Impact of preoperative Controlling nutritional status (CONUT) score on perioperative morbidity and survival outcomes in patients with bladder cancer treated with radical cystectomy

Introduction:Despite several improvements in surgical technique,radical cystectomy (RC) remains an highly morbid operation and evenin contemporary series the combined surgical, medical and diseasemorbidity results in a low 5-years overall survival (OS). Furthermore,the age of patients undergoing RC has increased and the ability topredict perioperative morbidity is crucial in the preoperative workupof RC. Immune-nutritional status have gained special attention inoncological patients and might play an important role in humancancer development and progression. The controlling nutritionalstatus (CONUT), a score based on the serum albumin concentration,lymphocyte count and total cholesterol concentration, is a compre-hensive index that could provide an immune response status and long-term nutritional effect of the host. Recently, its prognostic value hasbeen reported in many types of malignancies but it’s never tested inbladder cancer (BC). The aim of the study is to evaluate the role ofpreoperative CONUT score in the assessment of both oncologicaloutcomes and perioperative morbidity in patients underwent RC fornon-metastatic BC.Materials and methods:We retrospectively evaluated data from 347patients who underwent RC for BC at five european high-volumecenters between January 2002 and December 2018. Patients weredivided into two groups according to the optimal cut-off value of CONUT score. Relationships of CONUT score with clinicopathologicalcharacteristics, perioperative complications (according to the Calvien-Dindo system), 30-days readmission, 90-days mortality, cancer-specific mortality (CSM), overall mortality (OM) and progression-freesurvival (PFS) were analyzed.Results:Cut-off value to discriminate between high and low CONUTscore was determined calculating the ROC curve: the area under thecurve was 0.72 with an optimal cut-off of 3 points. A high preoperativeCONUT score was.significantly correlated with older age, worse ASA score, advanced pTstage, high grade and node-positive disease, positive surgical margins(PSM), higher median length of stay and 30-days readmission (allp < 0.05). At multivariable binomial logistic regression analysisadjusted for age, sex, BMI, ASA score, pT, pN and type of urinarydiversion, high CONUT was an independent predictor of perioperativemajorcomplications (grade 3–5) (OR 2.9; 95%CI 1.6–5.4; p < 0.001) and30-days readmission(OR 2.5; 95%CI 1.3–4.9; p = 0.001). At multi-variable Cox’s regression analysis adjusted for age, sex, BMI, ASA score,presence of adjuvant therapy, pT, pN, LVI, PSM and concomitant cis,high CONUT was an independent predictor of CSM(HR 3.6; 95%CI 2.4–5.5; p < 0.001), OM(HR 2.5; 95%CI 1.7–3.4; p < 0.001) and worse PFS(HR 2.7; 95%CI 1.9–3.9; p < 0.001).Conclusions:Preoperative CONUT score can be used as a simple andinexpensive biomarker to predict perioperative morbidityand survivaloutcomes in patients with BC after radical cystectomy.