Relationships of preoperative Controlling Nutritional Status with tumor postoperative recurrence and metastasis in cervical cancer patients

Objective To investigate the predictive value of preoperative Controlling Nutritional Status (CONUT) score for tumor postoperative recurrence and metastasis in cervical cancer patients.

Methods The clinical and follow-up data of 134 cervical cancer patients who underwent curative resection at the Department of Gynecology in our hospital from January 2017 to April 2019 were retrospectively analyzed. The preoperative CONUT score of each patient was calculated according to the serum level of albumin, peripheral lymphocytes counts and total cholesterol level. The best cut-off point of preoperative CONUT score for the prediction of tumor recurrence and metastasis in cervical cancer patients was identified by time-dependent receiver operation characteristics (tROC) curve, and the correlation between preoperative CONUT and recurrence free survival rate of cervical cancer patients was evaluated by Kaplan-Meier method. The univariate and multivariate Cox regression analysis was used to identify the independent risk factors for postoperative recurrence and metastasis in cervical cancer patients.

Results The tROC curve showed that the best cut-off point of preoperative CONUT score for the prediction of tumor recurrence and metastasis in cervical cancer patients was 3 points, with an area under curve (AUC) value of 0.709 (95%CI, 0.587 to 0.830). All patients were divided into high CONUT score group(≥3)and low CONUT score group(< 3) based on the best cut-off value. The results showed that high CONUT was significantly correlated with higher risk of pelvic lymph node metastasis and advanced International Federation of Gynecology and Obstetrics (FIGO) staging. During the follow-up period, tumor recurrence and metastasis were observed in 22 patients (16.4%). The survival curves showed that the 3-year recurrence free survival rate of patients in the high CONUT score group and low CONUT score group were 69.5% and 89.3%, respectively (P=0.007). The univariate and multivariate Cox regression analysis demonstrated that higher preoperative CONUT score(HR=2.771; 95%CI, 1.158 to 6.626; P=0.022), higher FIGO staging (HR=2.968; 95%CI, 1.183 to 7.444; P=0.020) and lymphovascular space invasion (HR=2.589; 95%CI, 1.031 to 6.499; P=0.043) were independent predictors of RFS for cervical cancer patients.

Conclusion CONUT score might be used as an effective indicator in prediction of tumor recurrence and metastasis, and preoperative CONUT score ≥3 suggests a poor prognosis for cervical cancer patients.