A clinical database with a consecutive patient cohort was reviewed to determine whether the preoperative CONUT score effectively predicted postoperative complications for GC patients who underwent laparoscopic gastrectomy. The findings showed that the preoperative CONUT score served as a significant predictor of short-term outcomes for patients with GC.
The prognosis of cancer is not only related to tumour factors but is also associated with patient status, especially nutritional status29, 30. The CONUT score was originally proposed by Ignacio de Ulíbarri J in 200514 as an integrated scale for assessing the nutritional status of inpatients. The CONUT score is calculated by parameters that are easy to acquire, including serum albumin, the total lymphocyte count and cholesterol level, which reflect protein reserves, immune function and lipid metabolism, respectively. The condition of hypoalbuminemia suggests that the body is in a stage of hypercatabolism, which is prevalent among cancer patients, especially with cachexia. Lymphocytes are important cellular components of the human immune response system that help to fight tumours by inhibiting cancer cell proliferation, invasion and migration31. Saka et al32 reported that the exhaustion of T cells was closely associated with poor prognosis in cancer. Cholesterol plays a vital role in modulating the activity of membrane proteins, which may be associated with the initiation and progression of cancer and interactions with the immune system. Yang et al33 reported that cholesterol inhibited hepatocellular carcinoma invasion and metastasis by promoting CD44 localization in lipid rafts. Therefore, this assessment scale is able to provide an integrated, rapid and low-cost nutritional evaluation of patients.
Previous studies have proposed diversified prognostic predictors for GC, such as the PNI6, 19, 34–37, PLR8, 38, 39, etc. These nutrition score scales are based on routine parameters from blood examinations and are applied to assess the prognosis of cancer patients. In our study, we analysed the assessment capability of these scales for predicting postoperative complications with ROC curves, and the CONUT score showed the best performance. In addition, we identified age and RBC counts as independent risk factors for complications. In other words, old age, anaemia and malnutrition had an adverse effect on short-term outcomes in patients after gastrectomy for GC, which was consistent with prior studies40, 41.
In previous studies, most researchers focused on the long-term survival associated with the CONUT score among GC patients9, 18–22, with little focus on postoperative complications. Ryo et al18 mentioned the incidence of some complications, such as anastmostic leakage and intra-abdominal abscess, in relation to the CONUT score. Huang et al40 reported that the CONUT score was a significant risk factor for total complications and one-year survival in elderly GC patients. In our study, stratified analysis of postoperative complications was further performed comparing low and high CONUT scores. Sometimes some patients suffered multiple complications. For example, after surgery, one patient suffered a sudden stomach ache and subsequent fever, with abdominal tenderness and rebound tenderness as a result of duodenal stump rupture, rapidly developed grievous intra-abdominal abscess, and had to undergo a second operation with suturing, irrigation and drainage. Our analysis indicated that a higher ratio of patients with a high CONUT score developed postoperative complications. We speculated that patients with hypoalbuminemia, decreased lymphocytes and hypocholesterolaemia were more likely to experience negative conditions with slow tissue repair and delayed wound healing, increasing their susceptibility to infection, prolonging their reliance on parenteral nutrition support, and increasing their probability of abdominal effusion. SSIs are infections of the incision, organ or nearby space that occur after surgery, which can be combined with complex comorbidities and antimicrobial-resistant pathogens, and increase the challenges and expenses of treatment42. There was almost significant difference in SSIs between two groups in this study. The respiratory complications after surgery included pneumonia and hydrothorax, which occurred more frequently in the high CONUT score group, as Song Ryo et al reported18. We considered that long stays in bed and infrequent cough and sputum may be to blame. In summary, the CONUT score acts as an evaluation strategy for precise risk stratification for postoperative complications, which allows doctors to implement active nutritional interventions for GC patients.
Despite our findings, there were still some limitations of the present study. First, this single-centre study included a homogeneous cohort of patients with a fixed surgical team. Second, a retrospective study cannot rule out selection bias. Finally, follow-up assessments of the CONUT score after surgery were not available, which resulted in a lack of dynamic observations of the nutrition status. Therefore, prospective multi-center studies should be warranted to confirm the predictive significance of the CONUT score for GC patients, to validate the effectiveness of preoperative nutritional interventions and to compare the CONUT score with other commonly used nutritional assessments.