Prognostic and Clinicopathological Significance of Nutritional C Reactive Protein Ratio in Metastatic Colorectal Cancer Patients

Background: Prognosis in metastatic colorectal cancer (mCRC) is influenced by systemic inflammation and nutritional status. The Nutritional C-reactive Protein Ratio (NCR), a composite index integrating body mass index (BMI), albumin, as well as the C reactive protein (CRP), has emerged as a potential prognostic biomarker. This research aimed to assess the prognostic, clinicopathological value of the NCR among patients who had metastatic colorectal cancer. Methods: This retrospective cohort research involved 100 patients having de novo mCRC treated at Zagazig University Hospitals between January 2019, January 2024. Clinical, laboratory, treatment data were gathered from medical records. NCR was assessed as BMI × albumin / CRP. Results: The median age was 53 years, most patients had ECOG performance status ≥1. The majority (81%) had received ≥2 prior chemotherapy lines. Mean overall survival (OS) was 19 months median were not reached, while mean progression-free survival (PFS) was 6 months median were not reached. Patients with low NCR had significantly worse mean OS (11 vs. 22 months, p < 0.001) mean PFS (3.4 vs. 6.8 months, p < 0.001). Low NCR was associated with older age, lower BMI, hypoalbuminemia, elevated CRP, CEA, ECOG 2, higher tumor grade, multiple metastases, particularly bone involvement. ROC analysis showed high predictive performance (AUC = 0.971; sensitivity 93.8%, specificity 94.7%). Conclusion: NCR could be a strong, independent prognostic marker in mCRC. integrate nutritional inflammatory status provides superior prognostic discrimination. NCR represents a simple, cost-effective, non-invasive tool that may aid in risk stratification, management of patients with metastatic colorectal cancer.