Objective To investigate the predictive value of controlling nutritional status CONUT as a marker of recurrence and metastasis in HER2-positive early breast cancer patients. Method A total of 154 HER2-positive early breast cancer patients who underwent surgical resection and trastuzumab treatment in Affiliated Tumor Hospital of Xinjiang Medical University from January 2012 to October 2020 were retrospectively analyzed. CONUT score was calculated according to the lymphocyte count in peripheral blood serum albumin and total cholesterol level. The cut-off value of CONUT score was identified by the receiver operation characteristics curve ROC curve and all patients were divided into high CONUT and low CONUT group based on the cut-off point. The comparison of baseline characteristics between the two groups was performed using Chi square χ 2 test or Fisher exact test. The Kaplan-Meier curves were plotted and the correlation between CONUT score and recurrence-free survival RFS of breast cancer patients was determined by the univariate and multivariate Cox regression analysis. Result The ROC curve showed that the best cut-off value of CONUT score for predicting recurrence and metastasis of breast cancer patients was 2. 5 with an AUC value of 0. 689 95% CI 0. 577-0. 801 . All patients were divided into high CONUT ≥3 points and low CONUT <3 points group according to this cut-off value. Kaplan-Meier survival curves showed that the 5-year RFS of the two patient groups were 69. 7% and 86. 9% with a significantly statistical significance χ 2 = 8. 001 P= 0. 005 . Subgroup analysis further demonstrated that CONUT ≥3 were significantly associated with recurrence and metastasis of breast cancer patients irrespective of TNM stage stage I 5-year RFS 80. 9% vs 96. 9% χ 2 = 7. 946 P= 0. 005 stage Ⅱ 5-year RFS 45. 6% vs 68. 2% χ 2 = 4. 589 P = 0. 048 . The results of univariate and multivariate Cox analysis indicated that tumor size HR= 2. 184 95%CI = 1. 062-4. 492 P= 0. 034 lymph node metastasis HR = 2. 739 95%CI = 1. 283-5. 847 P = 0. 009 as well as CONUT score HR = 2. 513 95%CI = 1. 196-5. 280 P = 0. 015 were independent risk factors for recurrence and 肿瘤代谢与营养电子杂志 2022 年 6 月 9 日第 9 卷第 3 期 Electron J Metab Nutr Cancer, Jun. 9, 2022, Vol. 9, No. 3 ·333· metastasis in HER2-positive early breast cancer patients. Conclusion CONUT might be a predictor of recurrence and metastasis in HER2-positive early breast cancer patients and it might provide important clinical guidance for cancer surveillance and individualized treatment.