The Controlling Nutritional Status Score Is a Significant Independent Predictor of Poor Prognosis in Patients With Malignant Pleural Mesothelioma

Our plain-English summary of The Controlling Nutritional Status Score Is a Significant Independent Predictor of Poor Prognosis in Patients With Malignant Pleural Mesothelioma, by S. Takamori, G. Toyokawa, K. Taguchi, et al (Clinical Lung Cancer, 2017).

The study

• Authors: S. Takamori, G. Toyokawa, K. Taguchi, M. Edagawa, S. Shimamatsu, R. Toyozawa, K. Nosaki, T. Seto, F. Hirai, M. Yamaguchi, F. Shoji, T. Okamoto, M. Takenoyama, Y. Ichinose
• Journal: Clinical Lung Cancer
• Published: 2017;18(4):e303-e313
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Malignant pleural mesothelioma (MPM) is a devastating neoplasm; however, some patients exhibit a good response to chemotherapy or multidisciplinary therapy, including surgery and chemotherapy. It is therefore important to discover the factors that can be used to select patients who will benefit from such treatment. Although the Controlling Nutritional Status (CONUT) score has been used to predict the prognosis in other types of malignancy, its utility in patients with MPM is unknown. The aim of this study was to clarify the clinical significance of the CONUT in patients with MPM.

Methods: The data of 83 patients, who were treated with surgery, chemotherapy, or multidisciplinary therapy, were analyzed in the present study. A cut-off CONUT score of 2 was used to classify all of the patients into low or high CONUT groups.

Results: Fifty-two of the 83 patients were classified into the low CONUT group. A high CONUT score was significantly correlated with chemotherapy alone (P = .011). The high CONUT group had significantly poorer overall survival (OS) (P < .001) and disease- or progression-free survival (DFS/PFS) (P < .001). The clinical stage and the CONUT score were found to be independent predictive factors for the OS: clinical stage, I/II and III/IV; P = .001 and CONUT score, ≥ 3 and ≤ 2; P = .011, respectively. The clinical stage and the CONUT score were also independent predictive factors for DFS/PFS: clinical stage, I/II and III/IV; P = .006 and CONUT score, ≥ 3 and ≤ 2; P = .013, respectively.

Conclusions: The CONUT score was an independent predictor of a poor prognosis in the patients with MPM. This score provides useful information for selecting patients who will benefit from the treatment.

Copyright © 2017 Elsevier Inc. All rights reserved.

In plain English

This retrospective study looked at 83 patients with malignant pleural mesothelioma diagnosed between January 1995 and December 2015 at the National Kyushu Cancer Center in Fukuoka, Japan, and treated with chemotherapy, surgery, or both. The authors tested whether the Controlling Nutritional Status (CONUT) score, calculated from blood albumin, cholesterol and lymphocyte count, was linked to survival. Asbestos was not studied as a factor. Exposure records existed for 33 patients, and 28 of them were exposed. Fifty-two patients had a low score (2 or less) and 31 a high score (3 or more). The high-score group had significantly poorer overall survival and poorer disease- or progression-free survival. In the multivariate analysis, where clinical stage was the only other factor with reported results, a high score remained linked to shorter overall survival (hazard ratio 1.92, 95% CI 1.17-3.11) and to recurrence or progression (hazard ratio 1.88, 95% CI 1.14-3.06). Advanced clinical stage was also linked. The authors concluded that a high CONUT score was associated with a poor prognosis. They noted that the study was retrospective and that the cut-off needs checking in other populations.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective study of patients treated at a single cancer center
• Who was studied: 110 patients were diagnosed with malignant pleural mesothelioma from January 1995 to December 2015 at the National Kyushu Cancer Center, Fukuoka, Japan. The authors excluded 21 who received best supportive care alone and 6 without cholesterol data, leaving 83. Of these, 56 had chemotherapy alone, 25 had surgery after chemotherapy and 2 had surgery alone. The median age was 59 years and 66 were male.
• Exposure: The factor studied was the pre-treatment CONUT nutritional score, based on serum albumin, cholesterol and lymphocyte count. Asbestos exposure was only recorded as a patient characteristic: records were available for 33 patients, 28 of whom were exposed. No fiber types were given.
• Main results:
  • 52 of the 83 patients were in the low CONUT group (score 2 or less) and 31 were in the high group (score 3 or more).
  • A low CONUT score was significantly associated with surgical treatment (P = .011). Among surgery patients, 22 were low and 5 high; among chemotherapy patients, 30 were low and 26 high.
  • In the whole group, the low CONUT group had significantly better overall survival (P less than .001).
  • In the multivariate analysis of overall survival, a CONUT score of 3 or more versus 2 or less had a hazard ratio of 1.92 (95% CI 1.17-3.11, P = .011). Clinical stage was the only other factor with multivariate results shown in the table.
  • Clinical stage was also an independent factor for overall survival. Stage III/IV versus I/II had a hazard ratio of 2.22 (95% CI 1.36-3.69, P = .001) in the multivariate analysis.
  • The low CONUT group had significantly better disease- or progression-free survival (P less than .001). In the multivariate analysis, a high score had a hazard ratio of 1.88 (95% CI 1.14-3.06, P = .013).
  • For predicting 1-year survival, the CONUT score had 73.1% sensitivity and 64.0% specificity (area under the curve 0.772).
  • Among the 27 patients who had surgery, the low CONUT group had significantly better overall survival (P = .017) and disease-free survival (P = .016). In the multivariate analysis for this subgroup, a high score had a hazard ratio of 4.86 (95% CI 1.16-19.14, P = .032).
  • Among the 56 patients who had chemotherapy alone, the low CONUT group had significantly better overall survival (P = .024) and progression-free survival (P = .016) on survival curves. However, the univariate and multivariate analyses in this subgroup found no significant prognostic factors. The table shows a hazard ratio of 1.50 (95% CI 0.85-2.67, P = .162) for a high CONUT score.
• The authors' conclusion: The authors concluded that a high CONUT score was associated with a poor prognosis in patients with malignant pleural mesothelioma. They said it may help select patients who will benefit from chemotherapy or multidisciplinary therapy, and that the findings should be evaluated in further prospective studies.
• Limitations the authors state:
  • The study was retrospective, so the authors said it is still difficult to assert that CONUT is useful for selecting patients who will benefit from treatment.
  • The cut-off CONUT value needs to be validated in other populations.
  • It is unclear whether CONUT is the most useful prognostic index compared with others, such as the prognostic nutritional index or the neutrophil-lymphocyte ratio.
  • The chemotherapy-alone subgroup was heterogeneous: it included some stage I/II patients who did not have surgery because of complications or social reasons. This may explain why its multivariate analysis did not reach significance.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Prognosis, Pleural Mesothelioma, Neoplasm, Chemotherapy, Overall Survival, Progression-Free Survival.

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• Body composition and nutritional status in malignant pleural mesothelioma: implications for activity levels and quality of life — E. Jeffery, Y.C.G. Lee, et al. (2019)
• Serum albumin as a significant prognostic factor in patients with malignant pleural mesothelioma — Z.H. Yao, G.Y. Tian, et al. (2014)
• Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial — C. Baldwin, A. Spiro, et al. (2011)
• The C-Reactive Protein/Albumin Ratio is a Novel Significant Prognostic Factor in Patients with Malignant Pleural Mesothelioma: A Retrospective Multi-institutional Study — S. Takamori, G. Toyokawa, et al. (2018)
• Programmed cell death 1 ligand 1 (PD-L1) expression is associated with poor prognosis of malignant pleural mesothelioma patients with good performance status — E. Rrapaj, L. Giacometti, et al. (2021)

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