Prognostic significance of a combined and controlled nutritional status score and EBV-DNA in patients with advanced nasopharyngeal carcinoma: a long-term follow-up study

OBJECTIVE: Several studies have reported that the controlling nutritional status (CONUT) score is a prognostic predictor for survival among patients with different types of cancer. We assessed the prognostic value of changes in the CONUT score during treatment and the ΔCONUT-EBV DNA score in patients with advanced nasopharyngeal carcinoma (NPC). METHODS: We retrospectively analyzed 433 patients with advanced NPC having no evidence of metastasis from January 2007 to June 2011; the patients underwent radical concurrent chemoradiotherapy (CCRT) at Sun Yat-sen University Cancer Center and were grouped based on their ΔCONUT and ΔCONUT-EBV DNA scores. Kaplan-Meier curves were used to compare the patient outcomes according to the cut-off ΔCONUT score and the ΔCONUT-EBV DNA scoring system. RESULTS: Among all patients, overall survival (OS) was independently predicted by a high ΔCONUT score (P = 0.031) and high EBV DNA (P < 0.001). The ΔCONUT-EBV DNA score [OS area under the curve (AUC) = 0.621; progression free survival (PFS)-AUC = 0.612; distant metastasis-free survival (DMFS)-AUC = 0.622] was more predictive of OS, PFS, and DMFS in patients with advanced NPC than the ΔCONUT score (OS-AUC = 0.547; PFS-AUC = 0.533; DMFS-AUC = 0.522) and pretreatment plasma EBV DNA levels alone (OS-AUC = 0.600; PFS-AUC = 0.591, DMFS-AUC = 0.610). The ΔCONUT-EBV DNA score was significantly correlated with OS, PFS, and DMFS in patients with advanced NPC treated with CCRT. CONCLUSIONS: The ΔCONUT-EBV DNA score may be useful in clinical practice as a convenient biomarker for predicting the outcomes in patients with advanced NPC treated with CCRT.