Prognostic value of glasgow prognostic score, systemic immune-inflammatory index, and CRP/albumin ratio in patients with metastatic colorectal cancer

Objective: The aim of this study was to assess the prognostic value of inflammatory biomarkers including the Glasgow Prognostic Score (GPS), Systemic Immune Inflammation Index (SII), CRP/Albumin Ratio (CAR), along with other inflammation-based markers [Hemoglobin, Albumin, Lymphocyte, Platelet Score (HALP), Neutrophil/Lymphocyte Ratio (NLR)] in patients with colorectal cancer who were diagnosed with metastasis at the time of diagnosis or developed metastasis during follow-up. Materials and Methods: This study is a single-center, retrospective investigation. The data of 120 patients with colon and rectal cancer who presented to the outpatient clinics of the Department of Medical Oncology at Manisa Celal Bayar University Faculty of Medicine between 2010 and 2022, and were diagnosed with metastatic disease at the time of diagnosis or developed metastasis during follow-up, were retrospectively analyzed. The inflammatory biomarkers GPS, High C-reactive Protein (CRP) concentration (>10 mg/L), and hypoalbuminemia (<3.5 g/dL) were determined using a combination approach. The prognostic scoring system (0, 1, 2) was defined as follows: patients with high CRP (>10 mg/L) and hypoalbuminemia (<3.5 g/dL) received 2 points. Patients with only one of these biochemical abnormalities received a score of 1. Patients with none of these abnormalities were assigned a score of 0. CAR and NLR were calculated using the laboratory data from the patients' files. SII was calculated as P*N/L, where P, N, and L represented the peripheral platelet, neutrophil, and lymphocyte counts, respectively. The HALP score was calculated as the product of hemoglobin (g/L) × albumin (g/L) levels × lymphocyte count (/L), divided by the platelet count (/L). In our study, these inflammatory biomarkers were evaluated in terms of their ability to predict prognosis based on overall survival. Results: HALP (AUC=0.347, p=0.010) and NLR (AUC=0.627, p=0.033) can be used for predicting mortality. HALP has a value of 0.3604 (23.2% sensitivity, 51.2% specificity). NLR has a value of 3.2159 (58.9% sensitivity, 63.4% specificity). It was found that SII, CAR, and BMI/CRP ratio could not differentiate the state of exitus (p>0.05). Patients with GPS 2 had a 3.6-fold increased risk of death compared to those with GPS 0 (HR=3.687, p<0.001). A one-unit increase in the HALP score reduces the risk of death by 75% (HR=0.256, p=0.031). Conclusion: In patients with mKRK, GPS, HALP score, and NLR have prognostic value in terms of overall survival, while CAR and SII were found to have no prognostic value in predicting average survival.