Pan-immune-inflammation in colon cancer: A prognostic biomarker and the role of tumor location in personalized care

Despite advances in surgery, chemotherapy, and radiotherapy, the treatment of colorectal cancer (CRC) requires more personalized approaches based on tumor biology and molecular profiling. While some relevant mutations have been associated with differential response to immunotherapy, such as RAS and BRAF mutations limiting response to anti-epithelial growth factor receptor drugs or microsatellite instability predisposing susceptibility to immune checkpoint inhibitors, the role of inflammation in dictating tumor progression and treatment response is still under investigation. Several inflammatory biomarkers have been identified to guide patient prognosis. These include the neutrophil-lymphocyte ratio, Glasgow prognostic score (GPS) and its modified version, lymphocyte-C-reactive protein ratio, and platelet-lymphocyte ratio. However, these markers are not yet included in the standard clinical management of patients with CRC, and further research is needed to evaluate their efficacy in different patient populations. A recent study by Wang et al , published in the World Journal of Gastroenterology , sheds light on the prognostic significance of pan-immune-inflammation value (PIV) in CRC, particularly concerning primary tumor location. Specifically, the authors found that a high PIV was strongly correlated with worse disease-free survival in patients with left-sided colon cancer, whereas no such association was observed in patients with right-sided colon cancer. Integrating tumor location into the prognostic assessment of CRC may improve our ability to more accurately identify high-risk patients and develop personalized treatment plans that are more likely to improve patient outcomes.