Prognostic impact of the controlling nutritional status score in patients with peripheral T-cell lymphoma

Figures & data

Table 1. Assessment of undernutrition degree by the CONUT score.

	Undernutrition degree
Parameter	Normal	Mild	Moderate	Severe
Serum Albumin (g/dL)	≥3.5	3.0-3.4	2.5-2.9	<2.5
Score	0	2	4	6
T-Chol (mg/dL)	≥180	140-179	100-139	<100
Score	0	1	2	3
TLC (/μL)	≥1600	1200-1599	800-1199	<800
Score	0	1	2	3
Screening Total Score	0-1	2-4	5-8	9-12

CONUT: Controlling Nutrition Status; T-Chol: Total cholesterol; TLC: total lymphocyte count.

Table 2. Patients' characteristics at diagnosis.

	All patients (N = 99)	Non-survivor group (n = 55)	Survivor group (n = 44)	p Value
Age, year - median, range	67 (16-87)	69 (34-87)	62.5 (16-84)	0.01
Male - n (%)	69 (69.7)	39 (70.9)	30 (68.2)	0.828
Diagnosis - n (%)
PTCL-NOS	65 (65.7)	39 (70.9)	26 (59.1)	0.002
AITL	13 (13.1)	8 (14.5)	5 (11.4)
ALK-positive ALCL	10 (10.1)	1 (1.8)	9 (20.5)
ALK-negative ALCL	5 (5.1)	1 (1.8)	4 (9.1)
EATL	5 (5.1)	5 (9.1)	0 (0.0)
HSTL	1 (1.0)	1 (1.8)	0 (0.0)
ECOG PS ≥ 2 - n (%)	33 (33.3)	26 (47.3)	7 (15.9)	0.001
Extranodal sites ≥ 2 - n (%)	24 (24.5)	16 (29.6)	8 (18.2)	0.240
Ann Arbor Stage III/IV - n (%)	78 (78.8)	49 (89.1)	29 (65.9)	0.007
Elevated LDH (>ULN) - n (%)	59 (59.8)	37 (67.3)	22 (50.0)	0.101
sIL-2R (U/ml) - median, range	2666 (204-106000)	3370 (204-106000)	2290 (209-386200)	0.422
sIL-2R ≥ 2000 - n (%)	59 (59.6)	35 (63.6)	24 (54.5)	0.413
BMI ≥ 22 - n (%)	48 (49.0)	26 (48.1)	22 (50.0)	1.000
Bulky mass - n (%)	6 (9.1)	2 (5.6)	4 (13.3)	0.399
B symptoms - n (%)	49 (50.0)	29 (53.7)	20 (45.5)	0.543
BM involvement (%)	21 (21.2)	13 (23.6)	8 (18.2)	0.623
IPI - n (%)
Low (0, 1)	22 (22.2)	5 (9.3)	17 (38.6)	0.001
Low intermediate (2)	20 (20.2)	10 (18.5)	10 (22.7)
High intermediate (3)	32 (32.3)	20 (37.0)	12 (27.3)
High (4, 5)	24 (24.2)	19 (35.2)	5 (11.4)
Serum Albumin (g/dl) - median, range	3.7 (1.9-4.7)	3.3 (2.0-4.7)	3.75 (1.9-4.7)	0.006
T-Chol (mg/dL) - median, range	147 (72-252)	144 (72-252)	162 (84-246)	0.097
TLC (/μL) - median, range	1140 (8-15218)	1112 (8-15218)	1143.5 (79-9020)	0.709
CONUT - n (%)
Score - median, range	3 (0-12)	5 (0-12)	3 (0-11)	0.026
Normal (0-1)	16 (16.2)	7 (12.7)	9 (20.5)	0.043
Mild (2-4)	45 (45.5)	20 (36.4)	25 (56.8)
Moderate (5-8)	23 (23.3)	17 (30.9)	6 (13.6)
Severe (9-12)	15 (15.2)	11 (20.0)	4 (9.1)
Fisrt treatment - n (%)				0.419
CHOP	44 (44.4)	23 (41.8)	21 (47.7)
THP-COP	43 (43.4)	23 (41.8)	20 (45.5)
Hyper-CVAD	2 (2.0)	1 (1.8)	1 (2.3)
BSC/Steroid	10 (10.1)	8 (14.5)	2 (4.5)

AITL: angioimmunoblastic T-cell lymphoma; ALCL: anaplastic large cell lymphoma; ALK: anaplastic lymphoma kinase; BM: bone marrow; BMI: body mass index; BSC: best supportive care; CONUT: Controlling Nutrition Status; EATL: enteropathy-associated T-cell lymphoma; ECOG PS: Eastern Cooperative Oncology Group performance status; HSTL: hepatosplenic T-cell lymphoma; IPI: International Prognostic Index; LDH: Lactate dehydrogenase; PTCL-NOS: peripheral T-cell lymphoma; not otherwise specified; sIL-2R: soluble interleukin-2 receptor; T-Chol: Total cholesterol; TLC: total lymphocyte count; ULN: Upper limit of normal.

Table 3. Nutritional status according to the CONUT score and patients' characteristics.

