ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
A Combined Immune–Nutritional Score (GRIm–CONUT) as a Prognostic Indicator in Neoadjuvant-Treated Esophageal Squamous Cell Carcinoma
Provisionally accepted
Qichang Xie1
Junpeng Zhan1Xiaolin Ye2Cheng Huang1
Chun Chen1
Bin Zheng1Guobing Xu1
Zhang Yang1*Yong Zhu1*- 1Fujian Medical University Union Hospital, Fuzhou, China
- 2Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
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Background: Reliable biomarkers that predict treatment response and long-term outcomes in neoadjuvant-treated esophageal squamous cell carcinoma (ESCC) remain limited. The Gustave Roussy Immune (GRIm) score and the Controlling Nutritional Status (CONUT) score respectively reflect systemic inflammation and nutritional status. This study evaluated whether integrating these indices (GRIm–CONUT) improves prognostic prediction in ESCC. Methods: We retrospectively analyzed 216 patients with resectable ESCC who received neoadjuvant chemotherapy, chemoradiotherapy, or chemoimmunotherapy followed by curative (R0) esophagectomy between June 2016 and December 2021. GRIm and CONUT scores were calculated from pre-treatment laboratory parameters , and patients were classified into three GRIm–CONUT categories (0, 1, 2). Logistic regression identified independent predictors of pathological complete response (pCR). Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan–Meier and Cox proportional hazards models. A nomogram incorporating GRIm–CONUT and ypTNM staging was developed and validated using bootstrap resampling. Results: Higher GRIm–CONUT scores were significantly associated with lower pCR rates (p < 0.01) and poorer OS and RFS (all p < 0.001). Multivariate logistic regression confirmed GRIm–CONUT score, cN stage, and neoadjuvant regimen as independent predictors of pCR. In multivariate Cox analysis, GRIm–CONUT and ypN stage remained independent predictors of OS, while GRIm–CONUT, ypT stage, and ypN stage independently predicted RFS. A GRIm–CONUT–based nomogram demonstrated superior discrimination (C-index 0.717 vs. 0.659 for ypTNM) and offered greater clinical net benefit in decision-curve analysis. Conclusions: The GRIm–CONUT composite score is an independent predictor of pCR, OS, and RFS in ESCC patients undergoing neoadjuvant therapy and surgery. As an inexpensive and readily obtainable biomarker, it enables more accurate prognostic stratification and may support personalized perioperative management. Prospective multicenter validation is warranted.
Keywords: Controlling Nutritional Status score, esophageal squamous cell carcinoma, GustaveRoussy Immune score, Neoadjuvant Therapy, nomogram, prognosis
Received: 09 Dec 2025; Accepted: 11 Feb 2026.
Copyright: © 2026 Xie, Zhan, Ye, Huang, Chen, Zheng, Xu, Yang and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zhang Yang
Yong Zhu
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