Purpose

This study aims to evaluate the prognostic value of controlling nutritional status (CONUT) score in determining the prognosis of patients with hepatocellular carcinoma (HCC) treated with conventional transcatheter arterial chemoembolization (cTACE).

Methods

This study retrospectively analyzed 936 patients who underwent cTACE for HCC between January 2012 and December 2018, and divided them into two groups based on their CONUT score. To balance the bias in baseline characteristics, propensity score matched (PSM) analysis was conducted. The Kaplan–Meier method was used to establish a cumulative survival curve, and the log-rank test was employed to determine differences in overall survival (OS) and progression-free survival (PFS) among the CONUT score groups. Furthermore, the Cox proportional hazard model was employed to assess the correlation between CONUT score and OS and PFS, whereby hazard ratios (HRs) and 95% confidence intervals (95% CIs) were computed.

Results

Before PSM, the median OS for the low (≤ 3) and high (≥ 4) CONUT group (558 vs. 378 patients) was 21.7 and 15.6 months, respectively, and the median PFS was 5.7 and 5 months. Following PSM, both the low and high CONUT score groups comprised 142 patients. The low CONUT score group exhibited a significantly longer OS compared to the high CONUT score group, as determined by the log-rank test (median OS 22.2 vs. 17.0 months, P = 0.014). No significant association was observed between CONUT group and PFS (median PFS 6.4 vs. 4.7 months, log-rank test, P = 0.121). Cox proportional hazard regression analysis revealed that a CONUT score of ≥ 4 was an independent risk factor for OS in patients with HCC who underwent cTACE (HR = 1.361; 95% CI: 1.047–1.771; P = 0.022). These findings were consistent across most subgroup analyses.

Conclusion

A high CONUT score has been found to be a prognostic factor for poorer OS in patients with HCC who underwent cTACE.

Level of Evidence

Level 3, Non-randomized controlled cohort.

中文翻译：

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控制营养状况 (CONUT) 评分与接受传统经导管动脉化疗栓塞治疗的肝细胞癌患者的总体生存率相关：倾向评分匹配分析

目的

本研究旨在评估控制营养状况（CONUT）评分在确定接受传统经导管动脉化疗栓塞（cTACE）治疗的肝细胞癌（HCC）患者预后中的预后价值。

方法

该研究回顾性分析了2012年1月至2018年12月期间接受cTACE治疗HCC的936例患者，并根据CONUT评分将其分为两组。为了平衡基线特征的偏差，进行了倾向评分匹配（PSM）分析。采用Kaplan-Meier法建立累积生存曲线，并采用时序检验确定CONUT评分组间总生存期（OS）和无进展生存期（PFS）的差异。此外，采用 Cox 比例风险模型来评估 CONUT 评分与 OS 和 PFS 之间的相关性，从而计算风险比 (HR) 和 95% 置信区间 (95% CI)。

结果

PSM 之前，低（≤ 3）和高（≥ 4）CONUT 组（558 例患者与378 例患者）的中位 OS 分别为 21.7 个月和 15.6 个月，中位 PFS 分别为 5.7 个月和 5 个月。 PSM 后，低 CONUT 评分组和高 CONUT 评分组均包含 142 名患者。根据对数秩检验确定，低 CONUT 评分组的 OS 明显长于高 CONUT 评分组（中位 OS 22.2 个月与17.0 个月，P  = 0.014）。 CONUT 组与 PFS 之间未观察到显着关联（中位 PFS 6.4 个月与4.7 个月，对数秩检验，P  = 0.121）。 Cox比例风险回归分析显示，CONUT评分≥4是接受cTACE的HCC患者OS的独立危险因素（HR = 1.361；95% CI：1.047–1.771；P  = 0.022）。这些发现在大多数亚组分析中都是一致的。

结论

研究发现，高 CONUT 评分是接受 cTACE 的 HCC 患者 OS 较差的一个预后因素。

证据水平

3 级，非随机对照队列。