyonel indeks
• prognoz
• kutanöz T hücreli lenfoma

Prognostic value of the controlling nutritional status (CONUT) and the Prognostic Nutritional Index (PNI) scores in mycosis fungoides

Abstract

Aims: Mycosis fungoides (MF) is the most prevalent cutaneous T-cell lymphoma, exhibiting an indolent but potentially progressive course. Although the tumor-node-metastasis-blood (TNMB) system is the standard prognostic tool, survival outcomes vary among patients with the same stage, underscoring the need for complementary biomarkers. The Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI) are composite indicators reflecting systemic nutritional and immune status. Their prognostic value has been established in hematologic malignancies, but their role in MF remains unclear. To evaluate the prognostic significance of CONUT and PNI scores in MF and to examine their associations with disease stage, inflammatory markers, and clinical progression. Methods: This retrospective study included 130 patients with histologically confirmed MF. Demographic, clinical, and laboratory parameters were collected at baseline. CONUT and PNI were calculated using serum albumin, total cholesterol, and lymphocyte count. Patients were classified into early (IA-IIA) and advanced (≥IIB) stages per ISCL/EORTC criteria. Comparative analyses, Spearman correlations, ROC curve analyses, and multivariate logistic regressions were performed to determine predictive factors for advanced disease (p<0.05). Results: Advanced-stage patients (19.2%) demonstrated significantly lower albumin (p=0.009), cholesterol (p=0.018), and lymphocyte counts (p=0.028), accompanied by higher CRP (p=0.004), LDH (p=0.012), and β₂-microglobulin (B2M) levels (p<0.001). Both indices showed strong correlations with systemic inflammation: CONUT correlated positively with β2M (r=0.621, p<0.001), while PNI correlated inversely with disease stage (r=-0.201, p=0.032). ROC analysis revealed excellent discriminative ability for advanced MF (AUC=0.812 for CONUT, 0.835 for PNI), with optimal cutoff values of 2.5 and 45.5, respectively. In multivariate models, elevated CONUT (OR=2.23, p=0.008) and reduced PNI (OR=0.88, p=0.004) independently predicted advanced disease, alongside increased β2M. Conclusion: The CONUT and PNI scores reflect the integrated effects of malnutrition, inflammation, and immune imbalance in MF. Their strong association with advanced stage and systemic disease burden highlights their clinical potential as accessible, low-cost biomarkers for early risk stratification. Prospective multicenter validation is warranted to confirm these findings and establish clinically relevant cutoff values for prognostic use.

Keywords

• Mycosis fungoides
• CONUT score
• prognostic nutritional index
• prognosis
• cutaneous T-cell lymphoma

References

1. Hodak E, Amitay-Laish I. Mycosis fungoides: a great imitator. Clin Dermatol. 2019 ;37(3):255-267. doi:10.1016/j.clindermatol.2019.01.004
2. Mourad A, Gniadecki R. Overall survival in mycosis fungoides: a systematic review and meta-analysis. J Invest Dermatol. 2020;140(2):495-497.e5. doi:10.1016/j.jid.2019.07.712
3. Larocca C, Kupper T. Mycosis fungoides and sézary syndrome: an update. Hematol Oncol Clin North Am. 2019;33(1):103-120. doi:10.1016/j.hoc.2018.09.001
4. Zhang Y, Chen Q, Lu C, Yu L. Prognostic role of controlling nutritional status score in hematological malignancies. Hematology. 2022;27(1):653-658. doi:10.1080/16078454.2022.2078040
5. Tiglioglu M, A Öztürk HB, Yıldız A, et al. The utility of CONUT score in indolent lymphoma patients. Niger J Clin Pract. 2023;26(9):1290-1296. doi:10.4103/njcp.njcp_20_23
6. Zuo J, Lei T, Zhong S, et al. C-reactive protein levels, the Prognostic Nutritional Index, and the lactate dehydrogenase-to-lymphocyte ratio are important prognostic factors in primary central nervous system lymphoma: a single-center study of 223 patients. Neurosurg Rev. 2023;47 (1):17. doi:10.1007/s10143-023-02248-1
7. Akgün Çağlıyan G, Hacıoğlu S, Ünver Koluman B, et al. Is CONUT score a Prognostic Index in patients with diffuse large cell lymphoma? Turk J Med Sci. 2021;51(4):2112-2119. doi:10.3906/sag-2101-406
8. Gürsoy V, Hunutlu FÇ, Pinar IE, et al. The clinical impacts of the controlling nutritional status score on patients with Hodgkin lymphoma. Eur Rev Med Pharmacol Sci. 2023;27(20):9916-9927. doi:10.26355/eurrev_202310_34170

