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(CRP), and clinicopathological variables were studied in a training set of 175 patients with CRC. Univariate and multivariate Cox regression models were used to determine the role of NAR. Independent predictors of survival identified in multivariate analysis were externally validated in an independent cohort of 128 patients with CRC. RESULTS: Univariate analyses showed that NAR (p<0.001), tumor size (p¼0.008), tumor depth (p¼0.001), lymph node metastais (p<0.001), TNM stage (p<0.001), CEA (p¼0.001), CA19-9 (p<0.001), CRP (p¼0.0013), and NLR (p¼0.014) were all predictors of overall survival in the training set. Multivariate analysis revealed the NAR (hazard ratio [HR] 4.75, 95% CI: 1.57-13.45), and TNM stage (HR 5.74, 95% CI: 2.04-18.46) as independent predictors of worse overall survival in this population. The NAR retained independent prognostic value in the external validation set (HR 3.22, 95% CI: 1.02-9.75). The predictive accuracy of the combined NAR and TNM classification (c score 0.7) appeared superior to that of the TNM classification alone (c score 0.6). CONCLUSIONS: The presence of a novel systemic inflammatory response, as measured by the NAR, is an independent and externally validated predictor of poor overall survival in patients with CRC.

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