Cancer Management and Research (Jan 2020)
High Preoperative Controlling Nutritional Status Score Predicts a Poor Prognosis in Patients with Localized Upper Tract Urothelial Cancer: A Propensity Score Matching Study in a Large Chinese Center
Abstract
Zhengqing Bao, 1–3,* Yifan Li, 4,* Bao Guan, 1–3,* Gengyan Xiong, 1–3 Lei Zhang, 1–3 Qi Tang, 1–3 Tianyu Wang, 1–3 Xuesong Li, 1–3 Dong Fang, 1–3, 5 Liqun Zhou 1–3 1Department of Urology, Peking University First Hospital, Beijing 100034, People’s Republic of China; 2Institute of Urology, Peking University, Beijing 100034, People’s Republic of China; 3National Urological Cancer Center, Beijing 100034, People’s Republic of China; 4Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225000, People’s Republic of China; 5Andrology Center, Peking University First Hospital, Beijing 100034, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dong Fang; Liqun ZhouDepartment of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku StXicheng District, Beijing 100034, People’s Republic of ChinaTel +86-10-83575006Fax +86-10-66551726Email [email protected]; [email protected]: The aim of this study was to elucidate the prognostic value of the preoperative controlling nutritional status (CONUT) score, a new index based on the total lymphocyte count, serum albumin concentration and total cholesterol concentration, in patients with localized upper tract urothelial cancer (UTUC) after radical nephroureterectomy (RNU) using propensity score matching (PSM) analysis.Methods: We retrospectively reviewed 908 consecutive patients with localized UTUC who underwent RNU between 1999 and 2015. Patients were divided into two groups according to the optimal cutoff value of the preoperative CONUT score. Relationships between the CONUT score with clinicopathological characteristics, overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were analyzed before and after 1:1 PSM.Results: A high preoperative CONUT score was significantly correlated with older age, low body mass index (BMI), poor American Statistical Association (ASA) score, advanced pathological T stage, and tumor squamous or glandular differentiation (all p< 0.05). Kaplan-Meier curves showed poor OS, CSS, and DFS for patients with a high CONUT score before and after PSM (all p< 0.001). Furthermore, multivariate analyses revealed that a high preoperative CONUT score was an independent risk factor for poor DFS (hazard ratio [HR] 1.418, 95% confidence interval [CI] 1.132– 1.776, p=0.002) before PSM and an independent risk factor for poor DFS (HR 1.333, 95% CI 1.010– 1.760, p=0.042) and OS (HR 1.459, 95% CI 1.010– 2.107, p=0.044) after PSM.Conclusion: A high preoperative CONUT score is an independent prognostic factor for poor outcomes in patients with localized UTUC after RNU.Keywords: controlling nutritional status score, upper tract urothelial carcinoma, propensity score matching, prognosis
