SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Association of preoperative controlling nutritional status score with clinical outcomes among surgical esophageal cancer patients: a meta-analysis
Provisionally accepted
- 1West China Hospital of Sichuan University, Chengdu, China
- 2Kidney Research Institute, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, chendu, China
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Purpose To identify the relationship between preoperative controlling nutritional status (CONUT) score and long-term and short-term outcomes in esophageal cancer patients receiving esophagectomy. Methods The Web of Science, EMBASE, PubMed and CNKI databases were searched up to January 24, 2025. Primary outcome was the long-term survival such as the overall survival (OS), disease-free survival (DFS) and cancer- specific survival (CSS). Secondary outcomes included the postoperative overall complication, incision infection, anastomotic fistula, pneumonia, respiratory complication, 90-day death, cardiovascular complication, major adverse cerebrocardiovascular event (MACCE), pulmonary atelectasis and pulmonary embolism. Hazard ratio (HR) and odds ratio (OR) with 95% confidence interval (CI) were separately combined for the primary and secondary outcomes. Subgroup analysis for the OS and DFS by neoadjuvant therapy and pathological type were further conducted. Results Eighteen studies with 5495 cases were included. Pooled results manifested that elevated preoperative CONUT score predicted significantly worse OS (HR=1.75, 95% CI: 1.30-2.37, P＜0.001), DFS (HR=1.21, 95% CI: 1.13-1.30, P＜0.001) and CSS (HR=2.60, 95% CI: 1.65-4.10, P＜0.001). Subgroup analysis for the OS and DFS by the history of neoadjuvant therapy and pathological type demonstrated similar results. Furthermore, elevated CONUT score was significantly related to increased risk of overall complication (OR=1.50, 95% CI: 1.14-1.96, P=0.004), pneumonia (OR=1.60, 95% CI: 1.23-2.08, P＜0.001), respiratory complication (OR=1.60, 95% CI: 1.26-2.03, P＜0.001), cardiovascular complication (OR=3.660, 95% CI: 1.068-12.550, P=0.039), MACCE (OR=1.920, 95% CI: 1.068-3.452, P=0.040) and pulmonary atelectasis (OR=2.314, 95% CI: 1.408-3.805, P＜0.001). Conclusion Preoperative CONUT score might serve as a prognostic indicator in surgical esophageal cancer and patients with elevated CONUT score are suggested to experience worse long-term and short-term clinical outcomes.
Keywords: Controlling Nutritional Status score, esophageal cancer, Surgery, long-termoutcomes, short-term outcomes, Meta-analysis
Received: 28 Aug 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Ji, Wang, Mei, Zheng, Lin and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mei Yang, yangmeixw2025@163.com
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