Original StudyThe Controlling Nutritional Status Score Is a Significant Independent Predictor of Poor Prognosis in Patients With Malignant Pleural Mesothelioma
Introduction
Malignant pleural mesothelioma (MPM), which is mainly caused by asbestos, is a devastating neoplasm that occurs worldwide. Although the production and use of asbestos throughout the world has been decreasing owing to prohibition or restriction in more than 50 countries since the 1970s, asbestos is still imported or exported in some countries.1 Furthermore, MPM is also known to be induced by genetic alterations such as BAP1 and NF2.2 Thus, the number of patients with MPM is expected to increase in these countries, and MPM will remain a disease of concern in the coming decades. MPM is an aggressive disease, and patients with MPM generally have a shorter life expectancy in comparison to patients with other malignancies, although some patients exhibit a good response to chemotherapy or multidisciplinary therapy.3 It is therefore important to discover the factors that can be used to select patients who will benefit from such treatments.
Recently, factors that reflect the nutritional status, such as albumin or skeletal muscle mass, have been reported to be associated with the prognosis in patients with gastric, intestinal, and lung cancer.4, 5, 6 The prognostic nutritional index (PNI) has also been reported to predict overall survival (OS) in patients with MPM.7, 8 The Controlling Nutritional Status (CONUT), a novel nutritional index, consists of 3 clinical factors: the albumin and cholesterol levels and the lymphocyte count (Table 1). The CONUT has already been reported as an independent prognostic factor in patients with gastric and intestinal cancer.9, 10 However, the prognostic significance of CONUT in patients with MPM has not been investigated. The present study aims to clarify the clinical significance of the CONUT in patients with MPM.
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Patients
From January 1995 to December 2015, 110 patients were diagnosed with MPM at the clinical research institute, National Kyushu Cancer Center (Fukuoka, Japan). Twenty-one of these patients, who received the best supportive care (BSC) alone, were excluded from the study. Six of the remaining 89 patients, whose serum cholesterol data were unavailable, were also excluded. Thus, the data of 83 patients were analyzed in the present study. The clinical stage was determined according to the International
Patient Characteristics
The patient characteristics are shown in Table 2. The median age was 59 years (range, 31-81 years), and 66 (79.5%) patients were male. Forty-five (54.2%) were current or former smokers, and 34 (41.0%) had a smoking history of ≥ 20 pack-years. Records of asbestos exposure were available for 33 (39.8%) patients. Twenty-eight (84.8%) of the 33 patients were exposed to asbestos. Thirty (36.1%) were clinical stage IV. The pathologic diagnoses of 58 patients for whom the data were available were as
Discussion
The CONUT score consists of 3 laboratory values, namely the albumin and cholesterol levels and the lymphocyte count. The albumin and cholesterol levels are well-known indexes of nutrition. The nutritional status has been found to be a good indicator of the immune response; thus, hypoalbuminemia and hypocholesterolemia are suggested to result in an impaired immune response.12 Indeed, malnutrition is reported to be a significant prognostic factor in patients with MPM.7, 8 On the other hand,
Disclosure
The authors have stated that they have no conflicts of interest.
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