The HALP–CONUT Integrated Score Predicts Survival and Postoperative Complications in Locally Advanced Esophageal Squamous Cell Carcinoma Following Neoadjuvant Therapy: Evidence from a Multicenter Retrospective Cohort Study

Background The prognostic role of nutrition–inflammation indices in esophageal squamous cell carcinoma (ESCC) requires further investigation. We developed the HALP–CONUT Integrated Score (HCIS) and evaluated its ability to predict survival and postoperative complications in locally advanced ESCC patients undergoing neoadjuvant therapy. Methods This multicenter retrospective study analyzed 410 patients. HCIS was calculated by integrating the HALP index and CONUT score. Patients were stratified into risk groups. Survival was analyzed using Kaplan–Meier and Cox regression. Logistic regression assessed associations with complications and pathologic complete response (pCR). Predictive performance was evaluated using ROC curves, C-index, and decision curve analysis. Results Patients with high HCIS scores had significantly worse overall survival (OS) compared with those in lower-risk groups (p < 0.001). Multivariate Cox analysis confirmed HCIS as an independent prognostic factor for OS (HR 4.59, 95% CI 2.64–7.97, p < 0.001). Higher HCIS scores were also independently associated with increased risk of major postoperative complications (OR 7.144, 95% CI 3.698–13.813, p < 0.001) and a lower likelihood of achieving pCR (OR 6.470, 95% CI 3.577–12.40, p = 0.005). Predictive models incorporating HCIS demonstrated superior discrimination compared with models based on HALP or CONUT alone (AUC for OS: 0.789 vs 0.711 and 0.703, respectively). Conclusion HCIS is a robust biomarker that integrates hematologic, nutritional, and inflammatory parameters. It independently predicts survival, postoperative complications, and pCR, providing a valuable tool for risk stratification and individualized treatment planning in locally advanced ESCC.