Two kind systems are currently available to assess the

Two kind systems are currently available to assess the nutritional status of cancer patients, one is largely based on some subjective parameters, the other is totally based on the objective parameters. For score systems largely based on some subjective parameters, like Nutritional Risk Screening Score 2002 [32], and Subjective Global Assessment [33]. Above score systems needed the patients to recall the general condition of food intake or the loss of appetite within 6 months. All these indices were mostly influenced by subjective parameters of different patients, thus might easily give rise to a huge bias thus leading to an inaccurate result. There were many sore systems based on objective parameters, however, only few of them could evaluate the immune nutrition status of patients. ALB, BMI or other single indexes could also represent the nutritional status of HCC patients. However, they Crystal Violet australia may be not be comprehensive enough and therefore cannot represent the immune function of HCC patients. For comprehensive objective evaluation systems, prognostic nutrition index (PNI) and CONUT score are two most common used evaluating tools. PNI is the significant prognostic factor for evaluating short-term outcomes or OS of patients with HCC after hepatectomy [34,35]. PNI and CONUT both used ALB and TLC, two objective parameters for calculating. Compared with PNI, CONUT also included TC into consideration. A high CONUT score rather PNI was found to be an independent predictor of in-hospital mortality for HCC patients after hepatectomy [36]. COUNT score is totally based on three objective parameters (ALB, TLC, and TC). Serum ALB is known as a predictor of the immune-nutritional status, especially for HBV-related HCC patients [37]. Hypoalbuminemia has proved to be strongly associated with cachexia and poor perioperative outcomes in different malignancies [38,39]. TLC, an immunological indicator, combining with neutrophil or monocyte count has proved to be an effective detector to predict survival in HCC patients [40]. Serum TC level was reported to be correlated with OS in HCC patients [41]. Besides, the liver is also a key organ involved in lipid metabolism [42]. Based on the above evidence, CONUT seems to be a good option for evaluating the immune-nutritional function in HCC patients. We previously found that preoperative immune function of HCC patients was suppressed when compared with healthy controls [14]. In this study, we found that patients with high CONUT score not only had a significantly worse nutritional status but a poorer immune function preoperatively. After the shock of hepatectomy, the postoperative immune function of patients with high COUNT score remained poor as compared with patients with low COUNT score. In addition, the recovery ability of immune function from the baseline value to postoperative day 7 in patients with higher CONUT score was also worse. Likewise, patients with poor immune-nutritional function seemed to have a higher incidence of postoperative complications and longer hospital stay. Child-Pugh score system is the most popular model to evaluate liver reserve function and assess the candidates eligible for hepatectomy at present but it not concerns about the immune-nutritional function. A systematic review on head and neck cancer patients also found that patients with a better immune-nutrition status had fewer complications [43]. Nevertheless, nutritional supplement has already been proved to improve clinical features and laboratory data in HCC patients. Perioperative or postoperative supplementation of a branched-chain amino acid-enriched nutrient-mixture is clinically beneficial in reducing the morbidity associated with postoperative complications and in shortening the duration of hospitalization of HCC patients undergo liver resection [44,45]. In addition, branched-chain amino acid supplementation is beneficial for cirrhotic patients after radiofrequency ablation to relieve mental stress and reduce the risks for intrahepatic recurrence and complications [46]. Additional perioperative immune-nutrition therapy still could bring beneficial effects on clinical outcomes and immune status [47], addressing the importance of taking perioperative immune-nutrition status into consideration.