{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T09:09:05Z","timestamp":1788944945167,"version":"build-2803163510"},"reference-count":27,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Metastatic pancreatic adenocarcinoma is related to poor prognosis and is frequently accompanied by malnutrition, inflammation, and immune dysregulation. The Controlling Nutritional Status (CONUT) score is a composite laboratory-based index that may reflect aspects of nutritional and immune status. This study aimed to evaluate the association between pretreatment CONUT score and overall survival (OS) in patients with metastatic pancreatic adenocarcinoma receiving first-line systemic chemotherapy. Materials and Methods: In this retrospective analysis, a total of 156 patients diagnosed with metastatic pancreatic adenocarcinoma between January 2017 and July 2024 and treated with first-line systemic chemotherapy were included. Based on the conventional CONUT classification, patients were categorized a priori into normal-CONUT (scores 0\u20131) and elevated-CONUT (scores \u2265 2) groups, with CONUT additionally evaluated as a continuous score. OS was estimated using the Kaplan\u2013Meier method. Univariable and multivariable Cox regression analyses were performed to evaluate the association between the CONUT score, selected clinical factors, and overall survival. Results: The cohort demonstrated a median OS of 9.1 months (95% CI: 6.6\u201311.6). OS was significantly better among individuals classified in normal CONUT group relative to elevated CONUT group (14.1 vs. 6.5 months, respectively, p &lt;0.001). Higher continuous CONUT scores were also associated with shorter OS (HR 1.23 (1.14\u20131.32), p &lt; 0.001). In multivariable analysis, an elevated CONUT score (HR, 2.40 (1.63\u20133.52); p &lt;0.001), liver metastases (HR 1.99 (1.31\u20133.02); p = 0.001), and the presence of comorbidity (HR, 1.88 (1.28\u20132.75); p = 0.001) remained significantly associated with shorter OS. Conclusions: An elevated pretreatment CONUT score was associated with shorter overall survival in this selected chemotherapy-treated cohort. As a readily available laboratory-based index, CONUT may provide additional prognostic information; however, prospective studies are needed to determine whether it adds value beyond established clinical factors.<\/jats:p>","DOI":"10.3390\/medicina62091732","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T08:05:43Z","timestamp":1788941143000},"page":"1732","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pretreatment CONUT Score and Overall Survival in Patients with Metastatic Pancreatic Adenocarcinoma Receiving First-Line Chemotherapy: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3613-6482","authenticated-orcid":false,"given":"Zeynep","family":"Alaca Topcu","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Goztepe Prof. Dr. Suleyman Yalc\u0131n City Hospital, Istanbul Medeniyet University, \u0130stanbul 34722, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Serhat","family":"Demirer","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Haydarpasa Numune Research and Training Hospital, \u0130stanbul 34668, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7336-4647","authenticated-orcid":false,"given":"Tuba","family":"Baydas","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Goztepe Prof. Dr. Suleyman Yalc\u0131n City Hospital, Istanbul Medeniyet University, \u0130stanbul 34722, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Mehmet","family":"Besiroglu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Goztepe Prof. Dr. Suleyman Yalc\u0131n City Hospital, Istanbul Medeniyet University, \u0130stanbul 34722, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Mahmut","family":"Gumus","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Goztepe Prof. Dr. Suleyman Yalc\u0131n City Hospital, Istanbul Medeniyet University, \u0130stanbul 34722, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref_1","unstructured":"OECD (2025). Health at a Glance 2025: OECD Indicators, OECD Publishing."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1002\/ijc.35278","article-title":"The GLOBOCAN 2022 cancer estimates: Data sources, methods, and a snapshot of the cancer burden worldwide","volume":"156","author":"Filho","year":"2025","journal-title":"Int. J. Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1016\/S0140-6736(20)30974-0","article-title":"Pancreatic cancer","volume":"395","author":"Mizrahi","year":"2020","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1038\/s41575-021-00457-x","article-title":"Pancreatic cancer epidemiology: Understanding the role of lifestyle and inherited risk factors","volume":"18","author":"Klein","year":"2021","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_5","first-page":"38","article-title":"CONUT: A tool for controlling nutritional status. First validation in a hospital population","volume":"20","author":"Mancha","year":"2005","journal-title":"Nutr. Hosp."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Wang, X., Yang, J., Hou, Y., Wu, T., Wang, X., Zhang, X., and Zhou, X. (2026). Prognostic value of the Controlling Nutritional Status (CONUT) score in cancer: An umbrella review of systematic reviews and meta-analyses. Front. Nutr., 13.","DOI":"10.3389\/fnut.2026.1854644"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ma, X., Zou, W., and Sun, Y. (2022). Prognostic Value of Pretreatment Controlling Nutritional Status Score for Patients With Pancreatic Cancer: A Meta-Analysis. