---
title: "CBC-derived inflammatory indices in colorectal cancer: diagnostic and prognostic head-to-head anal"
id: "british-journal-of-cancer-0-complete-blood-count-derived-inflammation-indices-in-colorectal-cancer-head-to"
canonical_url: "https://medichelpline.com/clinical-feed/british-journal-of-cancer-0-complete-blood-count-derived-inflammation-indices-in-colorectal-cancer-head-to"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "British Journal of Cancer"
source_url: "https://www.nature.com/articles/s41416-026-03647-z"
published_at: "2026-10-24T08:11:29.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# CBC-derived inflammatory indices in colorectal cancer: diagnostic and prognostic head-to-head anal
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/british-journal-of-cancer-0-complete-blood-count-derived-inflammation-indices-in-colorectal-cancer-head-to
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** British Journal of Cancer
- **Source URL:** [Original Journal Publication](https://www.nature.com/articles/s41416-026-03647-z)
- **Published At:** 2026-10-24T08:11:29.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- Investigators compared five routine complete blood count (CBC)-derived inflammatory indices—**NLR**, **PLR**, **MLR**, **SIRI** and **SII**—in patients with colorectal cancer (CRC) against a large healthy screening cohort. - The study cohort included 2,305 CRC patients and 78,281 health‑screening controls; an external replication cohort comprised 1,031 CRC patients. - Methods used by the study team included propensity score matching, Cox regression for survival analyses, restricted cubic splines to assess dose–response, and Harrell’s concordance index for discrimination. - All five indices were elevated in CRC patients versus controls and were independently associated with overall survival in multivariable models, according to the authors. - The **MLR** retained both diagnostic and prognostic significance in Stage I disease; this Stage I signal was replicated in the external cohort. - Quartile analyses showed dose–response trends for each index; the investigators observed non-linear threshold effects specifically for **MLR** and **SIRI**. - Incremental prognostic improvement beyond tumor stage was described as modest using concordance metrics. - The team derived population reference intervals and found substantial overlap between CRC and healthy populations, limiting utility for screening based on single cutpoints. - Cross‑population transferability assessment using NHANES indicated non‑uniform transferability of reference intervals between populations. - The authors noted that reference intervals should not be used as CRC screening or treatment thresholds; the data highlight reproducible signal but limited standalone clinical screening performance.
## Clinical Analysis & Structured Key Points
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[nature](https://www.nature.com/) 2. [british journal of cancer](https://www.nature.com/bjc) 3. [articles](https://www.nature.com/bjc/articles?type=article) 4. article Complete blood count-derived inflammation indices in colorectal cancer: head-to-head case-control and prognostic analyses with population reference intervals and external replication [ Download PDF ](https://www.nature.com/articles/s41416-026-03647-z.pdf) [ Download PDF ](https://www.nature.com/articles/s41416-026-03647-z.pdf) * Article * [Open access](https://www.springernature.com/gp/open-science/about/the-fundamentals-of-open-access-and-open-research) * Published: 24 October 2026 Clinical Study # Complete blood count-derived inflammation indices in colorectal cancer: head-to-head case-control and prognostic analyses with