The inflammation–nutrition score supports the prognostic prediction of the TNM stage for colorectal cancer patients after curative resection

  • Shiki Fujino
  • Norikatsu MyoshiEmail author
  • Kazuhiro Saso
  • Msaru Sasaki
  • Satoshi Ishikawa
  • Yusuke Takahashi
  • Masayoshi Yasui
  • Masayuki Ohue
  • Taishi Hata
  • Chu Matsuda
  • Tsunekazu Mizushima
  • Masaki Mori
  • Yuichiro Doki
Original Article



Inflammation and the nutritional and immunologic status are known to be associated with the prognosis of malignant tumors. We aimed to examine inflammation–nutrition scores and predict the prognosis of colorectal cancer (CRC) patients by integrating nutritional and immunologic factors and tumor stage.


This study investigated 511 patients with CRC from 2007 to 2013: 380 in a training set (TS) and 131 in a validation set (VS). The Osaka Prognostic Score (OPS) used comprised 1 point each for C-reactive protein > 1.0 mg/dL, albumin (< 3.5 g/dL), and lymphocyte count < 1600. Patients were classified according to the total points. The modified Glasgow Prognostic Score and the Prognostic Nutritional Index were also examined. A nomogram for predicting the disease-free survival (DFS) and overall survival (OS) was constructed based on the OPS and TNM stage.


In the TS, a high OPS and high TNM stage were significant predictors of the DFS and OS. The C-indexes of the OPS for the DFS and OS were higher than those of other reported scoring systems. The C-index of the nomogram for the DFS was 0.762 in the TS and 0.675 in the VS. The C-index of the nomogram for the OS was 0.805 in the TS and 0.743 in the VS.


Integrating the TNM stage and OPS accurately predicted the prognosis of patients with CRC.


Colorectal cancer Nomogram Nutrition Inflammation Prognostic score 



Colorectal cancer


Overall survival


Disease-free survival

TNM stage

Tumor node metastasis stage


Modified Glasgow Prognostic Score


Prognostic Nutritional Index


C-reactive protein


Total lymphocyte counts


Osaka Prognostic Score


Training set


Validation set



The authors would like to thank Ms. Aya Ito for special technical assistance and Dr Trish Reynolds, MBBS, FRACP, from Edanz Group ( for editing a draft of this manuscript.


This work was supported in part by a grant-in-aid for scientific research (C, 41040220, 17K16542) and a 38th Japan Medical Woman’s Association Academic Research Grant.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

Supplementary material

595_2019_1861_MOESM1_ESM.docx (2.1 mb)
Supplementary file1 (DOCX 2143 kb)


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Shiki Fujino
    • 1
  • Norikatsu Myoshi
    • 1
    • 3
    Email author
  • Kazuhiro Saso
    • 1
  • Msaru Sasaki
    • 1
  • Satoshi Ishikawa
    • 1
  • Yusuke Takahashi
    • 2
  • Masayoshi Yasui
    • 2
  • Masayuki Ohue
    • 2
  • Taishi Hata
    • 1
  • Chu Matsuda
    • 1
  • Tsunekazu Mizushima
    • 1
  • Masaki Mori
    • 4
  • Yuichiro Doki
    • 1
  1. 1.Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineSuitaJapan
  2. 2.Department of SurgeryOsaka International Cancer InstituteOsakaJapan
  3. 3.Innovative Oncology Research and Regenerative MedicineOsaka International Cancer InstituteOsakaJapan
  4. 4.Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan

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