BACKGROUND: The prognostic role of nutrition-inflammation indices in esophageal squamous cell carcinoma (ESCC) requires further investigation. We developed the HALP-CONUT Integrated Score (HCIS) and evaluated its ability to predict survival and postoperative complications in locally advanced ESCC patients undergoing neoadjuvant therapy. METHODS: This multicenter retrospective study analyzed 410 patients. HCIS was calculated by integrating the HALP index and CONUT score. Patients were stratified into risk groups. Survival was analyzed using Kaplan-Meier and Cox regression. Logistic regression assessed associations with complications and pathologic complete response (pCR). Predictive performance was evaluated using ROC curves, C-index, and decision curve analysis. RESULTS: Patients with high HCIS scores had significantly worse overall survival (OS) compared with those in lower-risk groups (p < 0.001). Multivariate Cox analysis confirmed HCIS as an independent prognostic factor for OS (HR 4.59, 95% CI 2.64-7.97, p < 0.001). Higher HCIS scores were also independently associated with increased risk of major postoperative complications (OR 7.144, 95% CI 3.698-13.813, p < 0.001) and a lower likelihood of achieving pCR (OR 6.470, 95% CI 3.577-12.40, p = 0.005). Predictive models incorporating HCIS demonstrated superior discrimination compared with models based on HALP or CONUT alone (AUC for OS: 0.789 vs 0.711 and 0.703, respectively). CONCLUSION: HCIS is a robust biomarker that integrates hematologic, nutritional, and inflammatory parameters. It independently predicts survival, postoperative complications, and pCR, providing a valuable tool for risk stratification and individualized treatment planning in locally advanced ESCC.
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