Xu KZ, Hu WJ, Shang YH, Miao YD, Wang LN. Modified frailty index and systemic immune-inflammation enable biological risk stratification in geriatric colorectal cancer surgery. World J Gastrointest Oncol 2026; 18(7): 119003 [DOI: 10.4251/wjgo.v18.i7.119003]
Corresponding Author of This Article
Li-Na Wang, Associate Chief Physician, Associate Professor, Deputy Director, Cancer Center, Yantai Affiliated Hospital of Binzhou Medical University, The 2nd Medical College of Binzhou Medical University, No. 717 Jinbu Street, Muping District, Yantai 264100, Shandong Province, China. 786130430@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
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editorial
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Xu KZ, Hu WJ, Shang YH, Miao YD, Wang LN. Modified frailty index and systemic immune-inflammation enable biological risk stratification in geriatric colorectal cancer surgery. World J Gastrointest Oncol 2026; 18(7): 119003 [DOI: 10.4251/wjgo.v18.i7.119003]
World J Gastrointest Oncol. Jul 15, 2026; 18(7): 119003 Published online Jul 15, 2026. doi: 10.4251/wjgo.v18.i7.119003
Modified frailty index and systemic immune-inflammation enable biological risk stratification in geriatric colorectal cancer surgery
Kai-Zhen Xu, Wen-Jian Hu, Yu-Hui Shang, Yan-Dong Miao, Li-Na Wang
Kai-Zhen Xu, Department of Comprehensive Oncology, Shandong Provincial Public Health Clinical Centre, Jinan 250000, Shandong Province, China
Kai-Zhen Xu, Wen-Jian Hu, Yu-Hui Shang, Yan-Dong Miao, Li-Na Wang, Cancer Center, Yantai Affiliated Hospital of Binzhou Medical University, The 2nd Medical College of Binzhou Medical University, Yantai 264100, Shandong Province, China
Yan-Dong Miao, Department of Oncology, Xinhui District People's Hospital, Jiangmen 529100, Guangdong Province, China
Yan-Dong Miao, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510000, Guangdong Province, China
Co-first authors: Kai-Zhen Xu and Wen-Jian Hu.
Co-corresponding authors: Yan-Dong Miao and Li-Na Wang.
Author contributions: Xu KZ and Hu WJ performed the literature retrieval and wrote the manuscript; Xu KZ and Hu WJ contributed equally to this work. Shang YH prepared the figures. All authors approved the final manuscript. Xu KZ and Hu WJ contributed equally to this work as co-first authors. The designation of Miao YD and Wang LN as co-corresponding authors is necessitated by their synergistic leadership throughout the study. Miao YD acted as the primary project architect, responsible for conceptualizing the research goals and securing the financial support essential for this work. Crucially, Miao YD managed the overall coordination of research activities and took lead responsibility for the critical review and meticulous editing of the manuscript to ensure scientific precision. Simultaneously, Wang LN provided essential clinical leadership and oversight during the execution phase. She was responsible for the strategic planning of research activities and provided vital mentorship both within and external to the core team. This dual-leadership model ensured both the administrative integrity and the high academic rigor of the project.
Supported by Shandong Province Medical and Health Science and Technology Development Plan Project, No. 202203030713, No. 202303031093, No. 202503110210, and No. 202509030205; Yantai Science and Technology Program, No. 2024YD010; Science and Technology Program of Yantai affiliated Hospital of Binzhou Medical University, No. YTFY2022KYQD06; and Twenty-First Century Public Welfare Foundation Academic Research Project, No. JJH2025001 and No. JJH2025002.
Conflict-of-interest statement: No conflict of interest associated with any of the senior authors or other coauthors contributed their efforts to this manuscript.
Corresponding author: Li-Na Wang, Associate Chief Physician, Associate Professor, Deputy Director, Cancer Center, Yantai Affiliated Hospital of Binzhou Medical University, The 2nd Medical College of Binzhou Medical University, No. 717 Jinbu Street, Muping District, Yantai 264100, Shandong Province, China. 786130430@qq.com
Received: January 16, 2026 Revised: January 29, 2026 Accepted: February 9, 2026 Published online: July 15, 2026 Processing time: 170 Days and 22.8 Hours
Abstract
The global demographic shift toward an aging population has significantly increased the incidence of colorectal cancer (CRC) among older adults. However, chronological age alone is an insufficient predictor of surgical risk and oncological outcomes. A recent study published by Qi et al in World Journal of Gastrointestinal Oncology identifies the modified frailty index and the systemic immune-inflammation index as critical indices for predicting postoperative complications and recurrence-free survival. This editorial provides an in-depth analysis of how frailty and systemic inflammation intersect to dictate the clinical trajectory of geriatric CRC patients. We discuss the biological mechanisms of immunosenescence, the impact of physiological reserve depletion, and the necessity of incorporating multidimensional indices into routine clinical practice to facilitate personalized prehabilitation and optimized perioperative care.
Core Tip: Chronological age alone poorly captures operative risk in older adults with colorectal cancer. Integrating the modified frailty index with the systemic immune-inflammation index (platelet count × neutrophil count/lymphocyte count) enables biological risk stratification that better predicts postoperative complications and recurrence-free survival. This combined framework links frailty-related loss of physiological reserve with inflammaging-driven immune dysregulation, clarifying why vulnerable patients deteriorate after surgical stress and supporting individualized decisions, targeted prehabilitation, and intensified perioperative surveillance.
