Skip to main content

Advertisement

SpringerLink
Log in

CONUT: a novel independent predictive score for colorectal cancer patients undergoing potentially curative resection

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Controlling nutritional status (CONUT) score, calculated from serum albumin and total cholesterol concentrations and total lymphocyte count, is reportedly valuable for nutritional assessment. This study investigated whether CONUT score was predictive of outcomes in colorectal cancer (CRC) patients undergoing surgical resection.

Methods

Preoperative CONUT scores were retrospectively evaluated in 417 CRC patients who underwent potentially curative resection at Kumamoto University Hospital from March 2005 to August 2014. Patients were divided into four groups based on preoperative CONUT scores: normal, light, moderate, and severe. The associations of CONUT score with clinicopathological factors, patient survival, and postoperative complications were examined.

Results

CONUT score correlated significantly with age (P < 0.001), body mass index (P = 0.005), carcinoembryonic antigen (P = 0.002), and carbohydrate antigen 19-9 (P = 0.005) concentrations. Overall survival (OS) rate was significantly lower in patients with moderate/severe than light or normal CONUT scores. CONUT score was independently prognostic of OS [moderate/severe vs. normal, hazard ratio = 5.92, 95 % confidence interval (CI) 2.30–14.92; P < 0.001)]. Patients with moderate/severe CONUT scores were at greater risk for complications, especially for severe complications. Multivariate analysis showed that CONUT score was independently predictive of severe complications (moderate/severe vs. normal, odds ratio = 4.51, 95 % CI 1.89–10.74; P < 0.001).

Conclusions

CONUT score may predict survival and postoperative severe complications in CRC patients undergoing potentially curative resection. Management of CRC patients may need consideration of host nutritional status.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bistrian BR, Blackburn GL, Vitale J, Cochran D, Naylor J (1976) Prevalence of malnutrition in general medical patients. JAMA 235:1567–1570

    Article  CAS  PubMed  Google Scholar 

  2. Gupta D, Lammersfeld CA, Vashi PG, Burrows J, Lis CG, Grutsch JF (2005) Prognostic significance of subjective global assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr 59:35–40

    Article  CAS  PubMed  Google Scholar 

  3. Mohri Y, Inoue Y, Tanaka K, Hiro J, Uchida K, Kusunoki M (2013) Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J Surg 37:2688–2692

    Article  PubMed  Google Scholar 

  4. Park JH, Watt DG, Roxburgh CS, Horgan PG, McMillan DC (2015) Colorectal cancer, systemic inflammation, and outcome: staging the tumor and staging the host. Ann Surg 263(2):326–336

    Article  Google Scholar 

  5. Ignacio de Ulibarri J, Gonzalez-Madrono A, de Villar NG, Gonzalez P, Gonzalez B, Mancha A, Rodriguez F, Fernandez G (2005) CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 20:38–45

    CAS  PubMed  Google Scholar 

  6. The Japanese Society for Cancer of the Colon and Rectum. JSCCR Guidelines 2005 for the treatment of colorectal cancer. Tokyo: Kanehara & Co, Ltd.

  7. The Japanese Society for Cancer of the Colon and Rectum. JSCCR Guidelines 2010 for the treatment of colorectal cancer. Tokyo: Kanehara & Co, Ltd

  8. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishiguro M, Kanemitsu Y et al (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17:1–29

    Article  PubMed  Google Scholar 

  9. Sobin LH, Gospodarowitz MK, Wittekind CH (2009) TNM classification of malignant tumours. 7th ed. Wiley-Blackwell, New York

    Google Scholar 

  10. Cabre M, Ferreiro C, Arus M, Roca M, Palomera E, Serra-Prat M (2015) Evaluation of CONUT for clinical malnutrition detection and short-term prognostic assessment in hospitalized elderly people. J Nutr Health Aging 19:729–733

    Article  CAS  PubMed  Google Scholar 

  11. Tarantino I, Warschkow R, Worni M, Merati-Kashani K, Koberle D, Schmied BM, Muller SA, Steffen T, Cerny T, Guller U (2012) Elevated preoperative CEA is associated with worse survival in stage I-III rectal cancer patients. Br J Cancer 107:266–274

