Application of the Heidelberg Prognostic Pancreatic Cancer Score for Survival Risk Stratification in Stage II/III Colorectal Cancer

Background Reliable and broadly applicable tools for survival risk stratification in stage II/III colorectal cancer (CRC) remain limited. The Heidelberg prognostic pancreatic cancer (HELPP) score is a multidimensional index integrating tumor burden, systemic inflammation, nutritional status, and host physiological condition, and has been well validated for prognostication in pancreatic cancer. We hypothesized that this score would also be applicable to CRC and investigated its prognostic utility. Methods A consecutive cohort of 481 patients with pathological stage II/III CRC undergoing curative resection was retrospectively interrogated. The prognostic impact of the HELPP score was assessed using Kaplan-Meier estimates and Cox proportional hazards modeling. Results With a median follow-up of 65 months, 129 patients died. Kaplan-Meier analyses demonstrated clear and consistent stratification of both overall survival (OS) and relapse-free survival (RFS) according to the HELPP score. In univariate analyses, a HELPP score >3 was significantly associated with worse OS and RFS. Importantly, this association remained robust after adjustment for clinically relevant covariates, with HELPP score >3 independently predicting OS (hazard ratio [HR] 1.99, 95% confidence interval [CI] 1.25-3.18, P = 0.004) and RFS (HR 1.78, 95% CI 1.19-2.66, P = 0.005). Discussion The HELPP score delivers robust, independent prognostic stratification in stage II/III CRC and represents a practical, clinically actionable tool for refined risk assessment. Its integration into clinical practice may enable more precise tailoring of adjuvant therapy and surveillance, advancing individualized management in CRC.