Integrating nutritional and immune-inflammation-based index predicts disease-free survival of colorectal cancer patients undergoing radical surgery.

Background: of survival outcomes in various tumors. The study aimed to investigate the prognostic superiority of an integrated scoring system for long-term disease-free survival (DFS) in hospitalized patients with colorectal cancer (CRC). Methods: A review of 1,443 patients undergoing radical surgery for CRC was conducted. The prognostic nutritional index (PNI), systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) were identified and utilized to develop the integrated nutritional-inflammatory-immunological scores: the nutritional-systemic immune inflammation (N-SII) and nutritional-systemic inflammation response (N-SIRI) indices. Primary endpoint was the predictive power for survival determined by the area under the curve (AUC) using receiver operating characteristic analysis. Secondary outcomes included optimal cut-off values, hazard ratios (HRs) and the prediction of long-term DFS after discharge. Results: The integrated scores of N-SII and N-SIRI demonstrated superior prognostic accuracy for long-term DFS in CRC patients with greater integrated AUCs of 0.829 [95% confidence interval (CI): 0.802-0.856] and 0.850 (95% CI: 0.825-0.874) compared to PNI, SII or SIRI alone (AUC =0.760, 0.782 and 0.784) (P<0.001). Patients with an N-SII or N-SIRI score of 2 exhibited a higher CRC-progression risk [HR =2.442 (95% CI: 1.757-2.861) for N-SII and 2.527 (95% CI: 1.907-3.349) for N-SIRI] and shorter long-term DFS [31.19 (95% CI: 28.50-33.89) Conclusions: The integrated scores of N-SII and N-SIRI complemented the limitation of each individual index, demonstrating superior accuracy in predicting long-term DFS in CRC patients.