Relationship between preoperative modified frailty index, immune-inflammation index, and outcomes of colorectal cancer surgery in older patients

doi:10.4251/wjgo.v18.i2.115224

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Feb 15, 2026 (publication date) through Feb 23, 2026

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World Journal of Gastrointestinal Oncology

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1948-5204

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

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World J Gastrointest Oncol. Feb 15, 2026; 18(2): 115224
Published online Feb 15, 2026. doi: 10.4251/wjgo.v18.i2.115224

Relationship between preoperative modified frailty index, immune-inflammation index, and outcomes of colorectal cancer surgery in older patients

Xing-Si Qi, Jing Xie, Nai-Ling Liu, Lin Yang

Xing-Si Qi, Nai-Ling Liu, Lin Yang, Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China

Jing Xie, Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China

Author contributions: Qi XS and Yang L designed the study; Qi XS wrote the manuscript; Xie J and Liu NL analyzed the data and prepared the images; Yang L revised the manuscript. All the authors contributed to the study and approved the final version of the manuscript.

Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Affiliated Hospital of Qingdao University, No. QYFY WZLL 30089.

Informed consent statement: The ethics committee approved the waiver of informed consent due to the retrospective nature of this study.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The data used in this study can be obtained from the corresponding author upon request.

Corresponding author: Lin Yang, MD, Associate Chief Physician, Department of Gastroenterology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266003, Shandong Province, China. yanglin@qdu.edu.cn

Received: October 28, 2025
Revised: November 28, 2025
Accepted: December 29, 2025
Published online: February 15, 2026
Processing time: 97 Days and 22.1 Hours

Abstract

BACKGROUND

With the aging of the population, the proportion of older patients with colorectal cancer (CRC) is increasing annually. Preoperative frailty and chronic inflammatory responses may increase the risk of postoperative complications and affect long-term survival.

AIM

To assess modified frailty index (mFI) and systemic immune-inflammation index (SII) for predicting postoperative prognosis in older patients with CRC.

METHODS

We retrospectively analyzed 247 older patients with CRC who underwent radical resection. The SII was calculated as platelet count × neutrophil count/lymphocyte count. Patients were grouped by complication occurrence. Univariate and multivariate analyses were performed for mFI, SII, and postoperative complications. Using receiver operating characteristic curve analysis, the critical SII value for predicting postoperative recurrence was identified, which was then used to divide patients into high/low mFI and high/low SII groups. Using Kaplan-Meier method between-group survival curves were drawn.

RESULTS

The 30-day complication rate was 12.55%. Multivariate logistic regression analysis identified smoking history [odds ratio (OR) = 4.822], prolonged operation time (OR = 1.037), and elevated preoperative mFI (OR = 9.342) and SII (OR = 1.002) as independent risk factors for postoperative complications (P < 0.05). On survival analysis, the average recurrence-free survival (RFS) for patients with a low mFI was 47.04 months [95% confidence interval (CI): 45.30-48.79], significantly better than the 33.83 months (95%CI: 31.31-36.36) for patients with a high mFI (log-rank, P < 0.001). The average RFS for patients with a low SII was 47.00 months (95%CI: 45.07-48.94), significantly better than the 40.06 months (95%CI: 31.37-43.74) for those with a high SII (log-rank, P < 0.001).

CONCLUSION

In older patients with CRC, the preoperative mFI and SII were significantly correlated with postoperative complications and RFS, warranting closer attention to early recurrence detection and intervention.

Keywords: Colorectal cancer; Laparoscopic radical resection; Postoperative complications; Recurrence-free survival; Modified frailty index; Systemic immune-inflammation index

Core Tip: Preoperative assessment using the modified frailty index and systemic immune-inflammation index provides valuable predictive ability for evaluating surgical risk and prognosis in older patients undergoing colorectal cancer resection. Incorporating these indices into clinical practice can help healthcare providers stratify older patients with colorectal cancer based on surgical risk, allowing targeted perioperative management to improve recovery and survival rates.