NRS-2002 and CONUT scores and prognostic analysis of patients with advanced hepatocellular carcinoma and Nomogram model construction

Abstract

Abstract: Objective: Nutritional risk screening-2002 (NRS-2002) and controlling nutritional status (CONUT) scores were used to evaluate the nutritional status of patients with advanced hepatocellular carcinoma (HCC) before transcatheter arterial chemoembolization (TACE).The influencing factors of postoperative death were analyzed and Nomogram model was constructed. Methods: 113 patients with advanced HCC who received TACE therapy in Affiliated Hospital of West Anhui Health Vocational College from January 2016 to January 2020 were selected.Univariate and multivariate Cox proportional hazards models were used to analyze the factors affecting the death of patients with advanced HCC.The influential factors of death were used as predictors of the Nomogram model.Internal dataset validation, consistency index(C-index), decision curve analysis (DCA), and time-ROC curve were used to evaluate the predictive performance of Nomogram model. Results: NRS-2002 screened 76 (67.3%) patients with malnutrition, and 758 (51.3%) patients with malnutrition were screened by CONUT score. Kappa value was 0.238 (P < 0.05). The survival time of malnutrition patients screened by NRS-2002 and CONUT score was lower than that of patients with normal nutrition (P < 0.05). Multivariate Cox proportional hazards model analysis showed that ascites (yes), BCLC grade (grade C), PVTT (yes), TACE frequency (>2), TBIL (> 27 μ mol/L) and NRS-2002 (malnutrition) were the independent risk factors of death in patients with advanced HCC (P < 0.05). The results of internal validation showed that the C-index of 6-month survival rate, 12-month survival rate and 24-month survival rate were 0.701 (95%CI: 0.668—0.801), 0.697 (95%CI: 0.611—0.794) and 0.651 (95%CI: 0.601—0.754), respectively. When the risk threshold of nomogram model was higher than 0.16 and lower than 0.89 for predicting the death of patients with advanced HCC after TACE, it provides significant additional clinical benefits. The AUC of Nomogram model was higher than that of BCLC, PVTT, ascites, TACE times, TBIL and NRS-2002. Conclusion: The Nomogram model has high clinical practice and accuracy, and can guide the treatment and management of patients with advanced HCC.

Key words: Hepatocellular carcinoma, Transcatheter arterial chemoembolization, Survival rate, Model

Huang Guirong, Wu Deping, Chen Fangpeng, Han Shanshan. NRS-2002 and CONUT scores and prognostic analysis of patients with advanced hepatocellular carcinoma and Nomogram model construction[J]. Electronic Journal of Liver Tumor, 2021, 8(2): 62-68.

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