Krishnan A. From inflammation to precision medicine in colon cancer: Methodological considerations and future directions. World J Gastrointest Surg 2026; 18(2): 114796 [DOI: 10.4240/wjgs.v18.i2.114796]
Corresponding Author of This Article
Arunkumar Krishnan, MD, MSHCM, Assistant Professor, Senior Scientist, Department of Oncology, Atrium Health Levine Cancer, 1021 Morehead Medical Drive, Charlotte, NC 28204, United States. dr.arunkumar.krishnan@gmail.com
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Oncology
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Letter to the Editor
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 27, 2026 (publication date) through Feb 26, 2026
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Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Krishnan A. From inflammation to precision medicine in colon cancer: Methodological considerations and future directions. World J Gastrointest Surg 2026; 18(2): 114796 [DOI: 10.4240/wjgs.v18.i2.114796]
World J Gastrointest Surg. Feb 27, 2026; 18(2): 114796 Published online Feb 27, 2026. doi: 10.4240/wjgs.v18.i2.114796
From inflammation to precision medicine in colon cancer: Methodological considerations and future directions
Arunkumar Krishnan
Arunkumar Krishnan, Department of Cancer Medicine, Atrium Health Levine Cancer, Charlotte, NC 28204, United States
Author contributions: Krishnan A conceptually developed the manuscript and conducted the assessment; Krishnan A was responsible for preparing the manuscript draft, which was subsequently reviewed and approved for final publication.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Corresponding author: Arunkumar Krishnan, MD, MSHCM, Assistant Professor, Senior Scientist, Department of Oncology, Atrium Health Levine Cancer, 1021 Morehead Medical Drive, Charlotte, NC 28204, United States. dr.arunkumar.krishnan@gmail.com
Received: September 28, 2025 Revised: November 3, 2025 Accepted: December 8, 2025 Published online: February 27, 2026 Processing time: 151 Days and 7.2 Hours
Abstract
A recent study by Zhu SS et al evaluated the prognostic value of the systemic immune-inflammation index and serum lactoferrin in older patients with colon cancer. While this work highlights the potential role of inflammation-based biomarkers in predicting survival, several methodological and analytical concerns limitations constrain its clinical applicability. These include a small sample size, a single-center observational design, a short follow-up duration, incomplete adjustment for confounding variables, and reliance on cut-off thresholds derived from receiver operating characteristic analyses, which increases the risk of overfitting. Moreover, the reported predictive accuracy was moderate, yet the findings were presented as clinically decisive, warranting caution in interpretation. Future studies should aim for multicenter, prospective cohorts with larger sample sizes, longer follow-up periods, and the integration of established prognostic indices and molecular biomarkers. Incorporating rigorous statistical validation and exploring biomarker dynamics over time would strengthen external validity. Addressing these issues could advance the development of reliable, inflammation-based prognostic tools and support individualized treatment strategies for elderly colon cancer patients.
Core Tip: A study by Zhu SS et al reported that the systemic immune-inflammation index and serum lactoferrin levels predict survival in elderly patients with colon cancer. While promising, the study was limited by a small, single-center cohort, a short follow-up period, and an incomplete adjustment for confounders. Predictive accuracy was only moderate, yet conclusions were overstated. To ensure clinical utility, future research should validate systemic immune-inflammation index and lactoferrin in larger, multicenter studies with longer follow-up, benchmark them against established prognostic indices, and incorporate molecular markers. Such efforts are crucial to establishing reliable, externally validated prognostic tools for the individualized management of older colon cancer patients.
