ArticleFrontiers in oncology2026
Development and validation of a pre-chemotherapy nomogram integrating systemic immune-inflammation index and prognostic nutritional index to predict severe adjuvant toxicity in colorectal cancer.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Severe toxicities frequently complicate adjuvant chemotherapy for stage II/III colorectal cancer (CRC), leading to dose reductions and compromised outcomes. While the Systemic Immune-Inflammation Index (SII) and Prognostic Nutritional Index (PNI) are established prognostic markers, their value in predicting chemotherapy tolerance, reflecting physiological reserve, remains understudied. This study evaluated baseline pre-chemotherapy SII and PNI to construct a validated nomogram for predicting severe chemotherapy-induced toxicity (CIT). Methods: We retrospectively analyzed 306 patients with stage II/III CRC receiving oxaliplatin-based adjuvant chemotherapy (CAPOX or mFOLFOX6). The primary endpoint was grade 3-4 adverse events. Optimal pre-chemotherapy cut-off values were determined via ROC analysis and the Youden index. Independent predictors from multivariate logistic regression were integrated into a nomogram. Performance was assessed via discrimination (apparent and optimism-corrected AUC via 500 bootstrap resamples), calibration (plots and Brier score), and clinical utility (Decision Curve Analysis, DCA). Results: Severe CIT occurred in 78 (25.5%) patients. Baseline high SII (adjusted OR = 8.56, P < 0.001) and low PNI (adjusted OR = 4.69, P < 0.001) were independent risk factors. The nomogram (Age, SII, PNI) showed excellent discrimination (apparent AUC: 0.868; optimism-corrected AUC: 0.867) and strong calibration (Brier score: 0.1114). Patients in the high-risk group (probability ≥37.4%) experienced a significantly shorter median therapy duration (4.1 vs. 4.8 months) and a markedly lower oxaliplatin relative dose intensity (median 76.7% vs. 100.0%) compared to the low-risk group (both P < 0.001). DCA confirmed the nomogram offered greater net clinical benefit than single markers or traditional assessments. Conclusion: Pre-chemotherapy elevated SII and decreased PNI are robust predictors of severe toxicity. The proposed nomogram is a reliable, cost-effective tool for risk stratification, enabling risk-adapted strategies like nutritional prehabilitation, dose adjustment, and prophylactic growth factor support for high-risk CRC patients.
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