population reference intervals and external replication * [Eun Kyung Choe](https://www.nature.com/articles/s41416-026-03647-z#auth-Eun_Kyung-Choe-Aff1-Aff2)[1](https://www.nature.com/articles/s41416-026-03647-z#Aff1),[2](https://www.nature.com/articles/s41416-026-03647-z#Aff2), * [Min Jung Kim](https://www.nature.com/articles/s41416-026-03647-z#auth-Min_Jung-Kim-Aff1-Aff3)[1](https://www.nature.com/articles/s41416-026-03647-z#Aff1),[3](https://www.nature.com/articles/s41416-026-03647-z#Aff3), * [Dong Woon Lee](https://www.nature.com/articles/s41416-026-03647-z#auth-Dong_Woon-Lee-Aff4)[4](https://www.nature.com/articles/s41416-026-03647-z#Aff4), * [Sung Chan Park](https://www.nature.com/articles/s41416-026-03647-z#auth-Sung_Chan-Park-Aff4)[4](https://www.nature.com/articles/s41416-026-03647-z#Aff4), * [Dae Kyung Sohn](https://www.nature.com/articles/s41416-026-03647-z#auth-Dae_Kyung-Sohn-Aff4)[4](https://www.nature.com/articles/s41416-026-03647-z#Aff4), * [Jae Hwan Oh](https://www.nature.com/articles/s41416-026-03647-z#auth-Jae_Hwan-Oh-Aff4)[4](https://www.nature.com/articles/s41416-026-03647-z#Aff4), * [Seung-Bum Ryoo](https://www.nature.com/articles/s41416-026-03647-z#auth-Seung_Bum-Ryoo-Aff1) [ORCID: orcid.org/0000-0001-6407-0444](https://orcid.org/0000-0001-6407-0444)[1](https://www.nature.com/articles/s41416-026-03647-z#Aff1), * [Seung-Yong Jeong](https://www.nature.com/articles/s41416-026-03647-z#auth-Seung_Yong-Jeong-Aff1)[1](https://www.nature.com/articles/s41416-026-03647-z#Aff1), * [Kyu Joo Park](https://www.nature.com/articles/s41416-026-03647-z#auth-Kyu_Joo-Park-Aff1)[1](https://www.nature.com/articles/s41416-026-03647-z#Aff1) & * … * [Ji Won Park](https://www.nature.com/articles/s41416-026-03647-z#auth-Ji_Won-Park-Aff1-Aff2-Aff3) [ORCID: orcid.org/0000-0003-0046-8175](https://orcid.org/0000-0003-0046-8175)[1](https://www.nature.com/articles/s41416-026-03647-z#Aff1),[2](https://www.nature.com/articles/s41416-026-03647-z#Aff2),[3](https://www.nature.com/articles/s41416-026-03647-z#Aff3) Show authors [_British Journal of Cancer_](https://www.nature.com/bjc) (2026) [Cite this article](https://www.nature.com/articles/s41416-026-03647-z#citeas) Save article [ View saved research ](https://www.nature.com/saved-research) ## Abstract ### Background Systemic inflammation drives cancer progression. We investigated the clinical utility of five routine complete blood count (CBC)-derived inflammatory biomarkers, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), monocyte–lymphocyte ratio (MLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII), in colorectal cancer (CRC) patients. ### Methods We performed head-to-head case-control and prognostic analyses of five indices in 2305 CRC patients and 78,281 health‑screening controls, with replication in 1031 CRC patients. Analyses included propensity score matching, Cox regression, restricted cubic splines, and Harrell’s concordance index. Population reference intervals were derived, and cross‑population transferability was assessed using the National Health and Nutrition Examination Survey (NHANES). ### Results All indices were elevated in CRC patients and independently associated with survival. MLR retained diagnostic and prognostic significance in Stage I disease and was replicated. Dose–response trends were observed across quartiles, with non‑linear threshold effects for MLR and SIRI. Incremental prognostic gains beyond stage were modest. Reference intervals showed substantial overlap between CRC and healthy populations, limiting screening utility. NHANES comparison revealed non‑uniform transferability. ### Conclusion CBC‑derived indices demonstrated reproducible diagnostic and prognostic relevance, with MLR particularly