Controlling Nutritional Status score does not predict patients' overall survival or hepatocellular carcinoma recurrence after deceased donor liver transplantation.
Controlling Nutritional Status
hepatocellular carcinoma
inflammation
liver transplantation
malnutrition
tumor recurrence
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
01
04
2019
revised:
23
12
2019
accepted:
07
01
2020
pubmed:
21
1
2020
medline:
24
6
2021
entrez:
21
1
2020
Statut:
ppublish
Résumé
The Controlling Nutritional Status (CONUT) score is a newly developed laboratory-derived immunonutritional score which has been validated as prognostic marker for survival and tumor recurrence in surgically treated patients with various tumor types, including hepatocellular carcinoma (HCC). The aim of the present study was to test the CONUT score performance in HCC patients treated with liver transplantation (LT). A retrospective study on a bi-centers cohort of 280 HCC patients submitted to LT between 2006 and 2017 was performed. Indication to LT was limited to Milan criteria or UCSF criteria, defined by preoperative imaging. Median pre-LT CONUT score was 5 (interquartile range 3-7). Overall patients' survival at 1, 3, and 5 years was 84%, 76.6%, and 68.3%, respectively. Multivariate analysis showed that HCC recurrence (hazard ratio [HR] = 1.987, P = .012] and pre-LT neutrophil to lymphocyte ratio (NLR) (HR = 1.064, P = .003) were independent risk factors for reduced survival. Cumulative incidence of HCC recurrence at 1, 3, and 5 years was 5.1%, 11.5%, and 15.5%, respectively. Pre-LT platelet-to-lymphocyte ratio (PLR) (subdistribution hazard ratio [SHR] = 1.086, P = .044], tumor max diameter (SHR = 1.695, P < .001), and bilobar tumor distribution (SHR = 6.892, P = .006) were independent risk factors for tumor recurrence. The CONUT score did not show any prognostic value. The CONUT score did not predict poor survival or tumor recurrence in LT recipients.
Sections du résumé
BACKGROUND
The Controlling Nutritional Status (CONUT) score is a newly developed laboratory-derived immunonutritional score which has been validated as prognostic marker for survival and tumor recurrence in surgically treated patients with various tumor types, including hepatocellular carcinoma (HCC). The aim of the present study was to test the CONUT score performance in HCC patients treated with liver transplantation (LT).
METHODS
A retrospective study on a bi-centers cohort of 280 HCC patients submitted to LT between 2006 and 2017 was performed. Indication to LT was limited to Milan criteria or UCSF criteria, defined by preoperative imaging.
RESULTS
Median pre-LT CONUT score was 5 (interquartile range 3-7). Overall patients' survival at 1, 3, and 5 years was 84%, 76.6%, and 68.3%, respectively. Multivariate analysis showed that HCC recurrence (hazard ratio [HR] = 1.987, P = .012] and pre-LT neutrophil to lymphocyte ratio (NLR) (HR = 1.064, P = .003) were independent risk factors for reduced survival. Cumulative incidence of HCC recurrence at 1, 3, and 5 years was 5.1%, 11.5%, and 15.5%, respectively. Pre-LT platelet-to-lymphocyte ratio (PLR) (subdistribution hazard ratio [SHR] = 1.086, P = .044], tumor max diameter (SHR = 1.695, P < .001), and bilobar tumor distribution (SHR = 6.892, P = .006) were independent risk factors for tumor recurrence. The CONUT score did not show any prognostic value.
CONCLUSIONS
The CONUT score did not predict poor survival or tumor recurrence in LT recipients.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13786Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Takagi K, Yagi T, Umeda Y, et al. Preoperative controlling nutritional status (CONUT) score for assessment of prognosis following hepatectomy for hepatocellular carcinoma. World J Surg. 2017;41(9):2353-2360.
Harimoto N, Yoshizumi T, Sakata K, et al. Prognostic significance of preoperative controlling nutritional status (CONUT) score in patients undergoing hepatic resection for hepatocellular carcinoma. World J Surg. 2017;41(11):2805-2812.
Iseki Y, Shibutani M, Maeda K, et al. Impact of the preoperative controlling nutritional status (CONUT) score on the survival after curative surgery for colorectal cancer. PLoS ONE. 2015;10(7):e0132488.
Toyokawa T, Kubo N, Tamura T, et al. The pretreatment controlling nutritional status (CONUT) score is an independent prognostic factor in patients with resectable thoracic esophageal squamous cell carcinoma: results from a retrospective study. BMC Cancer. 2016;6(16):722.
