Journal of Capital Medical University ›› 2025, Vol. 46 ›› Issue (3): 410-419.doi: 10.3969/j.issn.1006-7795.2025.03.003

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Comparison of the prognostic value of 15 nutritional/inflammatory indicators in postoperative cancer patients

Liu Xiaoqian1,2#, Sun Kai1,2#, Wang Xiaolin1,2， Zhao Qianqian1,2, Wu Xiaoxiao1,2, Shen Fangqi1,2, Chen Xi1,2,Tian Chenxu1,2, Wu Di1,2, Song Chunhua3, Xu HongXia4, Cong Minghua5, Shi Hanping1,2, Jia Pingping1,2*   

  1. 1.Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China; 2. State Market Regulation, Key Laboratory of Cancer FSMP for State Market Regulation, Beijing 100038, China; 3.College of Public Health, Zhengzhou University, Zhengzhou 450001, China, 4.Department of Clinical Nutrition, Daping Hospital, Army Medical University, Chongqing 400037, China; 5.Department of Comprehensive Oncology，Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021，China
  • Received:2025-02-27 Online:2025-06-21 Published:2025-06-24
  • Supported by:
    This study was supported by National Natural Science Foundation of China (82273940), the National Key Research and Development Program of China (2022YFC2010100,2022YFC2010101).

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Abstract: Objective  To explore and identify the nutritional/inflammatory indicator with the highest predictive potential for overall survival (OS) in postoperative tumor patients so as to provide guidance for postoperative rehabilitation of tumor patients. Methods  Data from 3 191 surgical patients were collected, including 15 nutritional/inflammatory indicators. The maximum selection rank statistic method was used to calculate the optimal cut-off values for continuous indicators. The Kaplan-Meier method was used to assess OS, and Cox proportional hazards models were used to analyze the association between the aforementioned 15 indicators and survival. The predictive value of these 15 indicators was evaluated with receiver operating characteristic (ROC) curves and C-index. Results  Multivariate analysis showed that all 15 indicators were significantly associated with poorer OS in surgical patients (P<0.05 for all). Time-dependent area under the curve (AUC) and C-index analysis indicated that 3 indicators with the highest predictive potential in OS in postoperative tumor patients were the nutritional risk index (NRI) (C-index: 0.597), C-reactive protein-to-albumin ratio (CAR) (C-index: 0.587), and C-reactive protein-to-lymphocyte ratio (CLR) (C-index: 0.587). The optimal cut-off value for NRI was determined to be 104.31 (i.e., NRI<104.31 suggests malnutrition) with the maximum selection rank statistic method, the optimal cut-off value for CAR to be 0.05 (i.e., CAR≥0.05 suggests a strong inflammatory response, often accompanied by malnutrition), and the optimal cut-off value for CLR to be 1.18 (i.e., CLR≥1.18 suggests a strong inflammatory response). Subgroup analysis indicated that NRI, CAR, and CLR had good correlation with tumor staging, and there were significant differences between tumor node metastasis (TNM) Ⅲ/Ⅳ stage patients and TNM Ⅰ/Ⅱ stage patients when there was a strong inflammatory response or malnutrition. Conclusion In postoperative tumor patients, NRI, CLR, and CAR have high prognostic value. Combining  these with the patient's clinical stage, it enables more precise guidance for clinical diagnosis and treatment strategies. 

Key words: inflammation indicators, nutritional indicators, cancer, postoperative outcomes, prognosis prediction

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