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Stiksma J, Grootendorst DC, van der Linden PW (2014) CA 19-9 as a marker in addition to CEA to monitor colorectal cancer. Clin Colorectal Cancer 13:239–244

    Article  PubMed  Google Scholar 

  13. Fukushima K, Ueno Y, Kawagishi N, Kondo Y, Inoue J, Kakazu E, Ninomiya M, Wakui Y, Saito N, Satomi S, Shimosegawa T (2014) The nutritional index ‘CONUT’ is useful for predicting long-term prognosis of patients with end-stage liver diseases. Tohoku J Exp Med 224:215–219

    Article  Google Scholar 

  14. Elinav E, Nowarski R, Thaiss CA, Hu B, Jin C, Flavell RA (2013) Inflammation-induced cancer: crosstalk between tumours, immune cells and microorganisms. Nat Rev Cancer 13:759–771

    Article  CAS  PubMed  Google Scholar 

  15. Renfro LA, Loupakis F, Adams RA, Seymour MT, Schmoll HJ, Douillard JY, Hurwitz H, Fuchs CS, Diaz-Rubio E, Porschen R, Tournigand C, Chibaudel B et al (2015) Body mass index is prognostic in metastatic colorectal cancer: pooled analysis of patients from first-line clinical trials in the ARCAD database. J Clin Oncol 34(2):144–150

    Article  PubMed  PubMed Central  Google Scholar 

  16. Moon HG, YT J, Jeong CY, Jung EJ, Lee YJ, Hong SC, Ha WS, Park ST, Choi SK (2008) Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol 15:1918–1922

    Article  PubMed  Google Scholar 

  17. Miyamoto Y, Baba Y, Sakamoto Y, Ohuchi M, Tokunaga R, Kurashige J, Hiyoshi Y, Iwagami S, Yoshida N, Watanabe M, Baba H (2015) Negative impact of skeletal muscle loss after systemic chemotherapy in patients with unresectable colorectal cancer. PLoS One 10 e0129742

  18. Toyokawa TKN, Shibutani M, Sakurai K, Nagahara H, Tanaka H, Muguruma K, Ohtani H, Yashiro M, Maeda K, Ohira M, Hirakawa K (2015) The pretreatment controlling nutritional status (CONUT) score as an independent prognostic factor in patients with clinical stage I-III esophageal squamous cell carcinoma. Ann Oncol 26(Supplement 4):iv1–iv100

    Google Scholar 

  19. Iseki Y, Shibutani M, Maeda K, Nagahara H, Ohtani H, Sugano K, Ikeya T, Muguruma K, Tanaka H, Toyokawa T, Sakurai K, Hirakawa K (2015) Impact of the preoperative controlling nutritional status (CONUT) score on the survival after curative surgery for colorectal cancer. PLoS One 10 e0132488

  20. Cengiz O, Kocer B, Surmeli S, Santicky MJ, Soran A (2006) Are pretreatment serum albumin and cholesterol levels prognostic tools in patients with colorectal carcinoma? Med Sci Monit 12:CR240–CR247

    CAS  PubMed  Google Scholar 

  21. Peters SJ, Vanhaecke T, Papeleu P, Rogiers V, Haagsman HP, van Norren K (2010) Co-culture of primary rat hepatocytes with rat liver epithelial cells enhances interleukin-6-induced acute-phase protein response. Cell Tissue Res 340:451–457

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Honda H, Qureshi AR, Heimburger O, Barany P, Wang K, Pecoits-Filho R, Stenvinkel P, Lindholm B (2006) Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD. Am J Kidney Dis 47:139–148

    Article  CAS  PubMed  Google Scholar 

  23. Sonoda A, Ohnishi S, Nakao S, Iwashita Y, Hashimoto N, Ishida K, Kondo Y, Ishitsuka Y, Irie T (2015) Factors affecting serum albumin in the perioperative period of colorectal surgery: a retrospective study. BMC Res Notes 8:638

    Article  PubMed  PubMed Central  Google Scholar 

  24. Domenicali M, Baldassarre M, Giannone FA, Naldi M, Mastroroberto M, Biselli M, Laggetta M, Patrono D, Bertucci C, Bernardi M, Caraceni P (2014) Posttranscriptional changes of serum albumin: clinical and prognostic significance in hospitalized patients with cirrhosis. Hepatology 60:1851–1860

