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The prognostic value of controlling nutritional status (CONUT) score–based nomogram on extranodal natural killer/T cell lymphoma patients

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Abstract

Controlling nutritional status (CONUT) score as an original nutritional assessment tool can be used to assess the prognosis of patients with a variety of malignancies. However, the predictive power of CONUT in extranodal natural killer/T cell lymphoma (ENKTL) patients has never been demonstrated. Our retrospective multicenter study aimed to explore the prognostic value of CONUT in newly diagnosed ENKTL. A total of 1085 newly diagnosed ENKTL patients between 2003 and 2021 were retrospectively retrieved. Cox proportional hazard model was used to explore the prognostic factors of overall survival (OS). The survival rate of ENKTL was evaluated using Kaplan-Meier analysis, and log-rank test was applied to the difference between groups. We investigated the prognostic performance of CONUT, the International Prognostic Index (IPI), the Korean Prognostic Index (KPI), and the Prognostic Index of Natural Killer Cell Lymphoma (PINK) using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). The median age at diagnosis for the whole cohort was 47 years, and the male to female ratio was 2.2:1. The 5-year OS for all patients was 72.2%. Multivariable analysis showed that CONUT, age, bone marrow involvement, ECOG PS score, and Chinese Southwest Oncology Group and Asia Lymphoma Study Group ENKTL stage were identified as independent predictive factors for OS. Based on multivariable results, a prognostic nomogram was developed. Subgroup analysis demonstrated that patients with severe malnutrition had poorest clinical outcome. In addition, ROC curves and DCA analysis proved that compared with IPI, KPI, and PINK models, the CONUT score-based nomogram showed a better prognostic predictive efficiency of ENKTL. CONUT could effectively stratify the prognosis of ENKTL and the proposed nomogram based on CONUT was an effective prognostic model for prediction.

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Acknowledgements

Thanks to the Huaihai Lymphoma Working Group (HHLWG) for its participation in this study.

Funding

This study was funded by the Natural Science Foundation of Jiangsu Province, Grant/Award Number BK20171181; Jiangsu Key Research and Development Project of Social Development, Grant/Award Number BE2019638; Young Medical Talents of Jiangsu Science and Education Health Project, Grant/Award Number QNRC2016791; and Jiangsu Province’s Graduate Scientific Research Innovation Program (KYCX21–2685).

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Author notes

  1. Shuo Zhang, Cai Sun and Xicheng Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China

    Shuo Zhang, Cai Sun, Xicheng Chen, Dashan Li, Lingling Hu, Meng Zhang, Dongmei Yan & Wei Sang

  2. Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China

    Xudong Zhang

  3. Department of Hematology, The Affiliated Hospital of Jining Medical University, Jining, 272000, Shandong, China

    Hao Zhang

  4. Department of Hematology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China

    Jingjing Ye

  5. Department of Hematology, Tai’an Central Hospital, Tai’an, 271000, Shandong, China

    Ling Wang

  6. Department of Hematology, The First People’s Hospital of Lianyungang, Lianyungang, 222061, Jiangsu, China

    Tao Jia

  7. Department of Hematology, The General Hospital of Wanbei Coal-Electric Group, Suzhou, 234011, Anhui, China

    Taigang Zhu

  8. Department of Hematology, Yancheng First People’s Hospital, Yancheng, 224001, Jiangsu, China

    Yuqing Miao

  9. Department of Hematology, The First People’s Hospital of Huai’an, Huai’an, 223300, Jiangsu, China

    Chunling Wang

  10. Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100005, China

    Liang Wang

  11. Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China

    Ziyuan Shen

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  1. Shuo Zhang
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Contributions

WS and ZYS contributed to the conceptualization, supervision, and review. SZ, CS, and ZYS contributed to the formal analysis and writing—original draft. XCC, DSL, LLH, MZ, XDZ, HZ, JJY, LW, TJ, TGZ, QYM, CLW, LW, and DMY contributed to the data acquisition. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Wei Sang.

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Study approval was obtained from the independent Ethics Committees of each participating center in HHLWG and met Helsinki Declaration. Informed consent was obtained from each patient.

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Zhang, S., Sun, C., Chen, X. et al. The prognostic value of controlling nutritional status (CONUT) score–based nomogram on extranodal natural killer/T cell lymphoma patients. Ann Hematol 102, 1433–1442 (2023). https://doi.org/10.1007/s00277-023-05232-3

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