Objective:

To evaluate the association of a prespecified hemorrhage-coagulation immune phenotype (HCIP) with recurrence-free survival (RFS) and CD163/HO-1-enriched immune remodeling in colorectal cancer.

Approach:

• HCIP Definition: Defined from local hemorrhagic pathology assessed via H&E staining and systemic coagulation activation based on preoperative blood tests including fibrinogen, D-dimer, and platelet count.

Key Findings:

• 752 patients included in the final analytic cohort.
• HCIP-poor tumors associated with advanced AJCC stage, larger tumor size, ulceration, and necrosis.
• HCIP-poor tumors exhibited lower CD8+ T-cell density and higher CD163+ macrophage density.
• HCIP-poor status linked to worse RFS (adjusted HR 1.91, 95% CI 1.33-2.73).
• Fibrinogen was the most stable marker associated with RFS.

Interpretation:

HCIP identifies a hemorrhage-coagulation state linked to macrophage remodeling and recurrence risk in colorectal cancer.

Limitations:

• Retrospective design may introduce bias.
• Single-center study limits generalizability.

Conclusion:

HCIP links local hemorrhagic pathology and systemic coagulation activation to recurrence risk.