A Preoperative Symptom-tumor-nutrition Score Predicting Survival After Laparoscopic Resection for Colorectal Cancer

Background/Aim: To develop a simple preoperative prognostic score that integrates symptom burden, tumor biology, and nutritional status [symptom-tumor-nutrition (STN) score] in patients with stage II-III colorectal cancer (CRC) undergoing laparoscopic curative resection. Patients and Methods: We retrospectively analyzed 455 consecutive patients with stage II-III CRC who underwent laparoscopic colorectal resection between 2008 and 2018. The STN score (0-3) assigned 1 point each for the following: preoperative obstructive findings requiring decompression, carcinoembryonic antigen ≥5.0 ng/ml, and Prognostic Nutritional Index ≤40. The patients were stratified into low (0), mid (1), and high (2, 3) STN groups. The primary endpoints were disease-free survival (DFS) and overall survival (OS). Survival was assessed using Kaplan-Meier analysis and Cox proportional hazards models. Results: The DFS and OS scores of the high-STN group were significantly worse than those of the low- and mid-STN groups (both log-rank p<0.01). In the multivariable analysis, high-STN independently predicted poorer DFS [hazard ratio (HR)=2.21, 95% confidence interval (CI)=1.05-4.61; p=0.035] and OS (HR=2.29, 95%CI=1.01-5.15; p=0.045). Conclusion: The STN score is a practical preoperative tool that stratifies recurrence risk and long-term survival after laparoscopic resection of stage II-III CRC.