A Novel Nutrition-Related Prognostic Biomarker for Predicting Survival in Patients with Colorectal Cancer

Abstract Background Colorectal Cancer (CRC) is a major global malignancy with significant morbidity and mortality rates. Accurate prognostic assessment plays a vital role in the management of CRC patients. In this study, we aimed to investigate the prognostic significance of red blood cell count (RBC), and develop a comprehensive biomarker based on RBC and Onodera’s prognostic nutritional index (OPNI) to predict the prognosis of resectable CRC patients. Methods We retrospectively reviewed a cohort of 210 CRC patients who underwent radical resection between January 2015 and January 2017. Various clinical and hematological factors were assessed, including RBC, albumin, hemoglobin, and OPNI. A novel comprehensive biomarker, R-OPNI, was introduced, combining preoperative RBC with OPNI. The correlation between these factors and patient survival was analyzed, and the independent prognostic value of R-OPNI was assessed based on univariate and multivariate Cox models. Results Patients with higher RBC levels (≥ 3.9 x10 12 /L) experienced significantly improved overall survival compared to those with lower RBC levels (p < 0.001). High OPNI values were also associated with prolonged survival (p < 0.001). Notably, patients with lower R-OPNI scores (0 or 1) had notably poorer overall survival (p < 0.001). Multivariate analysis confirmed R-OPNI's independent prognostic significance (HR: 0.273, 95% CI: 0.098–0.763, p = 0.013). Furthermore, factors such as tumor site, albumin levels, albumin to globulin ratio, hemoglobin levels, and total protein levels demonstrated significant prognostic value in CRC survival. Conclusion R-OPNI is significantly associated with the survival of resectable CRC patients and serves as an independent prognostic predictor. The study also highlights the prognostic importance of RBC in CRC and emphasizes the value of assessing the preoperative nutritional status.