Toyokawa G, Kozuma Y, Matsubara T, et al. Prognostic impact of controlling nutritional status score in resected lung squamous cell carcinoma. J Thorac Dis. 2017;9(9):2942-2951.
Kuroda H, Sawayama H, Kurashige J, et al. Controlling Nutritional Status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection. Gastric Cancer. 2018;21(2):204-212.
Fukushima K, Ueno Y, Kawagishi N, et al. The nutritional index 'CONUT' is useful for predicting long-term prognosis of patients with end-stage liver diseases. Tohoku J Exp Med. 2011;224(3):215-219.
Kallwitz ER. Sarcopenia and liver transplant: the relevance of too little muscle mass. World J Gastroenterol. 2015;21(39):10982-10993.
Cescon M, Bertuzzo VR, Ercolani G, et al. Liver transplantation for hepatocellular carcinoma: role of inflammatory and immunological state on recurrence and prognosis. World J Gastroenterol. 2013;19(48):9174-9182.
Ignacio de Ulíbarri J, Gonzalez-Madrono A, de Villar NG, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20(1):38-45.
European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908-943.
Mazurak VC, Tandon P, Montano-Loza AJ. Nutrition and the transplant candidate. Liver Transpl. 2017;23:1451-1464.
Sinclair M, Gow PJ, Grossmann M, Angus PW. Review article: sarcopenia in cirrhosis-aetiology, implications and potential therapeutic interventions. Aliment Pharmacol Ther. 2016;43(7):765-777.
Tandon P, Raman M, Mourtzakis M, Merli M. A practical approach to nutritional screening and assessment in cirrhosis. Hepatology. 2017;65:1044-1057.
Nishikawa H, Shiraki M, Hiramatsu A, Moriya K, Hino K, Nishiguchi S. Japan Society of Hepatology guidelines for sarcopenia in liver disease (1st edition): Recommendation from the working group for creation of sarcopenia assessment criteria. Hepatol Res. 2016;46(10):951-963.
Harimoto N, Yoshizumi T, Inokuchi S, et al. Prognostic significance of preoperative controlling nutritional status (CONUT) score in patients undergoing hepatic resection for hepatocellular carcinoma: a multi-institutional study. Ann Surg Oncol. 2018;25(11):3316-3323.
Hammad A, Kaido T, Aliyev V, Mandato C, Uemoto S. Nutritional therapy in liver transplantation. Nutrients. 2017;9(10):1126.
Jeon JY, Wang HJ, Ock SY, et al. Newly developed sarcopenia as a prognostic factor for survival in patients who underwent liver transplantation. PLoS ONE. 2015;30(10):e0143966.
Anastácio LR, Ferreira SC. Nutrition, dietary intake, and eating behavior after liver transplantation. Curr Opin Clin Nutr Metab Care. 2018;21(5):381-387.
Pravisani R, Soyama A, Isola M, et al. Chronological changes in skeletal muscle mass following living-donor liver transplantation: An analysis of the predictive factors for long-term post-transplant low muscularity. Clin Transplant. 2019;33(4):e13495.
Zheng J, Cai J, Li H, et al. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as prognostic predictors for hepatocellular carcinoma patients with various treatments: a meta-analysis and systematic review. Cell Physiol Biochem. 2017;44(3):967-981.
Lai Q, Melandro F, Larghi Laureiro Z, et al. Platelet-to-lymphocyte ratio in the setting of liver transplantation for hepatocellular cancer: a systematic review and meta-analysis. World J Gastroenterol. 2018;24:1658-1665.
Lai Q, Castro Santa E, Rico Juri JM, Pinheiro RS, Lerut J. Neutrophil and platelet-to-lymphocyte ratio as new predictors of dropout and recurrence after liver transplantation for hepatocellular cancer. Transpl Int. 2014;27(1):32-41.
Lee EC, Kim SH, Shim JR, Park SJ. Small-for-size grafts increase recurrence of hepatocellular carcinoma in liver transplantation beyond milan criteria. Liver Transpl. 2018;24(1):35-43.
Hayashi H, Takamura H, Ohbatake Y, et al. Postoperative changes in neutrophil-to-lymphocyte ratio and platelet count: A simple prognostic predictor for adult-to-adult living donor liver transplantation. Asian J Surg. 2018;41(4):341-348.