Preoperative controlling nutritional status score predicts systemic disease recurrence in patients with resectable biliary tract cancer. Issue 2 (February 2023)

• Record Type: Journal Article
• Authors: Mito, Masato; Sakata, Jun; Hirose, Yuki; Abe, Shun; Saito, Seiji; Miura, Yohei; Ishikawa, Hirosuke; Miura, Kohei; Takizawa, Kazuyasu; Ichikawa, Hiroshi; Shimada, Yoshifumi; Kobayashi, Takashi; Wakai, Toshifumi
• Is Part Of: European journal of surgical oncology. Volume 49:Issue 2(2023)
• Page Start: 399
• Page End: 409
• Publication Date: 2023-02
• Subjects: Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2022.11.003
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: This study aimed to evaluate the association between the preoperative Controlling Nutritional Status (CONUT) score, survival outcomes, and recurrence pattern in patients with resectable biliary tract cancer (BTC). Methods: A total of 224 BTC patients (gallbladder, n = 69; intrahepatic bile ducts, n = 26; perihilar bile ducts, n = 72; distal bile duct, n = 57) who underwent surgery with curative intent were enrolled. The best cutoff point of the preoperative CONUT score in discriminating survival was determined using χ 2 scores. The sites of recurrence were subclassified as locoregional or distant. Results: Patients were subdivided into the CONUT-low (score ≤ 3, n = 156) and the CONUT-high (score > 3; n = 68) groups. In-hospital mortality occurred more frequently in the CONUT-high group than in the CONUT-low group (7.4% vs. 1.3%; p = 0.028). A high preoperative CONUT score was independently associated with worse overall survival (hazard ratio [HR] 1.906, p = 0.001), worse disease-specific survival (HR 1.840, p = 0.006), and worse recurrence-free survival (HR 1.680, p = 0.005). Recurrence developed in 110 (49.1%) patients. A high preoperative CONUT score was independently associated with a higher risk of distant recurrence (HR 2.245, p = 0.001), but not locoregional recurrence. The incidences of distant recurrence at 5 years were 55.4% and 34.2% in the CONUT-high and CONUT-low groups, respectively (p = 0.001). Conclusions: The preoperative CONUT score independently predicts survival outcomes and may serve as a surrogate marker of aggressive systemic disease recurrence in patients with resectable BTC. Highlights: A high preoperative CONUT score is closely associated with not only poor long-term outcomes but also a unique distant recurrence pattern in patients with resectable biliary tract cancer. The preoperative CONUT score predicts the prognosis and may serve as a surrogate marker of aggressive recurrence of systemic disease. Assessment of preoperative immune-nutritional status according to the CONUT score may aid in effective therapeutic decision-making for resectable biliary tract cancer.