The Predictive Role of Albumin and Neutrophil-to-Lymphocyte Ratio Score on Postoperative Outcomes and Survival in Older Patients With Colorectal Cancer

IntroductionColorectal cancer (CRC) is common among older patients, who face an increased risk of postoperative complications from malnutrition and systemic inflammation. The serum Albumin-Neutrophil-to-Lymphocyte Ratio Score (ANS), indicative of nutritional and inflammatory status, is a potential predictive tool in various cancers. This study evaluated the predictive value of preoperative ANS for postoperative survival and complications in older CRC patients.MethodsWe retrospectively analyzed 182 patients aged 65 and over who underwent curative-intent CRC surgery between 2018 and 2020 at a Taiwanese medical center. Based on pretreatment-ANS, patients were categorized into three groups: ANS 0, high albumin and low neutrophil-to-lymphocyte ratio (NLR); ANS 1, low albumin or high NLR; and ANS 2, low albumin and high NLR. Overall survival (OS), length of hospital stay (LOS), postoperative complications, and health-related quality of life (HRQoL) were analyzed and compared across groups.ResultsPatients in the ANS 2 group exhibited significantly poorer OS, with an adjusted hazard ratio of 2.90 (95% confidence interval [CI]:1.15-7.30, P = 0.024), compared to ANS 0. Additionally, they experienced a longer median LOS (14 vs 9 days, P < 0.001) and a higher risk of major postoperative complications (Odds ratio [OR] 3.74, 95% CI: 1.59-8.83, P = 0.003) and 30-day readmission rate (OR 5.04, 95% CI: 1.32-19.3, P = 0.018) than the ANS 0 group. ANS 2 patients reported worse HRQoL, particularly in mobility and maintaining purpose (P < 0.001 and P = 0.020, respectively), compared to ANS 0 patients.ConclusionPreoperative ANS significantly predicts survival, postoperative complications, and HRQoL in older CRC patients undergoing surgery, potentially guiding perioperative management.