Preoperative Noble and Underwood Score in Colorectal Cancer Surgery: A Stable Prognostic Marker Even among Tumor Marker-Negative Cases.

INTRODUCTION

Reliable and widely applicable tools for survival risk stratification in colorectal cancer (CRC) remain to be established. Although the Noble and Underwood (NUn) score, comprising white blood cell count, C-reactive protein, and serum albumin, has been reported to possess prognostic relevance in some malignancies, its role in CRC has yet to be elucidated. We retrospectively evaluated the association between the preoperative NUn score and survival outcomes in patients with resectable CRC.

METHODS

A total of 608 consecutive patients who underwent curative resection for CRC were analyzed. The impact of the preoperative NUn score on overall survival (OS) and relapse-free survival (RFS) was assessed using Cox proportional hazards models. Optimal cutoff values were determined using X-tile software.

RESULTS

The median follow-up period was 65 months. Kaplan-Meier analyses demonstrated that the preoperative NUn score effectively stratified OS and RFS, including among tumor marker-negative cases. In univariate analyses, a high NUn score was significantly associated with worse OS and RFS. Multivariate analyses adjusted for clinically relevant factors, including tumor marker positivity, confirmed that a high NUn score independently predicted worsened OS (hazard ratio [HR] 2.06, 95% confidence interval [CI] 1.24-3.41, p = 0.016) and RFS (HR 1.66, 95% CI 1.09-2.53, p = 0.011). These independent associations remained robust when the NUn score was analyzed as a continuous variable.

CONCLUSIONS

The preoperative NUn score independently predicted survival outcomes in resectable CRC and may serve as a practical tool to support individualized therapeutic decision-making.