Inflammation-Immunity-Nutrition Score: A Novel Prognostic Score for Patients with Resectable Colorectal Cancer

Abstract

Purpose This study was designed to investigate the prognostic value of the combination of high-sensitivity C-reactive protein, lymphocyte, and albumin in patients with resectable colorectal cancer. Patients and Methods Seven-hundred-and-nineteen patients who underwent colorectal cancer resection in Hubei Cancer Hospital were included. Inflammation-Immunity-Nutrition score (0–6) was constructed based on preoperative high-sensitivity C-reactive protein, lymphocyte, and albumin. Time-dependent receiver operating characteristic curve, decision curve, Kaplan-Meier survival curve, Cox regression, and C-index were conducted to detect the prognostic values of inflammation-immunity-nutrition score. The prognostic values of inflammation-immunity-nutrition score in different subgroups by sex, location of tumor, pathologic stage, and KRAS mutation were also explored. The prognostic performance of inflammation-immunity-nutrition score was further compared with that of other traditional prognostic indicators. Results The median follow-up time was 40 months. High inflammation-immunity-nutrition score (>2 scores) presented worse survival, with the adjusted hazard ratios (95% confidence intervals) of 3.106 (2.202–4.380) for overall survival and 2.105 (1.604–2.764) for disease-free survival. Besides, the associations of high inflammation-immunity-nutrition score with overall survival were even stronger in cases with wild type KRAS , with the adjusted hazard ratios (95% confidence intervals) of 4.018 (2.355–6.854). Considering the AUCs, C-indices, and hazard ratios estimates, inflammation-immunity-nutrition score presented better prognostic performance than high-sensitivity modified Glasgow prognostic score, high-sensitivity C-reactive protein to albumin ratio, prognostic nutrition index, carcinoembryonic antigen, and carbohydrate antigen 19-9 for overall survival. Conclusion Inflammation-immunity-nutrition score might serve as a powerful prognostic score in patients with colorectal cancer for overall survival, particularly in patients with wild type KRAS .

Prognostic value of inflammation‐immunity‐nutrition score in patients with hepatocellular carcinoma treated with anti‐PD‐1 therapy

“…A simple and novel serum biomarker, inflammation‐immunity‐nutrition score (IINS), which is based on hsCRP, LYM, and ALB, was proposed by Li et al and reported to play strong predictive roles in prognostic outcome for patients with resectable colorectal cancer (CRC). A high IINS was associated with the worse survival of CRC 12 . Furthermore, IINS might serve as an ideal biomarker because of being easily accessible, noninvasive, and cost‐effective.…”

“…A high IINS was associated with the worse survival of CRC. 12 Furthermore, IINS might serve as an ideal biomarker because of being easily accessible, noninvasive, and cost‐effective.…”

“…Studies have shown that prognostic scores derived from the combination of several of hsCRP, LYM, and ALB were constructed, such as hsCRP/ALB, hsCRP/LYM, PNI, and were superior to individual indicators in terms of predictive ability 6,8,9 . As a result, Li et al initiated that inflammation‐immunity‐nutrition score (IINS), which was simply based on hsCRP, LYM, and ALB, might be prognostic predictor for patients with resectable colorectal cancer, and high IINS presented treatment failure and poor prognosis 12 . However, the prognostic role of IINS in HCC patients treated with anti‐PD‐1 therapy has not been evaluated.…”

“… 6 , 8 , 9 As a result, Li et al initiated that inflammation‐immunity‐nutrition score (IINS), which was simply based on hsCRP, LYM, and ALB, might be prognostic predictor for patients with resectable colorectal cancer, and high IINS presented treatment failure and poor prognosis. 12 However, the prognostic role of IINS in HCC patients treated with anti‐PD‐1 therapy has not been evaluated. Therefore, this study evaluated the prognostic value of IINS on survival outcomes in patients with HCC treated with anti‐PD‐1 therapy using real‐world data.…”

The Efficacy of Different Inflammatory Markers for the Prognosis of Patients with Malignant Tumors

“…60,61 As a real-world clinical study with prognosis and malnutrition as the outcome variables, our study comprehensively reflects the overall situation of cancer patients to some extent. Although previous studies 14,62,63 have explored the use of inflammatory markers for prognostic prediction in patients with malignant tumors, there were certain limitations. First of all, there has been controversy about the choice of markers that best reflect inflammatory conditions.…”