Preoperative Albumin-derived Neutrophil-to-Lymphocyte Ratio Predicts Survival Across Pathological Stages of Colorectal Cancer

Background/Aim: The albumin-derived neutrophil-to-lymphocyte ratio (Alb-dNLR), reflecting nutritional and inflammatory status, has been reported as a prognostic marker in malignancies. However, its significance across all pathological stages of colorectal cancer remains unclear. This study evaluated preoperative Alb-dNLR in colorectal cancer surgery. Patients and Methods: We retrospectively analyzed 220 patients who underwent colorectal cancer resection at Tochigi Medical Center Shimotsuga. Alb-dNLR was calculated as serum albumin divided by the derived neutrophil-to-lymphocyte ratio. Patients were classified into high and low groups using a receiver operating characteristic–derived cutoff. Overall survival (OS) and clinicopathological characteristics were analyzed. Results: The optimal Alb-dNLR cutoff was 1.395. Low Alb-dNLR was associated with deeper tumor invasion, lymph node metastasis, and advanced stage. Logistic regression identified pT3-4 as an independent factor related to low Alb-dNLR (OR=6.776; 95% CI=2.310-25.501; p=0.0002). Low Alb-dNLR was associated with worse OS than high Alb-dNLR (5-year OS, 53.3% vs. 76.2%; p<0.001). This association was consistent across pathological stages. Low Alb-dNLR independently predicted poor OS (HR=3.359; 95% CI=1.89-6.81; p<0.0001). Conclusion: Preoperative Alb-dNLR is an independent prognostic marker associated with tumor progression and poor survival in colorectal cancer, with consistent prognostic value across pathological stages.