The usefulness of pretreatment controlling nutritional status score for predicting recurrence in patients with esophageal squamous cell carcinoma undergoing neoadjuvant immunochemotherapy: A real-world study

by Selleckchem | Apr 28 2023

Background: The controlling nutritional status (CONUT) score, as an immune-nutritional index, has been reported to be related to prognosis in several cancers. Neoadjuvant immunochemotherapy (nICT) is an emerging pattern for cancer treatment in recent years. However, the usefulness of CONUT in esophageal squamous cell carcinoma (ESCC) with nICT has not been reported so far. This study attempted to clarify the usefulness of CONUT in predicting disease-free survival (DFS) in ESCC with nICT.

Methods: Two hundred sixteen ESCC patients receiving nICT between 2019 and 2021 were retrospectively enrolled. Based on CONUT, the patients were divided into two groups: low groups (score ≤ 2) and high (score ≥ 3) groups. The relationships between CONUT and clinical characteristics were estimated. Cox regression analyses with hazard ratios (HRs) and 95% confidence intervals (CIs) were also performed to evaluate the prognostic factors of DFS.

Results: Fifty-nine (27.3%) patients achieved pathologic complete response (pCR), and 30 (13.9%) cases had a recurrence. There were 150 cases (69.4%) in low CONUT group and 66 cases (30.6%) in high CONUT group, respectively. The results revealed that vessel invasion (P = 0.037), postoperative pneumonia (P = 0.001), advanced ypT stage (P = 0.011), cTNM stage (P = 0.007), and ypTNM stage (P < 0.001) were significantly related to patients with a high CONUT score. A high pCR rate was found in patients with a low CONUT score (33.3% vs. 13.6%, P = 0.003), and a high recurrence rate was found in patients with a high CONUT score (24.2% vs. 9.3%, P = 0.004), respectively. Patients with a low CONUT score had a better 1-year DFS than those with a high CONUT score (90.7% vs. 75.8%, P = 0.004). Multivariate analyses indicated that the pretreatment CONUT score was an independent predictor regarding DFS (HR = 2.221, 95% CI: 1.067-4.625, P = 0.033).

Conclusion: A better response and a lower recurrence were found in ESCC patients with a lower pretreatment CONUT. As a useful index for immune-nutritional status, the CONUT might be a reliable prognostic indicator in ESCC patients with nICT.

Comments：

The study aimed to investigate the potential of the controlling nutritional status (CONUT) score, an immune-nutritional index, in predicting disease-free survival (DFS) in esophageal squamous cell carcinoma (ESCC) patients undergoing neoadjuvant immunochemotherapy (nICT). A total of 216 ESCC patients who received nICT between 2019 and 2021 were retrospectively enrolled in the study. The patients were divided into two groups based on their CONUT score: low groups (score ≤ 2) and high groups (score ≥ 3). Cox regression analyses were performed to evaluate the prognostic factors of DFS.

The study found that a high pretreatment CONUT score was significantly associated with vessel invasion, postoperative pneumonia, advanced ypT stage, cTNM stage, and ypTNM stage. Patients with a low pretreatment CONUT score had a better response to treatment, with a higher pathologic complete response (pCR) rate and a lower recurrence rate. In contrast, patients with a high pretreatment CONUT score had a higher recurrence rate. Additionally, patients with a low pretreatment CONUT score had a better 1-year DFS than those with a high CONUT score. Multivariate analyses revealed that the pretreatment CONUT score was an independent predictor of DFS.

In conclusion, the study suggests that the CONUT score may serve as a reliable prognostic indicator in ESCC patients undergoing nICT. A low pretreatment CONUT score is associated with a better response to treatment and a lower recurrence rate. Therefore, assessing the immune-nutritional status of patients using the CONUT score may help identify patients who may benefit from more aggressive treatment or closer follow-up.