	All patients (N = 99)	Normal or Mild undernutrition (CONUT score < 5) (n = 61)	Moderate or Severe undernutrition (CONUT score ≥ 5) (n = 38)	p Value
Age, year - median, range	67 (16-87)	66 (16-87)	68 (20-86)	0.206
Male - n (%)	69 (69.7)	42 (68.9)	27 (71.1)	1.000
Diagnosis - n (%)
PTCL-NOS	65 (65.7)	43 (70.5)	22 (57.9)	0.11
AITL	13 (13.1)	8 (13.1)	2 ( 5.3)
ALK-positive ALCL	10 (10.1)	1 ( 1.6)	4 (10.5)
ALK-negative ALCL	5 (5.1)	7 (11.5)	6 (15.8)
EATL	5 (5.1)	2 ( 3.3)	3 ( 7.9)
HSTL	1 (1.0)	0 ( 0.0)	1 ( 2.6)
ECOG PS ≥ 2 - n (%)	33 (33.3)	9 (14.8)	24 (63.2)	<0.001
Extranodal sites ≥ 2 - n (%)	24 (24.5)	12 (20.0)	12 (31.6)	0.232
Ann Arbor Stage III/IV - n (%)	78 (78.8)	45 (73.8)	33 (86.8)	0.138
Elevated LDH (>ULN) - n (%)	59 (59.8)	33 (54.1)	26 (68.4)	0.207
sIL-2R (U/ml) - median, range	2666 (204-106000)	1419 (204-38620)	4857 (1076-106000)	<0.001
sIL-2R ≥ 2000 - n (%)	59 (59.6)	25 (41.0)	34 (89.5)	<0.001
BMI ≥ 22 - n (%)	48 (49.0)	36 (60.0)	12 (31.6)	0.007
Bulky mass - n (%)	6 (9.1)	5 (11.9)	1 ( 4.2)	0.404
B symptoms - n (%)	49 (50.0)	19 (31.7)	30 (78.9)	<0.001
BM involvement (%)	21 (21.2)	8 (13.1)	13 (34.2)	0.021
IPI - n (%)
Low (0, 1)	22 (22.2)	17 (28.3)	5 (13.2)	<0.001
Low intermediate (2)	20 (20.2)	18 (30.0)	2 ( 5.3)
High intermediate (3)	32 (32.3)	17 (28.3)	15 (39.5)
High (4, 5)	24 (24.2)	8 (13.3)	16 (42.1)
Serum Albumin (g/dl) - median, range	3.7 (1.9-4.7)	3.9 (3.0-4.7)	2.75 (1.9-3.7)	<0.001
T-Chol (mg/dL) - median, range	147 (72-252)	170 (108-246)	122.5 (72-252)	<0.001
TLC (/μL) - median, range	1140 (8-15218)	1330 (79-9020)	749 (8-15218)	<0.001
First treatment - n (%)
CHOP	44 (44.4)	26 (42.6)	18 (47.4)	0.001
THP-COP	43 (43.4)	32 (52.5)	11 (28.9)
Hyper-CVAD	2 (2.0)	2 ( 3.3)	0 ( 0.0)
BSC/Steroid	10 (10.1)	1 ( 1.6)	9 (23.7)

AITL: angioimmunoblastic T-cell lymphoma; ALCL: anaplastic large cell lymphoma; ALK: anaplastic lymphoma kinase; BM: bone marrow; BMI: body mass index; BSC: best supportive care; CONUT: Controlling Nutrition Status; EATL: enteropathy-associated T-cell lymphoma; ECOG PS: Eastern Cooperative Oncology Group performance status; HSTL: hepatosplenic T-cell lymphoma; IPI: International Prognostic Index; LDH: Lactate dehydrogenase; PTCL-NOS: peripheral T-cell lymphoma: not otherwise specified; sIL-2R: soluble interleukin-2 receptor; T-Chol: Total cholesterol; TLC: total lymphocyte count; ULN: Upper limit of normal.

Figure 1. Association between the CONUT score and overall survival using the Cox proportional hazards model with restricted cubic spline with 4 knots. The solid line represents the log hazard ratio, and the shaded area is the 95% confidence interval. CONUT: controlling nutritional status.

Table 4. Univariate and multivariate COX proportional hazards analysis of clinical factors significantly associated with overall survival.

	Univariate analysis		Multivariate analysis
Factor	HR (95% CI)	p Value	HR (95% CI)	p Value
Female	1.097 (0.612-1.965)	0.755	0.998 (0.525-1.897)	0.994
ALK-positive ALCL	0.125 (0,017-0.906)	0.040	0.260 (0.034-1.989)	0.194
BM involvement	1.160 (0.623-2.163)	0.640	0.678 (0.318-1.444)	0.314
IPI, category
Low risk	(Reference group)		(Reference group)
Low-intermediate risk	2.229 (0.762-6.524)	0.144	1.896 (0.637-5.649)	0.251
High-intermediate risk	3.650 (1.368-9.737)	0.010	2.536 (0.900-7.142)	0.078
High risk	8.305 (3.076-22.420)	<0.001	3.895 (1.250-12.140)	0.019
CONUT, score	1.150 (1.064-1.244)	<0.001	1.119 (1.021-1.227)	0.017
BSC	11.03 (4.810-25.290)	<0.001	6.261 (2.325-16.860)	<0.001

ALCL: anaplastic large cell lymphoma; ALK: anaplastic lymphoma kinase; BM: bone marrow; BSC: best supportive care; CI: confidence interval; CONUT: Controlling Nutrition Status; HR: Hazard ratio; IPI: International Prognostic Index.

Figure 2. Kaplan-Meier curves of overall survival among 4 groups (A) and 2 groups (B) of the CONUT score. CONUT: controlling nutritional status.

Figure 3. Association between the CONUT score and overall survival of four groups divided by the International Prognostic Index using a covariate-adjusted restricted cubic spline hazard model. The solid line represents the log hazard ratio, and the shaded area is the 95% confidence interval. IPI: International Prognostic Index; CONUT: controlling nutritional status.