Modified CONUT score integrating C-reactive protein improves prognostic prediction in non-small cell lung cancer

Aims Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related mortality worldwide, highlighting the need for reliable prognostic indicators. The modified Controlling Nutritional Status (mCONUT) score integrates nutritional and inflammatory parameters. This study evaluated the prognostic value of mCONUT in NSCLC and developed an mCONUT-based nomogram.Patients and methods This multicenter cohort study included 900 patients with NSCLC. The previously reported CRP-integrated mCONUT scoring system was applied. The prognostic performance of CONUT and mCONUT was compared using concordance index, time-dependent receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Overall survival (OS) was the primary endpoint. Secondary outcomes included short-term survival, malnutrition, and quality of life. A nomogram was constructed based on independent prognostic factors.Results During a median follow-up of 33.4 months, 380 deaths occurred. mCONUT showed a higher C-index than CONUT for OS prediction (0.650 vs. 0.605). A high mCONUT score was independently associated with poorer OS (HR = 1.63, 95% CI: 1.28–2.06), increased short-term mortality, an increased risk of malnutrition, and worse quality of life. The mCONUT-based nomogram showed improved discrimination (C-index = 0.727).Conclusion mCONUT may serve as a supplementary prognostic tool for individualized risk stratification in patients with NSCLC.