Prognostic significance of the controlling nutritional status (CONUT) score in advanced urothelial carcinoma patients

Abstract

Introduction & objectives: The controlling nutritional status (CONUT) score, consisting of serum albumin, total lymphocyte count, and total cholesterol, is a validated and objective tool for nutritional assessment. Cancer-bearing patients often suffer from malnutrition in association with cachexia. We explored the prognostic role of malnutrition evaluated by the CONUT score in advanced urothelial carcinoma (aUC) patients.

Materials & methods: Between 2003 and 2018, 201 aUC patients with cT4 and/or metastases to lymph nodes/distant organs were treated at a single cancer center. Of these, 185 were subjects of this retrospective study, with 16 excluded due to missing data. Clinical variables examined included age, sex, performance status (PS), body mass index (BMI), primary tumor site, lymph node/visceral metastasis, treatments before and after the diagnosis of aUC, hemoglobin, lactate dehydrogenase, alkaline phosphatase (ALP), C-reactive protein (CRP) and the CONUT score. Associations between clinical variables and overall survival (OS) were examined using the Cox proportional hazards model.

Results: The median (range) CONUT score was 2 (0-8). A higher CONUT score was associated with poorer PS (P < 0.001), lower BMI (P = 0.007), lower hemoglobin (P < 0.001), higher ALP (P = 0.005), and higher CRP (P < 0.001). During follow-up (median 12.3 months), 133 (72%) patients died. The median OS periods for patients with CONUT scores of 0 to 1, 2 to 3 and ≥4 were 19.3, 13.3, and 7.7 months, respectively (P < 0.001). Multivariate analysis revealed a higher CONUT score to be an independent and significant adverse prognostic factor (2-3 vs. 0-1, hazard ratio [HR] 1.57, P = 0.024; ≥4 vs 0-1, HR 2.94, P < 0.001), along with greater age (P = 0.003), poorer PS (P = 0.006), lower BMI (P = 0.008), primary tumor site in the upper tract (P = 0.004), higher CRP (P < 0.001), no usage of pembrolizumab (P = 0.005), and no curative treatment after the diagnosis of aUC (P = 0.035).

Conclusion: This study showed the prognostic significance of the CONUT score in aUC patients. The CONUT score indicates a patient's general condition from the aspect of nutritional status, and appears to be independent of PS as a prognosticator.

Keywords: Advanced urothelial carcinoma; Malnutrition; Prognostic factor; controlling nutritional status (CONUT) score.