informative in early‑stage CRC. Reference intervals contextualise abnormality but should not be interpreted as CRC screening or treatment thresholds. ![](https://media.springernature.com/lw685/springer-static/image/art%3A10.1038%2Fs41416-026-03647-z/MediaObjects/41416_2026_3647_Figa_HTML.png) ### Explore related subjects Discover the latest articles and news in related subjects. * [Diagnostic markers](https://www.nature.com/subjects/diagnostic-markers) * [Prognostic markers](https://www.nature.com/subjects/prognostic-markers) ## Introduction Colorectal cancer (CRC) is the second leading cause of cancer-related mortality worldwide and has major public health implications [[1](https://www.nature.com/articles/s41416-026-03647-z#ref-CR1 "Baidoun F, Elshiwy K, Elkeraie Y, Merjaneh Z, Khoudari G, Sarmini MT, et al. Colorectal cancer epidemiology: recent trends and impact on outcomes. Curr Drug Targets. 2021;22:998–1009.")]. According to the World Health Organization, approximately 1.9 million new CRC cases occur worldwide annually, with this number predicted to rise substantially to 3.2 million cases annually by 2040, reflecting both ageing populations in developed nations and increasing incidence in developing countries. Despite advances in screening technologies, surgical techniques and adjuvant therapies, mortality rates remain not low, underscoring the need for improved prognostic tools enabling better patient risk stratification and individualised treatment planning. Chronic systemic inflammation contributes to cancer pathogenesis, progression and treatment resistance [[2](https://www.nature.com/articles/s41416-026-03647-z#ref-CR2 "Xie H, Wang S, Wei L, Lin S, Shi H, Chen J. Inflammatory score as a predictor of survival and nutritional deterioration in cancer patients: insights from a multicenter cohort study. Front Nutr. 2025;12:1631483."),[3](https://www.nature.com/articles/s41416-026-03647-z#ref-CR3 "Muthusami S, Ramachandran IK, Babu KN, Krishnamoorthy S, Guruswamy A, Queimado L, et al. Role of inflammation in the development of colorectal cancer. Endocr Metab Immune Disord Drug Targets. 2021;21:77–90."),[4](https://www.nature.com/articles/s41416-026-03647-z#ref-CR4 "Burgos-Molina AM, Tellez Santana T, Redondo M, Bravo Romero MJ. The crucial role of inflammation and the immune system in colorectal cancer carcinogenesis: a comprehensive perspective. Int J Mol Sci. 2024;25:6188."),[5](https://www.nature.com/articles/s41416-026-03647-z#ref-CR5 "Wang M, Zhao J, Zhang L, Wei F, Lian Y, Wu Y, et al. Role of tumor microenvironment in tumorigenesis. J Cancer. 2017;8:761–73."),[6](https://www.nature.com/articles/s41416-026-03647-z#ref-CR6 "Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420:860–7.")]. Immune dysregulation mediated by inflammatory cells has been shown to play a critical role in CRC progression [[4](https://www.nature.com/articles/s41416-026-03647-z#ref-CR4 "Burgos-Molina AM, Tellez Santana T, Redondo M, Bravo Romero MJ. The crucial role of inflammation and the immune system in colorectal cancer carcinogenesis: a comprehensive perspective. Int J Mol Sci. 2024;25:6188."), [7](https://www.nature.com/articles/s41416-026-03647-z#ref-CR7 "He R, Huang S, Lu J, Su L, Gao X, Chi H. Unveiling the immune symphony: decoding colorectal cancer metastasis through immune interactions. Front Immunol. 2024;15:1362709."), [8](https://www.nature.com/articles/s41416-026-03647-z#ref-CR8 "Rafa H, Benkhelifa S, AitYounes S, Saoula H, Belhadef S, Belkhelfa M, et al. All-trans retinoic acid modulates TLR4/NF-kappaB signaling pathway targeting TNF-alpha and nitric oxide synthase 2 expression in colonic mucosa during ulcerative colitis and colitis associated cancer. Mediat Inflamm. 