Pretreatment CONUT Score and Overall Survival in Patients with Metastatic Pancreatic Adenocarcinoma Receiving First-Line Chemotherapy: A Retrospective Cohort Study

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 0–1) and elevated-CONUT (scores ≥ 2) groups, with CONUT additionally evaluated as a continuous score. OS was estimated using the Kaplan–Meier 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: 6.6–11.6). OS was significantly better among individuals classified in normal CONUT group relative to elevated CONUT group (14.1 vs. 6.5 months, respectively, p <0.001). Higher continuous CONUT scores were also associated with shorter OS (HR 1.23 (1.14–1.32), p < 0.001). In multivariable analysis, an elevated CONUT score (HR, 2.40 (1.63–3.52); p <0.001), liver metastases (HR 1.99 (1.31–3.02); p = 0.001), and the presence of comorbidity (HR, 1.88 (1.28–2.75); 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.