Predictive value of the systemic inflammation grade for overall survival in patients with colorectal cancer after surgery: outperforming NLR and mGPS

Jianing Wang; Yujun Liu; Wenliang Jiang; Dongli Zhang; Chao Cheng; Cuixia Liu; Zhibin Zhao; Honggang Wang

doi:10.3389/fonc.2025.1529670

Predictive value of the systemic inflammation grade for overall survival in patients with colorectal cancer after surgery: outperforming NLR and mGPS

Front Oncol. 2025 Jun 17:15:1529670. doi: 10.3389/fonc.2025.1529670. eCollection 2025.

Authors

Jianing Wang^#¹, Yujun Liu², Wenliang Jiang^#², Dongli Zhang^#³, Chao Cheng², Cuixia Liu³, Zhibin Zhao³, Honggang Wang²

Affiliations

¹ Department of General Surgery, Beidahuang Industry Group General Hospital, Harbin, Heilongjiang, China.
² Department of General Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China.
³ Department of Gastroenterology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China.

^# Contributed equally.

Abstract

Background: Accurate prognostic stratification remains challenging in colorectal cancer (CRC) patients after curative resection. The Systemic Inflammation Grade (SIG), integrating neutrophil-to-lymphocyte ratio (NLR) and modified Glasgow Prognostic Score (mGPS), was proposed as a composite marker to refine risk assessment.

Methods: This retrospective study analyzed 263 CRC patients undergoing R0 resection (2015-2019). Preoperative NLR and mGPS were calculated, and SIG was categorized into low (0), medium (1), and high (≥2) groups. Associations between SIG and clinicopathological variables, chemotherapy compliance, and overall survival (OS) were evaluated using ROC analysis, Kaplan-Meier curves, and Cox regression. Subgroup analyses stratified by tumor location (colon vs. rectum) were performed to assess prognostic heterogeneity.

Results: Higher SIG scores correlated with elevated CEA (P=0.002), advanced TNM stage (P=0.001), and reduced chemotherapy compliance (64.0% non-compliant patients had SIG≥2, P<0.001). Multivariate analysis identified SIG (HR=2.24, P<0.001), CEA, tumor differentiation, and TNM stage as independent prognostic factors. SIG demonstrated superior prognostic accuracy (AUC=0.785) compared to NLR (0.713), mGPS (0.673), and TNM staging (0.675). Kaplan-Meier analysis revealed significant survival differences across SIG groups (5-year OS: 90.9% vs. 76.4% vs. 37.0%, P<0.001) and additional stratification within TNM stages. Subgroup analysis showed consistent prognostic efficacy of SIG in both colon and rectal cancers, with no significant interaction between SIG and tumor location (P=0.309).

Conclusions: SIG outperforms existing biomarkers and complements TNM staging by capturing systemic inflammation-driven risk heterogeneity. Its prognostic consistency across colon and rectal cancers supports its utility as a universal tool for postoperative risk stratification, guiding personalized adjuvant therapy and surveillance strategies.

Keywords: colorectal cancer; modified Glasgow prognostic score; neutrophil-to-lymphocyte ratio; overall survival; prognosis; systemic inflammation grade.