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.770894"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Tan, C.R., Yaffee, P.M., Jamil, L.H., Lo, S.K., Nissen, N., Pandol, S.J., Tuli, R., and Hendifar, A.E. (2014). Pancreatic cancer cachexia: A review of mechanisms and therapeutics. Front. Physiol., 5.","DOI":"10.3389\/fphys.2014.00088"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1177\/2050640620938987","article-title":"Pancreatic exocrine insufficiency and pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer: A systematic review and meta-analysis","volume":"8","author":"Avci","year":"2020","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Rovesti, G., Valoriani, F., Rimini, M., Bardasi, C., Ballarin, R., Di Benedetto, F., Menozzi, R., Dominici, M., and Spallanzani, A. (2021). Clinical Implications of Malnutrition in the Management of Patients with Pancreatic Cancer: Introducing the Concept of the Nutritional Oncology Board. Nutrients, 13.","DOI":"10.3390\/nu13103522"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12937-024-00920-w","article-title":"Prognostic potential of nutritional risk screening and assessment tools in predicting survival of patients with pancreatic neoplasms: A systematic review","volume":"23","author":"Yu","year":"2024","journal-title":"Nutr. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1038\/s41598-021-04128-4","article-title":"Clinical significance of controlling nutritional status score (CONUT) in evaluating outcome of postoperative patients with gastric cancer","volume":"12","author":"Xiao","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"17715","DOI":"10.1038\/s41598-023-45096-1","article-title":"Prognostic value of controlling nutritional status on clinical and survival outcomes in cancer patients treated with immunotherapy","volume":"13","author":"Zhang","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bae, M.I., Jung, H., Park, E.J., Kwak, Y.L., and Song, Y. (2024). Prognostic Value of the Controlling Nutritional Status (CONUT) Score in Patients Who Underwent Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy. Cancers, 16.","DOI":"10.3390\/cancers16152727"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.12669\/pjms.41.4.11660","article-title":"Controlling nutritional status score is a predictor of survival in hepatocellular carcinoma: A meta-analysis and meta-regression","volume":"41","author":"Chen","year":"2025","journal-title":"Pak. J. Med. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Takamizawa, Y., Shida, D., Boku, N., Nakamura, Y., Ahiko, Y., Yoshida, T., Tanabe, T., Takashima, A., and Kanemitsu, Y. (2020). Nutritional and inflammatory measures predict survival of patients with stage IV colorectal cancer. BMC Cancer, 20.","DOI":"10.1186\/s12885-020-07560-3"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"155","DOI":"10.5230\/jgc.2021.21.e14","article-title":"The Predictive Values of Pretreatment Controlling Nutritional Status (CONUT) Score in Estimating Short- and Long-term Outcomes for Patients with Gastric Cancer Treated with Neoadjuvant Chemotherapy and Curative Gastrectomy","volume":"21","author":"Jin","year":"2021","journal-title":"J. Gastric Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e26488","DOI":"10.1097\/MD.0000000000026488","article-title":"Prognostic impact of the pre-treatment controlling nutritional status score in patients with non-small cell lung cancer: A meta-analysis","volume":"100","author":"Peng","year":"2021","journal-title":"Medicine"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Une, M., Ito, M., Suzuki, H., Toide, M., Kobayashi, S., Fukushima, H., and Koga, F. (2022). Controlling Nutritional Status (CONUT) Score and Sarcopenia as Mutually Independent Prognostic Biomarkers in Advanced Urothelial Carcinoma. Cancers, 14.","DOI":"10.3390\/cancers14205075"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.pan.2026.04.008","article-title":"The clinical utility of nutritional and immunological indices as prognostic factors in pancreatic cancer after pancreatectomy","volume":"26","author":"Adachi","year":"2026","journal-title":"Pancreatology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.pan.2022.01.010","article-title":"Impact of Controlling nutritional status (CONUT) in patients with unresectable advanced pancreatic cancer receiving multi-agent chemotherapy: A single center, retrospective cohort study","volume":"22","author":"Uemura","year":"2022","journal-title":"Pancreatology"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Peker, P., Ge\u00e7gel, A., Y\u0131lmaz, S., C\u0131r\u0131k, C., Selvi, S., Duman, B.B., and \u00c7il, T. (2025). Prognostic Value of CONUT and ALBI in Metastatic Pancreatic Cancer: A Retrospective Cohort Study. Diagnostics, 15.","DOI":"10.3390\/diagnostics15243161"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.critrevonc.2010.05.007","article-title":"Comorbidity, not age, is prognostic in patients with advanced pancreatic cancer receiving gemcitabine-based chemotherapy","volume":"78","author":"Nakai","year":"2011","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.ijsu.2017.01.115","article-title":"The Charlson age comorbidity index predicts prognosis in patients with resected pancreatic cancer","volume":"39","author":"Asano","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.sopen.2023.02.001","article-title":"The impact of age and comorbidity on localized pancreatic cancer outcomes: A US retrospective cohort analysis with implications for surgical centralization","volume":"12","author":"Powers","year":"2023","journal-title":"Surg. Open Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1038\/s41698-025-01202-2","article-title":"Deciphering the liver\u2019s role in pancreatic cancer metastasis: Pathways and therapeutic approaches","volume":"9","author":"Inzunza","year":"2025","journal-title":"npj Precis. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.3748\/wjg.v23.i10.1872","article-title":"Prognostic value of site-specific metastases in pancreatic adenocarcinoma: A Surveillance Epidemiology and End Results database analysis","volume":"23","author":"Oweira","year":"2017","journal-title":"World J. Gastroenterol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1732\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T08:45:21Z","timestamp":1788943521000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1732"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":27,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["medicina62091732"],"URL":"https:\/\/doi.org\/10.3390\/medicina62091732","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]}}}