Controlling nutritional status score predicts clinical outcome in cancer patients treated with immune checkpoint inhibitor: a systematic review and meta-analysis

Lianghui Zhang^1,2Quanli Zhang³Tao Ling^4*Lingli Huang^5*

• ¹Changzhou Hospital of Traditional Chinese Medicine, Changzhou, China
• ²Suqian Hospital of Traditional Chinese Medicine, Suqian, China
• ³Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Jiangsu Key Laboratory of Innovative Cancer Diagnosis & Therapeutics, Nanjing, China
• ⁴Suqian First Hospital, Suqian, China
• ⁵Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China

Background: To investigate the association between pretreatment controlling nutritional status (CONUT) score and clinical outcomes for cancer patients treated with immune checkpoint inhibitors (ICIs). Methods: We conducted a comprehensive literature search of PubMed, Web of Science, Medline and Embase from inception of the databases to November 2025 to identify eligible studies concerning the relationship between pretreatment CONUT and survival outcomes in cancer patients treated with ICIs. Published data were extracted and risk ratio (RR) for objective response rate (ORR), disease control rate (DCR), and hazard ratio (HR) for overall survival (OS), progressive-free survival (PFS), along with 95% confidence intervals (CIs) were pooled. Data were analyzed using Stata14.0 software. Results: Ten studies involving 747 participants were included in this study. Patients were divided into low CONUT group and high CONUT group according to the cut-off value of CONUT score. Patients in high CONUT group had worse ORR and DCR than those in low CONUT group (RR 1.39, 95%CI 1.04-1.86；RR 1.64, 95%CI 1.32-2.03). Patients in high CONUT group had shorter PFS and OS than those in low CONUT group (1.71, 95%CI 1.21-2.42; 1.95, 95%CI 1.21-3.14). Subgroup analysis of cut-off value showed that PFS and OS of patients in high CONUT group were significantly shorter with a cut-off value of 3, and PFS of patients in high CONUT group were also worse than those of patients in the low CONUT group. Subgroup analysis of country indicated that both patients from Japan in high CONUT group had worse PFS and OS than those in low CONUT group, the OS of patients from China in high CONUT group was shorter than those in low CONUT group. Conclusion: The CONUT score has potential value as an effective biomarker for the efficacy and prognosis of cancer patients treated with ICIs. In the future, large-scale prospective cohort studies should be conducted to determine the optimal cut-off value of CONUT, and to explore whether early and proactive nutritional and anti-inflammatory support based on CONUT score can reverse the adverse prognosis.