2017;2017:7353252.")]. Routine preoperative complete blood count (CBC) testing provides composite indices that integrate multiple immune cell compartments. These indices, the neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), monocyte–lymphocyte ratio (MLR), systemic inflammation response index (SIRI) and systemic immune-inflammation index (SII), offer convenient, non-fasting and universally accessible measures of systemic inflammatory status [[9](https://www.nature.com/articles/s41416-026-03647-z#ref-CR9 "Goh JCH, Lim DYZ, Ke Y, Wong J, Abdullah HR. Preoperative inflammatory markers for prediction of postoperative clinical outcomes: a retrospective cohort study. Can J Anaesth. 2025;72:1496–510."),[10](https://www.nature.com/articles/s41416-026-03647-z#ref-CR10 "Dugăeşescu M, Andrei-Bitere I, Baciu M-R, Dănescu E, Liţescu A, Vidroiu S-T, et al. Hematological inflammatory markers and chronic diseases: current evidence and future perspectives. Hemato. 2025;6:42."),[11](https://www.nature.com/articles/s41416-026-03647-z#ref-CR11 "Borges E, Sousa M, Marum S, Castro M, Bouw MJ. The predictive value of preoperative neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index for organ failure following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a retrospective analysis. Int Surg J. 2025;12:2077–83."),[12](https://www.nature.com/articles/s41416-026-03647-z#ref-CR12 "Guven DC, Sahin TK, Erul E, Kilickap S, Gambichler T, Aksoy S. The association between the pan-immune-inflammation value and cancer prognosis: a systematic review and meta-analysis. Cancers. 2022;14:2675.")]. Five CBC-derived inflammatory biomarkers have demonstrated their clinical utility in cancer populations [[13](https://www.nature.com/articles/s41416-026-03647-z#ref-CR13 "Kumarasamy C, Sabarimurugan S, Madurantakam RM, Lakhotiya K, Samiappan S, Baxi S, et al. Prognostic significance of blood inflammatory biomarkers NLR, PLR, and LMR in cancer—a protocol for systematic review and meta-analysis. Medicine. 2019;98:e14834."),[14](https://www.nature.com/articles/s41416-026-03647-z#ref-CR14 "Yis OM, Bugdayci G, Pehlivan MB, Basol M. Roles of the systemic inflammatory response biomarkers in the diagnosis of cancer patients with solid tumors. Exp Biomed Res. 2018;2:37–43."),[15](https://www.nature.com/articles/s41416-026-03647-z#ref-CR15 "Sylman JL, Mitrugno A, Atallah M, Tormoen GW, Shatzel JJ, Tassi Yunga S, et al. The predictive value of inflammation-related peripheral blood measurements in cancer staging and prognosis. Front Oncol. 2018;8:78.")]. The NLR quantifies the balance between innate pro-inflammatory responses (neutrophilia) and adaptive anti-tumour immunity (lymphocyte-mediated) [[16](https://www.nature.com/articles/s41416-026-03647-z#ref-CR16 "Valero C, Lee M, Hoen D, Weiss K, Kelly DW, Adusumilli PS, et al. Pretreatment neutrophil-to-lymphocyte ratio and mutational burden as biomarkers of tumor response to immune checkpoint inhibitors. Nat Commun. 2021;12:729."), [17](https://www.nature.com/articles/s41416-026-03647-z#ref-CR17 "Heshmat-Ghahdarijani K, Sarmadi V, Heidari A, Falahati Marvasti A, Neshat S, Raeisi S. The neutrophil-to-lymphocyte ratio as a new prognostic factor in cancers: a narrative review. Front Oncol. 2023;13:1228076.")]. The MLR specifically captures monocytic and myeloid-derived suppressor cell activation relative to anti-tumour lymphocytic immunity [[18](https://www.nature.com/articles/s41416-026-03647-z#ref-CR18 "Ertekin SS, Mangas C, Riquelme-Mc Loughlin C, Carrera C, Malvehy J, Puig S, et al. Prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in melanoma patients: a cohort study. Acta Derm Venereol. 