Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2024; 16(2): 343-353
Published online Feb 15, 2024. doi: 10.4251/wjgo.v16.i2.343
Preoperative controlling nutritional status as an optimal prognostic nutritional index to predict the outcome for colorectal cancer
Li-Xiang Liu, Hao Wang, Bo Gao, Ting-Ting Xu, Qing-Gang Yuan, Shi-Zhen Zhou, Chao Ding, Ji Miao, Wen-Xian Guan
Li-Xiang Liu, Wen-Xian Guan, Department of General Surgery, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College, Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
Hao Wang, Shi-Zhen Zhou, Chao Ding, Ji Miao, Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
Bo Gao, Department of Clinical Nutrition, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Ting-Ting Xu, School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing 210008, Jiangsu Province, China
Qing-Gang Yuan, Department of General Surgery, Nanjing Drum Tower Clinical College of Xuzhou Medical University, Nanjing 210008, Jiangsu Province, China
Co-first authors: Li-Xiang Liu and Hao Wang.
Co-corresponding authors: Ji Miao and Wen-Xian Guan.
Author contributions: Liu LX, Wang H, Gao B, Ding C, Miao J and Guan WX designed the research; Liu LX, Yuan QG, Zhou SZ and Xu TT, performed the research; Ding C and Gao B contributed analytic tools; Liu LX, Wang H, Gao B and Ding C analyzed the data; Liu LX, Wang H, Gao B, Miao J and Guan WX wrote the paper; all authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. Liu LX and Wang H contributed equally to this work as co-first authors. Guan WX and Miao J contributed equally to this work as co-corresponding authors. There are three reasons for designating Liu LX and Wang H as co-first authors and Guan WX and Miao J as co-corresponding authors. First, the research was performed as a collaborative effort, and the designation of co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability. Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-corresponding authors best reflects this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers' understanding by offering various expert perspectives. Third, they put equal effort into the whole research process. The choice of these researchers as co-first authors/co-corresponding authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Liu LX and Wang H as co-first authors and Guan WX and Miao J as co-corresponding authors of is fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Supported by Clinical Trials from the Affiliated Drum Tower Hospital, Medical School of Nanjing University, 2022-LCYJ-PY-17; CIMF - CSPEN Project, Z-2017-24-2211; and Project of Chinese Hospital Reform and Development Institute, Nanjing University and Aid project of Nanjing Drum Tower Hospital Health, Education & Research Foundation, NDYG2022090.
Institutional review board statement: The entire process followed the ethical standards of the Declaration of Helsinki. This study was approved by the ethics committee of Nanjing Drum Tower Hospital and General Hospital of Eastern Theater Command, and was performed after informed consent was.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Xian Guan, PhD, Chief Physician, Department of General Surgery, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College, Nanjing Medical University, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu Province, China. guan__wenxian@sina.com
Received: September 3, 2023
Peer-review started: September 3, 2023
First decision: October 16, 2023
Revised: December 4, 2023
Accepted: December 20, 2023
Article in press: December 20, 2023
Published online: February 15, 2024
Abstract
BACKGROUND

The controlling nutritional status (CONUT) score effectively reflects a patient’s nutritional status, which is closely related to cancer prognosis. This study investigated the relationship between the CONUT score and prognosis after radical surgery for colorectal cancer, and compared the predictive ability of the CONUT score with other indexes.

AIM

To analyze the predictive performance of the CONUT score for the survival rate of colorectal cancer patients who underwent potentially curative resection.

METHODS

This retrospective analysis included 217 patients with newly diagnosed colorectal. The CONUT score was calculated based on the serum albumin level, total lymphocyte count, and total cholesterol level. The cutoff value of the CONUT score for predicting prognosis was 4 according to the Youden Index by the receiver operating characteristic curve. The associations between the CONUT score and the prognosis were performed using Kaplan-Meier curves and Cox regression analysis.

RESULTS

Using the cutoff value of the CONUT score, patients were stratified into CONUT low (n = 189) and CONUT high groups (n = 28). The CONUT high group had worse overall survival (OS) (P = 0.013) and relapse-free survival (RFS) (P = 0.015). The predictive performance of CONUT was superior to the modified Glasgow prognostic score, the prognostic nutritional index, and the neutrophil-to-lymphocyte ratio. Meanwhile, the predictive performances of CONUT + tumor node metastasis (TNM) stage for 3-year OS [area under the receiver operating characteristics curve (AUC) = 0.803] and 3-year RFS (AUC = 0.752) were no less than skeletal muscle mass index (SMI) + TNM stage. The CONUT score was negatively correlated with SMI (P < 0.01).

CONCLUSION

As a nutritional indicator, the CONUT score could predict long-term outcomes after radical surgery for colorectal cancer, and its predictive ability was superior to other indexes. The correlation between the CONUT score and skeletal muscle may be one of the factors that play a predictive role.

Keywords: Controlling nutritional status, Colorectal cancer, Prognostic marker, Sarcopenia, Skeletal muscle

Core Tip: The controlling nutritional status (CONUT) score was significantly associated with the postoperative prognosis of colorectal cancer patients. Compared with other nutritional scores, CONUT score could serve as an optimal prognostic nutritional index to predict the long-term outcome after radical surgery for colorectal cancer.