AIM: The Controlling Nutritional Status (CONUT) scoring system integrates components of inflammation and nutrition, both of which significantly influence cancer progression. However, its utility in colorectal cancer remains ambiguous and contradictory. The aim of this study is to evaluate the efficacy of the CONUT score in forecasting the prognosis of colorectal cancer patients. METHOD: A thorough search was performed on the Scopus, Medline, Europe PMC and Cochrane Library databases up to 18 November 2024. This review includes evidence that investigates the correlation between the CONUT score and outcomes in colorectal cancer patients. We utilized random-effects models to evaluate the hazard ratio (HR) for the occurrence of the outcomes. RESULTS: A total of 22 papers were included in the systematic review, with 20 of them included in the meta-analysis. The pooled analysis from multivariable data revealed that a high CONUT score was an independent predictor of poor overall survival (HR 2.02, 95% CI 1.74-2.34, p <
0.00002), disease-free survival (HR 2.96, 95% CI 1.28-6.85, p = 0.01), cancer-specific survival (HR 3.93, 95% CI 2.16-7.15, p <
0.00002) and recurrence-free survival (HR 1.76, 95% CI 1.42-2.19, p <
0.00002) among colorectal cancer patients. A high CONUT score was also correlated with a greater likelihood of postoperative complications than a low CONUT score in colorectal cancer patients (HR 2.04, 95% CI 1.44-2.89, p <
0.0002). CONCLUSIONS: This study suggests the prognostic capability of the CONUT score in forecasting the short- and long-term outcomes of colorectal cancer patients
it therefore can be routinely calculated to stratify the risk of patients.