CONUT score and Naples prognostic score (NPS) for dual prediction of survival and radiation toxicity in locally advanced non-small cell lung cancer with chemoradiotherapy.

Background: Although chemoradiotherapy (CRT) is the standard modality for the treatment of locally advanced non-small cell lung cancer (LA-NSCLC), there have been inconsistencies in the efficacy and toxicity of these treatment regimens. To address this issue, we sought to evaluate peripheral blood-derived nutrition-inflammation scoring indices as dual-purpose tools for predicting both survival outcomes and treatment-related toxicities in this patient population. Methods: The study included patients with LA-NSCLC who underwent CRT at Harbin Medical University Cancer Hospital between March 2019 and December 2022. Peripheral blood indicators before radiotherapy were used to calculate the neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), advanced lung cancer inflammation index (ALI), controlled nutritional status score (CONUT score), and Naples prognostic score (NPS). We analyzed and compared their relationships with prognosis and radiotherapy-related toxicity events. Results: In total, 126 patients were included in the study, with a median follow-up period of 53 months. In terms of survival prediction, the multivariate Cox regression analysis revealed that a high CONUT score [progression-free survival (PFS): hazard ratio (HR) =2.513, 95% confidence interval (CI): 1.336-4.727, P=0.004; overall survival (OS): HR =2.908, 95% CI: 1.527-5.538, P=0.001) and high NPS (PFS: HR =2.809, 95% CI: 1.517-5.203, P=0.001; OS: HR =3.345, 95%CI: 1.769-6.325, P<0.001) were independent risk factors for PFS and OS. Receiver operating characteristic (ROC) curve analysis indicated that when predicting 24- and 36-month PFS, the area under the curve (AUC) values of CONUT score were 0.791 (95% CI: 0.704-0.878) and 0.800 (95% CI: 0.724-0.877), respectively, and the corresponding values for the NPS were 0.741 (95% CI: 0.657-0.825) and 0.790 (95% CI: 0.715-0.866). When predicting 3- and 5-year OS, the AUCs of CONUT scores were 0.823 (95% CI: 0.746-0.900) and 0.817 (95% CI: 0.745-0.889), respectively, and the AUCs of NPS were both 0.802 (95% CI: 0.728-0.877, 95% CI: 0.727-0.878). In terms of predicting radiotherapy toxicity, grade ≥2 radiation pneumonitis or grade ≥2 radiation esophagitis served as the observation endpoints for assessing radiotherapy toxicity. Multivariable logistic regression analysis revealed that a high CONUT score [odds ratio (OR) =3.194, 95% CI: 1.001-10.207, P=0.049] and NPS group 2 (OR =8.243, 95% CI: 2.946-23.069, P<0.001) were associated with radiotherapy toxicity endpoint events. Conclusions: Among LA-NSCLC patients receiving CRT, the CONUT score and NPS prior to treatment were established to be associated with survival and grade ≥2 radiation-induced lung/esophageal toxicity. Prospective studies are required for further verification to guide clinical practice.