    Article  CAS  PubMed  Google Scholar 

  25. Okuyama H, Ichikawa Y, Sun Y, Hamazaki T, Lands WE (2007) Cancer and all-cause mortalities are lower in the higher total cholesterol groups among general populations. World Rev Nutr Diet 96:37–54

    PubMed  Google Scholar 

  26. Kreger BE, Anderson KM, Schatzkin A, Splansky GL (1992) Serum cholesterol level, body mass index, and the risk of colon cancer. The Framingham study. Cancer 70:1038–1043

    Article  CAS  PubMed  Google Scholar 

  27. de Martino M, Leitner CV, Seemann C, Hofbauer SL, Lucca I, Haitel A, Shariat SF, Klatte T (2015) Preoperative serum cholesterol is an independent prognostic factor for patients with renal cell carcinoma (RCC). BJU Int 115:397–404

    Article  PubMed  Google Scholar 

  28. Niendorf A, Nagele H, Gerding D, Meyer-Pannwitt U, Gebhardt A (1995) Increased LDL receptor mRNA expression in colon cancer is correlated with a rise in plasma cholesterol levels after curative surgery. Int J Cancer 61:461–464

    Article  CAS  PubMed  Google Scholar 

  29. Cardwell CR, Hicks BM, Hughes C, Murray LJ (2014) Statin use after colorectal cancer diagnosis and survival: a population-based cohort study. J Clin Oncol 32:3177–3183

    Article  PubMed  Google Scholar 

  30. Nielsen SF, Nordestgaard BG, Bojesen SE (2012) Statin use and reduced cancer-related mortality. N Engl J Med 367:1792–1802

    Article  CAS  PubMed  Google Scholar 

  31. Liang L, Zhu J, Jia H, Huang L, Li D, Li Q, Li X (2016) Predictive value of pretreatment lymphocyte count in stage II colorectal cancer and in high-risk patients treated with adjuvant chemotherapy. Oncotarget 7(1):1014–1028

    PubMed  Google Scholar 

  32. Network CGA (2012) Comprehensive molecular characterization of human colon and rectal cancer. Nature 487:330–337

    Article  Google Scholar 

  33. Moyes LH, Leitch EF, McKee RF, Anderson JH, Horgan PG, McMillan DC (2009) Preoperative systemic inflammation predicts postoperative infectious complications in patients undergoing curative resection for colorectal cancer. Br J Cancer 100:1236–1239

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Andreyev HJ, Norman AR, Oates J, Cunningham D (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 34:503–509

    Article  CAS  PubMed  Google Scholar 

  35. Fearon KC, Voss AC, Hustead DS (2006) Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr 83:1345–1350

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Japan

    Ryuma Tokunaga, Yasuo Sakamoto, Shigeki Nakagawa, Mayuko Ohuchi, Daisuke Izumi, Keisuke Kosumi, Katsunobu Taki, Takaaki Higashi, Yuji Miyamoto, Naoya Yoshida & Hideo Baba

  2. Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Eiji Oki

  3. Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Tokyo, Japan

    Masayuki Watanabe

Authors
  1. Ryuma Tokunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuo Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shigeki Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mayuko Ohuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daisuke Izumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keisuke Kosumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Katsunobu Taki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takaaki Higashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuji Miyamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Naoya Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Eiji Oki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Masayuki Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hideo Baba
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideo Baba.

Ethics declarations

Use of the clinical data was approved by the human ethics review committee of the graduate school of medicine, Kumamoto University.

Conflict of interest

The authors declare that they have no conflict of interest.

Source of funding

No financial support was received for this study.

Additional information

Presentation

We have not presented this study anywhere.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tokunaga, R., Sakamoto, Y., Nakagawa, S. et al. CONUT: a novel independent predictive score for colorectal cancer patients undergoing potentially curative resection. Int J Colorectal Dis 32, 99–106 (2017). https://doi.org/10.1007/s00384-016-2668-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-016-2668-5

Keywords

Search

Navigation