Controlling nutritional status score as a survival prognosticator in patients with head and neck cancer.

Abstract

Purpose: This study aimed to evaluate the prognostic significance of the preoperative Controlling Nutritional Status (CONUT) score in head and neck squamous cell carcinoma (HNSCC).

Methods: Patients with HNSCC who underwent radical surgery between 2008 and 2017 were retrospectively analyzed and randomly divided into training and validation cohorts by 3:1 ratio. The CONUT score, based on serum albumin, total cholesterol, and lymphocyte count measured within 1 week before surgery, was used. Univariate and multivariate Cox regression identified survival-related variables, forming the basis for predictive models developed in the training cohort and validated in the validation cohort.

Results: A total of 636 patients were enrolled in this study, including 477 patients in the training cohort and 159 patients in validation cohort. A CONUT cutoff value of 2 effectively stratified patients into two distinct prognostic groups with significant survival differences in both the training and validation cohorts. In the multivariate Cox model, a high CONUT score emerged as an independent negative prognosticator of overall survival (OS) and cancer specific survival (CSS) in both training and validation cohorts. The CONUT score-based nomograms accurately predicted OS (concordance index: 0.778 in training cohort and 0.709 in validation cohort) and CSS (concordance index: 0.830 in training cohort and 0.778 in validation cohort).

Conclusion: The preoperative CONUT score is a useful prognostic marker for surgically treated HNSCC, enhancing nomogram-based risk models to identify high-risk patients and guide treatment decisions effectively.