Introduction Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide. While TNM staging remains the cornerstone for prognostic stratification, growing evidence highlights the role of systemic inflammation and nutritional status in influencing oncologic outcomes. This study aimed to evaluate the prognostic significance of preoperative immunonutritional indices in patients undergoing curative resection for stage I–III CRC. Methods This retrospective cohort study included 616 patients treated between January 2013 and December 2021 at a single tertiary center. Preoperative indices—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and systemic inflammation score (SIS)—were calculated from routine blood tests performed within four weeks prior to surgery. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier curves and Cox proportional hazard models. Results After a median follow-up of 61.3 months, 185 deaths (30.0 %) and 74 recurrences (12.0 %) were recorded. All indices demonstrated significant associations with five-year OS and DFS in univariate analysis. In multivariate analysis, PLR>176.9 (HR 1.43; 95 % CI 1.06–1.94; p = 0.02) and LMR≤3 (HR 1.46; 95 % CI 1.8–1.99; p = 0.01) were independently associated with worse OS. For DFS, significant independent predictors of adverse outcomes included NLR>2.95 (HR 1.58; 95 % CI 1.15–2.15; p = 0.004), PLR>176.9 (HR 1.65; 95 % CI 1.20–2.26; p = 0.002), LMR≤3 (HR 1.57; 95 % CI 1.14–2.15; p = 0.006), SII>529.6 (HR 1.46, 95 % CI 1.07–1.99; p = 0.02), and SIS 1–2 (HR 1.43, 95 % CI 1.03–2.06; p = 0.04). Conclusion Preoperative immunonutritional indices are independent prognostic markers in nonmetastatic colorectal cancer. Their integration with standard staging system could enhance risk stratification and guide personalized treatment.
Relationship between preoperative inflammatory status and survival in patients undergoing curative surgery for colorectal cancer
Deidda S.;Armas M.;Zorcolo L.;Restivo A.
2026-01-01
Abstract
Introduction Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide. While TNM staging remains the cornerstone for prognostic stratification, growing evidence highlights the role of systemic inflammation and nutritional status in influencing oncologic outcomes. This study aimed to evaluate the prognostic significance of preoperative immunonutritional indices in patients undergoing curative resection for stage I–III CRC. Methods This retrospective cohort study included 616 patients treated between January 2013 and December 2021 at a single tertiary center. Preoperative indices—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and systemic inflammation score (SIS)—were calculated from routine blood tests performed within four weeks prior to surgery. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier curves and Cox proportional hazard models. Results After a median follow-up of 61.3 months, 185 deaths (30.0 %) and 74 recurrences (12.0 %) were recorded. All indices demonstrated significant associations with five-year OS and DFS in univariate analysis. In multivariate analysis, PLR>176.9 (HR 1.43; 95 % CI 1.06–1.94; p = 0.02) and LMR≤3 (HR 1.46; 95 % CI 1.8–1.99; p = 0.01) were independently associated with worse OS. For DFS, significant independent predictors of adverse outcomes included NLR>2.95 (HR 1.58; 95 % CI 1.15–2.15; p = 0.004), PLR>176.9 (HR 1.65; 95 % CI 1.20–2.26; p = 0.002), LMR≤3 (HR 1.57; 95 % CI 1.14–2.15; p = 0.006), SII>529.6 (HR 1.46, 95 % CI 1.07–1.99; p = 0.02), and SIS 1–2 (HR 1.43, 95 % CI 1.03–2.06; p = 0.04). Conclusion Preoperative immunonutritional indices are independent prognostic markers in nonmetastatic colorectal cancer. Their integration with standard staging system could enhance risk stratification and guide personalized treatment.
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