Preoperative immunonutrition status predicts survival after colorectal cancer resection: Nomogram based on modified systemic inflammation score

doi:10.3748/wjg.119360

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Publication Name

World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Aug 14, 2026; 32(30): 119360
Published online Aug 14, 2026. doi: 10.3748/wjg.119360

Preoperative immunonutrition status predicts survival after colorectal cancer resection: Nomogram based on modified systemic inflammation score

Kuan Wang, Bo-Xiang Zhang, Ke-Jin Li, Jun-Min Guan, Bo-Yang Li, Ze-Hao Hong, Xiang-Yue Zeng, Ze-Liang Zhao, Yi Chen

Kuan Wang, Xiang-Yue Zeng, Ze-Liang Zhao, Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China

Bo-Xiang Zhang, Yi Chen, Cancer Research Institute, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China

Ke-Jin Li, Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510000, Guangdong Province, China

Jun-Min Guan, Department of Gastrointestinal Oncology Surgery, Gastroenterology Center, People’s Hospital of Bortala Mongolian Autonomous Prefecture, Bole City 833499, Xinjiang Uygur Autonomous Region, China

Bo-Yang Li, Ze-Hao Hong, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China

Yi Chen, Xinjiang Key Laboratory of Translational Biomedical Engineering, Urumqi 830011, Xinjiang Uygur Autonomous Region, China

Co-first authors: Kuan Wang and Bo-Xiang Zhang.

Co-corresponding authors: Ze-Liang Zhao and Yi Chen.

Author contributions: Zhao ZL and Chen Y contributed to study concept and design; Wang K, Li KJ, Guan JM, Zeng XY, Li BY and Hong ZH collected clinical data; Wang K and Zhang BX performed data analysis and interpretation; Wang K drafted the manuscript; Chen Y and Zhao ZL critically revised the manuscript for important intellectual content and supervised the study; Wang K and Zhang BX contributed equally to this work as co-first authors; Zhao ZL and Chen Y contributed equally to this work as co-corresponding authors; and all authors approved the final version to be published.

AI contribution statement: No AI writing tools, including ChatGPT, Grammarly, DeepL, or any similar tools, were used at any stage of manuscript preparation. The entirety of the manuscript-including the Abstract, Introduction, Materials and Methods, Results, Discussion, and Conclusion-was written entirely by the authors. No portion of the main text was AI-generated. No AI tools were used for language polishing, translation, data analysis, or any form of writing assistance. All language editing and revision were performed manually by the authors. The study was independently designed, conducted, and interpreted by the research team. No AI tools participated in any aspect of study design or result interpretation. All figures in the manuscript were generated using standard statistical software (SPSS and R). No AI tools were used to generate any images or figures.

Supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region, No. 2022D01C297.

Institutional review board statement: The study was authorized by the Ethics Committee of Xinjiang Medical University Cancer Hospital (approval No. K-2024056) and the Ethics Committee of People’s Hospital of Bortala Mongolian Autonomous Prefecture (approval No. LLSH20241221), in accordance with the Declaration of Helsinki.

Informed consent statement: All study participants or their legal guardian provided written informed consent for the collection and use of clinical and personal data prior to study enrollment.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.

Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at 3097993756@qq.com. The shared data are de-identified, and all participants provided consent for data sharing.

Corresponding author: Yi Chen, MD, Professor, Cancer Research Institute, The Affiliated Cancer Hospital of Xinjiang Medical University, No. 789 Suzhou East Street, Xinshi District, Urumqi 830011, Xinjiang Uygur Autonomous Region, China. chenyicsu@outlook.com

Received: January 27, 2026
Revised: April 7, 2026
Accepted: April 17, 2026
Published online: August 14, 2026
Processing time: 177 Days and 11.8 Hours

Abstract

BACKGROUND

Colorectal cancer (CRC) imposes a heavy burden on global public health and economic development. Reliable and accessible biomarkers reflecting host-tumor interactions, including immune-nutritional status, are urgently needed to optimize postoperative management in resectable CRC. We hypothesized that the modified systemic inflammation score (mSIS), reflecting immune-nutritional status, could stratify overall survival (OS) after curative resection.

AIM

To develop and externally validate an mSIS-based nomogram for predicting OS after radical resection for CRC.

METHODS

This retrospective two-center cohort study included 489 stage I-III CRC patients undergoing curative-intent resection. The Affiliated Cancer Hospital of Xinjiang Medical University formed the training cohort (n = 293) and People’s Hospital of Bortala Mongolian Autonomous Prefecture the external validation cohort (n = 196). Cutoffs were determined using receiver operating characteristic analyses. OS was evaluated using Kaplan-Meier and Cox regression. The nomogram was assessed by time-dependent receiver operating characteristic curves, calibration, and decision curve analysis.

RESULTS

The optimal cutoffs were 2.96 for neutrophil-to-lymphocyte ratio and 38.95 g/L for albumin. Patients were stratified into three mSIS risk groups, and higher mSIS consistently indicated inferior survival. In the training cohort, 5-year OS rates were 93.75%, 61.26%, and 18.18% for mSIS 0, 1, and 2, respectively (log-rank P < 0.001). mSIS outperformed platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and systemic inflammation response index, with an area under the curve of 0.823, and remained an independent predictor of OS. The nomogram achieved area under the curve values of 0.880/0.874/0.891 (1-/3-/5-year) in the training cohort and 0.902/0.881/0.850 in the validation cohort.

CONCLUSION

The mSIS enables immune-nutritional stratification and individualized OS prediction in stage I-III CRC after curative resection, supporting postoperative risk classification and decision-making.

Keywords: Colorectal cancer; Systemic inflammation; Immunonutrition; Nomogram; Prognostic model

Core Tip: This study developed and externally validated a nomogram integrating multiple hematological indicators reflecting immune-nutritional status and systemic inflammation to predict overall survival after curative resection for colorectal cancer. The model demonstrated robust predictive performance in both the training and external validation cohorts. As a simple and readily generalizable tool, it may facilitate postoperative risk stratification, support individualized surveillance strategies, and inform precision clinical decision-making, ultimately improving long-term outcomes in patients with colorectal cancer.