2024;104:adv27571."),[19](https://www.nature.com/articles/s41416-026-03647-z#ref-CR19 "Liu Y, Hu C, Wu J, Zhou J, Wang W, Wang X, et al. Relationship between lymphocyte to monocyte ratio and brain metastasis in non-smalll cell lung cancer patients. Am J Transl Res. 2022;14:3936–45."),[20](https://www.nature.com/articles/s41416-026-03647-z#ref-CR20 "Obeagu EI. Monocyte-to-lymphocyte ratio as a subtype-specific biomarker in breast cancer prognosis: a narrative review. Ann Med Surg. 2025;87:8617–23.")]. The PLR captures platelet-mediated prothrombotic and pro-angiogenic responses relative to lymphocyte-mediated immunity [[15](https://www.nature.com/articles/s41416-026-03647-z#ref-CR15 "Sylman JL, Mitrugno A, Atallah M, Tormoen GW, Shatzel JJ, Tassi Yunga S, et al. The predictive value of inflammation-related peripheral blood measurements in cancer staging and prognosis. Front Oncol. 2018;8:78."), [21](https://www.nature.com/articles/s41416-026-03647-z#ref-CR21 "Kurtul A, Ornek E. Platelet to lymphocyte ratio in cardiovascular diseases: a systematic review. Angiology. 2019;70:802–18."),[22](https://www.nature.com/articles/s41416-026-03647-z#ref-CR22 "Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med. 2019;39:345–57."),[23](https://www.nature.com/articles/s41416-026-03647-z#ref-CR23 "Jiang QY, Xue RY. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio: markers predicting immune-checkpoint inhibitor efficacy and immune-related adverse events. World J Gastrointest Oncol. 2024;16:577–82.")]. The SIRI and SII represent more complex composite indices that integrate multiple cellular compartments to provide comprehensive inflammatory phenotyping [[24](https://www.nature.com/articles/s41416-026-03647-z#ref-CR24 "Yang CH, Wang XY, Zhang YH, Ding N. SIRI and SII as potential biomarkers of disease activity and lupus nephritis in systemic lupus erythematosus. Front Immunol. 2025;16:1530534."),[25](https://www.nature.com/articles/s41416-026-03647-z#ref-CR25 "Jiang P, Chen J, Li J. Association of the systemic immune-inflammatory index and systemic inflammatory response index with all-cause and cardiovascular mortality in individuals with metabolic inflammatory syndrome. Eur J Med Res. 2025;30:444."),[26](https://www.nature.com/articles/s41416-026-03647-z#ref-CR26 "Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of Systemic immune-inflammation index in cancer: a meta-analysis. J Cancer. 2018;9:3295–302.")]. The Glasgow Prognostic Score and its modified version have been evaluated for more than a decade [[27](https://www.nature.com/articles/s41416-026-03647-z#ref-CR27 "McMillan DC. The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer. Cancer Treat Rev. 2013;39:534–40.")], and studies confirm the prognostic relevance of inflammatory markers in CRC [[28](https://www.nature.com/articles/s41416-026-03647-z#ref-CR28 "Lu X, Guo W, Xu W, Zhang X, Shi Z, Zheng L, et al. Prognostic value of the Glasgow prognostic score in colorectal cancer: a meta-analysis of 9,839 patients. Cancer Manag Res. 2019;11:229–49."),[29](https://www.nature.com/articles/s41416-026-03647-z#ref-CR29 "Liu Y, He X, Pan J, Chen S, Wang L. Prognostic role of Glasgow prognostic score in patients with colorectal cancer: evidence from population studies. Sci Rep. 2017;7:6144."),[30](https://www.nature.com/articles/s41416-026-03647-z#ref-CR30 "He L, Li H, Cai J, Chen L, Yao J, Zhang Y, et al. Prognostic value of the Glasgow prognostic score or modified Glasgow prognostic score for patients with colorectal cancer receiving various treatments: a systematic review and meta-analysis. Cell Physiol Biochem. 2018;51:1237–49."),[31](https://www.nature.com/articles/s41416-026-03647-z#ref-CR31 "Tan Y, Hu B, Li Q, Cao W. Prognostic valu
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