The role of preoperative controlling nutritional status (CONUT) score in the assessment of survival outcomes in patients with muscle invasive bladder cancer (MIBC) treated with radical cystectomy: A pilot study

Introduction & Objectives: The aim of the study was to investigate the ability of the Controlling Nutritional (CONUT) score to predict the correlation between malnutrition and survival in patient affected by muscle invasive bladder cancer (MIBC) treated with radical cystectomy (RC). Materials & Methods: We retrospectively evaluated data from 127 patients who underwent RC for MIBC at our Institute between December 2012 and June 2017. CONUT score was calculated based on the serum albumin concentration, lymphocite count and total cholesterol concentration. Patients were classified into two groups: Those with high CONUT score and those with low CONUT score. Univariate analysis was performed. Recurrence-free (RFS) and Overall Survival (OS) rates were calculated and compared between the two groups. Results: Cut-off value to discriminate between high and low CONUT score was determined calculating the ROC curve: the area under the curve was 0.715 with an optimal cut-off of 3 points. 42 (33,1%) patients had high CONUT score. Distribution of data in low and high CONUT groups as mean age at surgery (71.4 ± 9.5 vs. 73.8 ± 7.6, p=0,16), sex (male 46 vs. 21 and female 39 vs. 21, p=0.70), mean hospitalization time (24,2 ± 10,9 vs 21.2 ± 6.7, p=0.11), tumor site and presence of multifocal disease (p=0.56), pT and pN stage (p=0.80, p=0.77), presence of high grade disease (75 vs. 35, p=0.22) lymphovascular invasion (LVI) (34 vs. 18, p=0.85), adjuvant chemotherapy (23 vs. 7, p=0.17), mean BMI (25.4 ± 4.1 vs. 25.7 ± 4.6, p=0.79) and urinary diversion were not statistically different between two groups. Only mean fibrinogen, as acute inflammatory index, was statistically greater in the high score group (370 ± 103,2 vs. 437,7 ± 144, p=0.03). OS and RFS rates were calculated with a mean follow-up of 30.5 ± 35.7 months in low CONUT group and 24.2 ± 28.8 in high CONUT group (p=0.34). Totally, 54 (42.5%) patients were alive: 44 (81.5%) with low score and 10 (18.5%) with high score (p=0.002). 44 (34,6%) had a recurrence disease: 19 (43.2%) in the low score group and 25 (56.8%) in the high score group (p<0.001). Conclusions: Preoperative determination of CONUT score can be used as a biomarker to predict outcomes in patients affected by muscle invasive bladder cancer (MIBC) undergoing RC. Considering a cut-off of 3 points an high CONUT score is statistically associated with OS and RFS. Further investigations should be necessary to confirm the good potential of this tool