Dissecting the impact of Controlling Nutritional Status (CONUT) score on survival outcomes and immune-inflammatory profiles in patients with advanced NSCLC undergoing first-line immunotherapy

Q: What does the CONUT score reflect in this study?

The CONUT score is calculated from serum albumin, lymphocyte count, and total cholesterol to represent nutritional reserves and immune competence.

Q: How were immune-related measurements performed?

Baseline blood samples were analyzed for immunophenotypes by flow cytometry and for cytokines using a multiplex array.

Q: What survival differences were observed between CONUT <3 and CONUT ≥3?

Patients with CONUT <3 had significantly longer progression-free survival and overall survival, and multivariable analysis confirmed the prognostic impact of CONUT for both endpoints.

Sep 30, 2026

Uploaded by jayni

Immunonutritional background is linked to cancer behavior and clinical outcomes. This study evaluates the prognostic value of the Controlling Nutritional Status (CONUT) score by relating it to blood immunophenotypes and cytokines to estimate survival benefit from first-line immune checkpoint inhibitors with or without chemotherapy in advanced non-small cell lung cancer. A prospective cohort provided CONUT variables (albumin, lymphocytes, total cholesterol), immune profiling, and multiplex cytokine measurements. In 137 evaluable patients, CONUT <3 showed longer progression-free and overall survival and a distinct immune-inflammatory signature.

LanguageEnglish

CategoryHealthcare

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Pages10

Reading Time25 min

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Abstract

Background

Material and methods

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Introduction

Open access Short report Dissecting the impact of Controlling Nutritional Status (CONUT) score on survival outcomes and immuneinflammatory profiles in patients with advanced NSCLC undergoing firstline immunotherapy Federica Pecci,1 Giulia Mazzaschi,1,2 Alessandra Dodi,1,2 Prisca Tamarozzi,1 Martina Manini,1 Marianna Peroni,1 Simona D’Agnelli,1 Lucas Moron Dalla Tor ,1 Giulia Bruschi,3 Monica Pluchino,2 Michela Verzè,2 Roberta Minari,2 Fabiana Perrone,2 Paola Bordi,2 Alessandro Leonetti,2 Federico Quaini,1 Nicola Sverzellati,4 Sebastiano Buti ,1,2 Marcello Tiseo 1,2 To cite: Pecci F, Mazzaschi G, Dodi A, et al. Dissecting the impact of Controlling Nutritional Status (CONUT) score on survival outcomes and immune-inflammatory profilesin patients with advanced NSCLC undergoing first-line immunotherapy. Journal for ImmunoTherapy of Cancer 2026;14:e013045 . doi:10 . 1136/ jitc-2025-013045 ► Additional supplemental material is published online only. To view, please visit the journal online ([https://doi.org/10.1136/](https://doi.org/10.1136/)[ ](https://doi.org/10.1136/)[jitc-2025-013045](jitc-2025-013045)) . FP and GM are joint first authors. Accepted 15 December 2025 © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. For numbered affiliations see end of article. Correspondence to Professor Marcello Tiseo; [marcello.tiseo@unipr.it](marcello.tiseo@unipr.it) ABSTRACT Background The immunonutritional background has been deeply implicated in cancer behavior and clinical outcomes. In this study, we explored the prognostic impact of the Controlling Nutritional Status (CONUT) score through its correlation with blood immunophenotypesand cytokines to provide an easily available non-invasive tool to predict the survival benefit from first-line immune checkpoint inhibitors±chemotherapy (ICI±CHT) in patients affected by advanced non-small cell lung cancer (aNSCLC) . Material and methods From a prospective cohort of patients with aNSCLC treated with first-line ICI±CHT, clinicopathological data and baseline blood samples for the assessment of CONUT score (albumin, lymphocytes, total cholesterol), relevant immunophenotypes (flow cytometry) and cytokines (multiplex array) were collected. Correlations of CONUT score with survival outcomes (progressionfree/overall survival [PFS/OS]) and circulating immuneinflammatory benchmarks were analyzed. Results Among 178 patients enrolled in the AIRC (Italian Association for Cancer Research) project, 153 received ICI±CHT as first-line. Nutritional status tested by CONUTscore was available in 137 cases and was <3, meaning good nutritional status, in 77 (56 .2%), whereas scored ≥3 in 60 (43 .8%), meaning an impaired nutritional status. Ata median follow-up of 27.4 months (95% CI 22.9 to 32 .0), patients with a CONUT score <3, compared to those with CONUT score ≥3, experienced significantly longer PFS (median PFS 8.03 vs 3.88 months, HR 0 .58, 95% CI 0.40 to 0.84, p=0 .004) and OS (median OS 22.24 vs 8.75 months, HR 0 .61, 95% CI 0.40 to 0 .94, p=0 .03) . The multivariable analysis, adjusting for age, histology, metastatic sites, sex, programmed death-ligand 1 (PD-L1), Eastern Cooperative Oncology Group Performance Status and treatment type, confirmed the prognostic impact of CONUT score in terms of PFS (HR 0 .61, 95% CI 0.41 to 0 .93, p=0 .02) and OS (HR 0.60, 95% CI 0.38 to 0.96 p=0 .03) . Patients with CONUTscore ≥3 displayed significantly higher blood levels of interleukin (IL)-1β, IL-12, IL-10, interferon-γ, IL-6, and soluble PD-L1 compared with those with CONUT score <3 . A higher fraction of CD14+ cells (p=0 .01) and CD8+Ki67+(p<0 .001) lymphocytes also characterized the blood of patients with CONUT score ≥3 compared with those with CONUT score <3 . Conclusion A baseline good nutritional status (CONUTscore <3) is associated with a distinct circulating immuneinflammatory pr

FAQs

What does the CONUT score reflect in this study?

The CONUT score is calculated from serum albumin, lymphocyte count, and total cholesterol to represent nutritional reserves and immune competence.

How were immune-related measurements performed?

Baseline blood samples were analyzed for immunophenotypes by flow cytometry and for cytokines using a multiplex array.

What survival differences were observed between CONUT <3 and CONUT ≥3?

Patients with CONUT <3 had significantly longer progression-free survival and overall survival, and multivariable analysis confirmed the prognostic impact of CONUT for both endpoints.

Sep 30, 2026

Uploaded by jayni