NUTRITIONAL RISK SCREENING SCORE IS ASSOCIATED WITH OMISSION OF ADJUVANT CHEMOTHERAPY FOR STAGE III COLON CANCER
Soo Young Lee*, Hyeong Rok Kim
Chonnam National University Hwasun Hospital, Hwasun, Jeonnam, Korea (the Republic of)
Aim: Adjuvant chemotherapy plays an important role in improving survival in patients with stage III colon cancer. Nutritional risk screening (NRS) score has been reported as a predictor of postoperative outcomes in patients undergoing abdominal surgery. This study aimed to evaluate the association between NRS score and administration of adjuvant chemotherapy for stage III colon cancer.
Method: A total of 404 stage III colon cancer patients who underwent curative resection between January 2012 and December 2015 were included. We utilized the CNUHH-NRST, which was developed and cross-validated on the basis of the NRS 2002 and MST, as a screening tool of nutritional risk. Patients with NRS scores ≥4 were compared with those with NRS scores <4, and the predictive factors for omission of adjuvant chemotherapy and prognostic factors for overall survival (OS) were analyzed.
Results: Eighty (19.8%) patients had high nutritional risk (NRS score ≥4). The patients with a nutritional risk had more right-sided tumors (63.8% vs. 38.6%, p < 0.001) and advanced tumor stages (stage IIIA, IIIB, and IIIC; 5.0, 70.0, and 25.0% vs. 7.7, 79.3, and 13.0%, p = 0.024) than those without nutritional risk. Postoperative complications showed no statistical difference (17.5% vs. 14.2%, p = 0.457) between the two groups according to nutritional risk. Adjuvant chemotherapy was administered to 83.9% (339/404) of patients included, while 16.1% did not receive postoperative chemotherapy. NRS score was associated with higher proportion of omission of adjuvant chemotherapy (26.3% vs. 13.6%, p = 0.006), which was significant after the adjustment of co-variables (adjusted odd ratio = 1.862, 95% confidence interval 1.007-3.445, p = 0.047). NRS score was not associated with OS (5-year OS, 84.8% vs. 85.9%, p = 0.358), and multivariable survival analysis showed that omission of adjuvant chemotherapy was an independent poor prognostic factor for OS (adjusted hazard ratio = 4.060, 95% confidence interval 2.081-7.921, p < 0.001).
Conclusion: NRS score was associated with omission of adjuvant chemotherapy in stage III colon cancer, which resulted in poor survival. Patients with nutritional risks who require advanced colon cancer surgery should be carefully managed.
Multivariate analysis of the predictive factors for omission of adjuvant chemotherapy
| Variable | Adjusted OR (95% CI) | P |
| ASA score ≥ 3 | 3.275 (1.385-7.741) | 0.007 |
| Tumor Size ≥ 5 cm | 2.206 (1.219-3.993) | 0.009 |
| NRS score ≥ 4 | 1.862 (1.007-3.445) | 0.047 |
OR, odds ratio; CI, confidence interval; ASA, American Society of Anesthesiologists; NRS, nutritional risk screening
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