Supplementary Material for: The Controlling Nutritional Status Score and Postoperative Complication Risk in Gastrointestinal and Hepatopancreatobiliary Surgical Oncology: A Systematic Review and Meta-Analysis

The controlling nutritional status (CONUT) score is associated with prognosis in gastrointestinal (GI) cancer patients, but the clinical significance of the CONUT score for postoperative short-term outcome remains controversial. The aim of this study was to investigate the impact of the CONUT score on postoperative outcomes in patients with GI and hepatopancreatobiliary (HPB) cancers. We conducted a systematic literature search of Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. Meta-analyses were performed to estimate the pooled risk ratio (RR) for postoperative complications in patients with lower ­CONUT score versus higher CONUT score. Furthermore, we explored the most appropriate cutoff value of the CONUT score to predict postoperative complications. Ten retrospective studies (5,138 patients) were included in this meta-analysis. Patients with higher CONUT score had an increased risk of mortality (RR 5.38, 95% CI 2.19–13.2, <i>p</i> &lt; 0.001, <i>I</i>² = 0%), postoperative major complications (RR 1.56, 95% CI 1.05–2.33, <i>p</i>= 0.03, <i>I</i>² = 79%), and overall complications (RR 1.38, 95% CI 1.16–1.63, <i>p</i> &lt; 0.001, <i>I</i>² = 6%). We found that the cutoff of CONUT ≤4 vs. CONUT ≥5 had the highest pooled RR compared with other cutoff values (RR 4.79, 95% CI 0.97–23.5, <i>p</i>= 0.05, <i>I</i>² = 91%). In conclusion, the present study suggests that the preoperative CONUT score was associated with an increased risk of mortality and complications in GI and HPB surgical oncology. Patients with higher CONUT score as compared with those having a lower score had approximately a fivefold mortality risk and an increased risk up to 55% on major and overall complications after GI and HPB surgery. Our analysis indicates that the appropriate cutoff value of the CONUT score to predict postoperative major complications would be between 4 and 5. The preoperative evaluation of the CONUT score would be helpful for predicting the risk of postoperative outcomes.

控制营养状况（controlling nutritional status, CONUT）评分与胃肠道（gastrointestinal, GI）癌症患者的预后密切相关，但该评分对术后短期结局的临床意义仍存在争议。本研究旨在探讨CONUT评分对GI及肝胆胰（hepatopancreatobiliary, HPB）癌症患者术后结局的影响。我们对Embase、Medline Ovid、Web of Science、Cochrane CENTRAL及Google Scholar进行了系统文献检索。通过荟萃分析估算低CONUT评分组相较于高CONUT评分组患者术后并发症的合并风险比（pooled risk ratio, RR）。此外，本研究还探索了用于预测术后并发症的最适宜CONUT评分截断值。本荟萃分析共纳入10项回顾性研究，涉及5138例患者。高CONUT评分患者的死亡风险显著升高（RR=5.38，95%置信区间（confidence interval, CI）2.19~13.2，*p*<0.001，*I*²=0%）、术后重大并发症风险升高（RR=1.56，95%CI 1.05~2.33，*p*=0.03，*I*²=79%）及总体并发症风险升高（RR=1.38，95%CI 1.16~1.63，*p*<0.001，*I*²=6%）。研究发现，相较于其他截断值，CONUT≤4与CONUT≥5的截断分组拥有最高的合并RR（RR=4.79，95%CI 0.97~23.5，*p*=0.05，*I*²=91%）。综上，本研究表明，术前CONUT评分与GI及HPB外科肿瘤患者的死亡及并发症风险升高相关。相较于低CONUT评分患者，高评分患者的死亡风险约为5倍，且GI及HPB术后重大并发症与总体并发症风险最高可升高55%。本分析显示，用于预测术后重大并发症的CONUT评分适宜截断值介于4~5之间。术前评估CONUT评分有助于预测患者术后结局的风险。