Pretreatment nutritional and inflammatory markers do not identify patients with unresectable metastatic colorectal cancer who would benefit from primary tumor resection (PTR) over upfront chemotherapy.

• In patients with a modified Glasgow prognostic score (MGPS) of 2 and hypoalbuminemia, PTR is linked to worse overall survival and progression-free survival compared to chemotherapy alone.
• Specifically, in the MGPS 2 subgroup, PTR increased the risk of disease progression (hazard ratio 3.56; p = 0.049).

These findings reinforce the current practice of avoiding routine PTR in asymptomatic patients regardless of nutritional or inflammatory status.