Combined Pan-Immune-Inflammation Value and Prognostic Nutritional Index as a Prognostic Biomarker for Colorectal Cancer Undergoing Enterectomy.

[BACKGROUND] Robust biomarkers are needed to address the prognostic heterogeneity in colorectal cancer (CRC). The pan-immune-inflammation value (PIV) and prognostic nutritional index (PNI) are biomarkers of systemic inflammation and immunonutritional status, respectively. This study aimed to develop and validate a novel combined PIV-PNI score to predict survival in CRC patients undergoing curative resection.

[METHODS] This study included a total of 2116 CRC patients who underwent surgical treatment. The PIV and PNI were evaluated and cut-off values were determined. The PIV-PNI value range was 0 to 2, where 2 represented high PIV (≥ 208.9) and low PNI (≤ 49.05), with high PIV or low PNI indicated by 1 and neither is represented by a 0, respectively. The Cox regression model was used to determine the independent risk factors affecting the prognosis of the patients. A nomogram based on PIV-PNI was constructed, and its performance was evaluated using the C-index, calibration curve, ROC curve, and DCA curve. Finally, the nomogram model was compared with the existing staging models.

[RESULTS] Patients with higher PIV-PNI scores had a poorer prognosis. In the multivariate analysis, it was found that the PIV-PNI score was an independent predictor for the overall survival rate and disease-free survival rate of CRC patients. The nomogram based on PIV-PNI demonstrated excellent discrimination, calibration, and clinical net benefit. The proposed nomogram performed better than other existing staging systems, as evidenced by its higher AUC value.

[CONCLUSION] The PIV-PNI score is a potent, non-invasive prognostic biomarker. The developed nomogram facilitates accurate risk stratification, potentially guiding personalized postoperative surveillance and adjuvant therapy decisions for CRC patients.