Abstract
BACKGROUND AND AIMS: Chronic inflammation is a hallmark of cancer progression. This multicenter cohort study aimed to evaluate the prognostic value of a novel inflammatory score, derived from baseline white blood cell (WBC) count and C-reactive protein (CRP) z-scores, in predicting survival outcomes and nutritional deterioration among cancer patients. METHODS: We analyzed data from 6,568 cancer patients across multiple institutions. The inflammatory score was categorized as mild, moderate, or severe. Kaplan-Meier survival analysis, Cox proportional hazards models, and restricted cubic splines were used to assess associations with all-cause mortality. Subgroup analyses were stratified by tumor type and pathological stage. Logistic regression models quantified associations between inflammatory scores and nutritional deterioration. RESULTS: Dose-response analyses revealed a nonlinear relationship between continuous inflammatory scores and mortality (HR = 1.200, 95% CI: 1.163-1.238, p < 0.001). Higher inflammatory scores were significantly associated with reduced survival (67.5% vs. 65.3% vs. 57.0% vs. 45.2%, p < 0.001). In fully adjusted models, severe inflammation conferred a 60.4% increased mortality risk (HR = 1.604, 95% CI: 1.464-1.757, p < 0.001) compared to mild inflammation. Subgroup analyses confirmed consistent associations across tumor types and pathological stages. Advanced-stage (III/IV) patients exhibited heightened sensitivity to inflammatory burden, underscoring its role in late-stage prognosis. Severe inflammation was also linked to higher rates of severe malnutrition (OR = 2.553, 95%CI: 2.226-2.927, p < 0.001) and cachexia (OR = 2.662, 95%CI: 2.323-3.049, p < 0.001). Validation cohorts reproduced these findings, underscoring the score's robustness. CONCLUSION: The inflammatory score, integrating WBC and CRP, is a strong independent predictor of survival and nutritional deterioration in cancer patients. Its clinical utility for risk stratification and guiding targeted anti-inflammatory therapies warrants further exploration.