Chen K, Li H, Chen HH. Association between lymphopenia and the survival of patients with colorectal cancer: A meta-analysis. World J Gastrointest Oncol 2026; 18(9): 119140 [DOI: 10.4251/wjgo.119140]
Corresponding Author of This Article
Kai Chen, Researcher, Department of Gastrointestinal Surgery, The Affiliated Hospital of Putian University, No. 999 Dongzhen East Road, Licheng District, Putian 351100, Fujian Province, China. chenkaipt@163.com
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Gastroenterology & Hepatology
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research-article
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Chen K, Li H, Chen HH. Association between lymphopenia and the survival of patients with colorectal cancer: A meta-analysis. World J Gastrointest Oncol 2026; 18(9): 119140 [DOI: 10.4251/wjgo.119140]
World J Gastrointest Oncol. Sep 15, 2026; 18(9): 119140 Published online Sep 15, 2026. doi: 10.4251/wjgo.119140
Association between lymphopenia and the survival of patients with colorectal cancer: A meta-analysis
Kai Chen, Hang Li, Han-He Chen
Kai Chen, Han-He Chen, Department of Gastrointestinal Surgery, The Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
Hang Li, Department of Surgery, Xindu Town Health Center, Putian 351100, Fujian Province, China
Author contributions: Li H designed research; Chen K designed research, analyzed data and analytic tools, wrote the paper and performed research; Chen HH wrote the paper and performed research.
AI contribution statement: AI tools were not listed as authors and were not used to generate original research data, conduct independent analyses, interpret results autonomously, or draw scientific conclusions. All scientific reasoning, methodological decisions, data interpretation, and conclusions were developed and validated exclusively by the author(s).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Kai Chen, Researcher, Department of Gastrointestinal Surgery, The Affiliated Hospital of Putian University, No. 999 Dongzhen East Road, Licheng District, Putian 351100, Fujian Province, China. chenkaipt@163.com
Received: January 20, 2026 Revised: March 13, 2026 Accepted: June 16, 2026 Published online: September 15, 2026 Processing time: 217 Days and 21.4 Hours
Abstract
BACKGROUND
Lymphopenia is a potential prognostic biomarker in colorectal cancer (CRC), but its association with survival remains unclear.
AIM
To evaluate the impact of lymphopenia on progression-free survival (PFS) and overall survival (OS) of CRC in a meta-analysis.
METHODS
We systematically searched PubMed, EMBASE, and Web of Science for cohort studies published up to May 7, 2025, investigating the association between lymphopenia, defined by the absolute lymphocyte count (ALC), and survival in CRC. Hazard ratio (HR) with 95% confidence interval (CI) were pooled using random-effects models by incorporating the possible influence of heterogeneity.
RESULTS
Thirteen retrospective cohort studies were included. Lymphopenia was significantly associated with worse PFS (HR = 2.49, 95%CI: 1.87-3.32, P < 0.001) and OS (HR = 2.10, 95%CI: 1.60-2.76, P < 0.001), with moderate heterogeneity (I2 = 43% and 39%, respectively). Subgroup analyses demonstrated that treatment-related lymphopenia had a stronger association with poor PFS than pretreatment lymphopenia (HR = 3.40 vs 1.90; P for subgroup difference = 0.02). PFS was also more adversely affected when ALC was defined using a lower cutoff (< 600/μL vs ≥ 600/μL, HR = 4.43 vs 1.98; P = 0.02). For OS, the associations were consistent across subgroups based on region, age, timing, and ALC cutoffs (all P for subgroup difference > 0.05). According to further meta-regression, the results were not significantly modified by ALC cutoffs.
CONCLUSION
Both pretreatment and treatment-related lymphopenia are potentially associated with worse survival in patients with CRC. These findings support the prognostic value of lymphocyte monitoring in CRC management.
Core Tip: This meta-analysis synthesized evidence from 13 retrospective cohort studies involving 3383 patients with colorectal cancer (CRC) to clarify the prognostic significance of lymphopenia. Both pretreatment and treatment-related lymphopenia were significantly associated with poorer progression-free and overall survival. Notably, treatment-related lymphopenia and lower absolute lymphocyte count cutoffs showed stronger associations with disease progression. These findings highlight lymphopenia as a simple, readily available immune biomarker for risk stratification and prognosis assessment in CRC, supporting closer lymphocyte monitoring during clinical management.
