ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Colorectal Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1529670
This article is part of the Research TopicImmune Predictive and Prognostic Biomarkers in Immuno-Oncology: Refining the Immunological Landscape of CancerView all 22 articles
Predictive Value of the Systemic Inflammation Grade (SIG) for Overall Survival in Patients with Colorectal Cancer After Surgery: Outperforming NLR and mGPS
Provisionally accepted
- 1Beidahuang Industry Group General Hospital, Harbin, China
- 2Jiangsu Taizhou People's Hospital, Taizhou, China
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Background: Accurate prognostic stratification remains challenging in colorectal cancer (CRC) patients after curative resection. The Systemic Inflammation Grade (SIG), integrating neutrophil-to-lymphocyte ratio (NLR) and modified Glasgow Prognostic Score (mGPS), was proposed as a composite marker to refine risk assessment.Methods: This retrospective study analyzed 263 CRC patients undergoing R0 resection (2015-2019). Preoperative NLR and mGPS were calculated, and SIG was categorized into low (0), medium (1), and high (≥2) groups. Associations between SIG and clinicopathological variables, chemotherapy compliance, and overall survival (OS) were evaluated using ROC analysis, Kaplan-Meier curves, and Cox regression.Subgroup analyses stratified by tumor location (colon vs. rectum) were performed to assess prognostic heterogeneity.Results: Higher SIG scores correlated with elevated CEA (P=0.002), advanced TNM stage (P=0.001), and reduced chemotherapy compliance (64.0% non-compliant patients had SIG≥2, P<0.001). Multivariate analysis identified SIG (HR=2.24, P<0.001), CEA, tumor differentiation, and TNM stage as independent prognostic factors. SIG demonstrated superior prognostic accuracy (AUC=0.785) compared to NLR (0.713), mGPS (0.673), and TNM staging (0.675). Kaplan-Meier analysis revealed significant survival differences across SIG groups (5-year OS: 90.9% vs. 76.4% vs. 37.0%, P<0.001) and additional stratification within TNM stages. Subgroup analysis showed consistent prognostic efficacy of SIG in both colon and rectal cancers, with no significant interaction between SIG and tumor location (P=0.309).Conclusions: SIG outperforms existing biomarkers and complements TNM staging by capturing systemic inflammation-driven risk heterogeneity. Its prognostic consistency across colon and rectal cancers supports its utility as a universal tool for postoperative risk stratification, guiding personalized adjuvant therapy and surveillance strategies.
Keywords: systemic inflammation grade, colorectal cancer, prognosis, Neutrophil-to-lymphocyte ratio, Modified Glasgow Prognostic Score, overall survival1
Received: 17 Nov 2024; Accepted: 28 May 2025.
Copyright: © 2025 Wang, Jiang, Liu, Zhao and WANG. 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: Honggang WANG, Jiangsu Taizhou People's Hospital, Taizhou, China
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