9. Okamoto S, Ureshino H, Kidoguchi K, Kusaba K, Kizuka-Sano H, Sano H. Clinical impact of the CONUT score in patients with multiple myeloma. Ann Hematol. 2020;99(1):113-119. doi:10.1007/s00277-019-03 844-2
10. Zhao J, Wu Y. Prognostic value of the controlling nutritional status (CONUT) score in patients with diffuse large B-cell lymphoma: a meta-analysis. World J Surg Oncol. 2025;23(1):28. doi:10.1186/s12957-025-036 63-y
11. Ma S, Zhang B, Lu T, Li D, Li T, Shen. Huaihai lymphoma working group. value of the Prognostic Nutritional Index (PNI) in patients with newly diagnosed, CD5-positive diffuse large B-cell lymphoma: a multicenter retrospective study of the Huaihai Lymphoma Working Group. Cancer. 2022;128(19):3487-3494. doi:10.1002/cncr.34405
12. Lee SF, Ng TY, Wong FCS. The value of Prognostic Nutritional Index in follicular lymphoma. Am J Clin Oncol. 2019;42(2):202-207. doi:10.1097/COC.0000000000000493
13. Wang F, Lu L, Zang H, Yue Y, Cao Y, Chen M. Malnutrition defined by Controlling Nutritional Status score was independently associated with prognosis of diffuse large B-cell lymphoma primarily on elderly patients. Hematology. 2025;30(1):2434276. doi:10.1080/16078454.2024.2434276.
14. Hristov AC, Tejasvi T, Wilcox RA. Mycosis fungoides, sézary syndrome, and cutaneous b-cell lymphomas: 2025 update on diagnosis, risk-stratification, and management. Am J Hematol. 2025;100(9):1603-1628. doi:10.1002/ajh.27735
15. Olsen E, Vonderheid E, Pimpinelli N, Willemze R, Kim Y, Knobler R. Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC). Blood. 2007;110(6):1713–22. doi:10.1182/blood-2007-03-055749
16. Go SI, Choi BH, Park MJ, et al. Prognostic impact of pretreatment skeletal muscle index and CONUT score in diffuse large B-cell lymphoma. BMC Cancer. 2023;23(1):1071.
17. Matsukawa T, Suto K, Kanaya M, et al. North Japan Hematology Study Group (NJHSG). Validation and comparison of prognostic values of GNRI, PNI, and CONUT in newly diagnosed diffuse large B cell lymphoma. Ann Hematol. 2020;99(12): 2859-2868. doi: 10.1007/s00277-020-04262-5
18. Li L, Shou L. Prognostic and clinicopathological significance of the Controlling Nutritional Status (CONUT) score in patients with lymphoma: a meta-analysis. BMJ Open. 2024;14(3):e078320. doi:10.1136/bmjopen-2023-078320
19. Liu Y, Sheng L, Hua H, Zhou J, Zhao Y, Wang B. An externally validated nomogram for predicting the overall survival of patients with diffuse large B-cell lymphoma based on clinical characteristics and systemic inflammatory markers. Technol Cancer Res Treat. 2023;22:153303382311 80785. doi:10.1177/15330338231180785
20. Farabi B, Seminario-Vidal L, Jamgochian M, et al. Updated review on prognostic factors in mycosis fungoides and new skin lymphoma trials. J Cosmet Dermatol. 2022;21(7):2742-2748. doi:10.1111/jocd.14528
21. Wu XB, Hou SL, Liu H. Systemic immune inflammation index, ratio of lymphocytes to monocytes, lactate dehydrogenase and prognosis of diffuse large B-cell lymphoma patients. World J Clin Cases. 2021;9(32):98 25-9834. doi:10.12998/wjcc.v9.i32.9825.
22. He J, Yin H, Xia Y, Wu JZ, Liang JH, Zhu HY. Prognostic nutritional index, a novel biomarker which predicts worse prognosis in diffuse large B cell lymphoma. Leuk Res. 2021;110:106664. doi:10.1016/j.leukres.2021. 106664