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Background <p>Colorectal cancer (CRC) is a major global health burden with significant prognostic heterogeneity among patients with stage I-III disease. Conventional clinicopathological parameters insufficiently predict individual outcomes, highlighting the need for novel, cost-effective biomarkers. The neutrophil percentage to albumin ratio (NPAR), reflecting systemic inflammation and nutritional status, has emerged as a promising prognostic indicator, but its role in early-stage CRC remains unclear.</p> Methods <p>We conducted a retrospective multicenter study involving 691 patients with stage I-III CRC from two independent centers, divided into training (<i>N</i> = 484) and validation (<i>N</i> = 207) cohorts. Clinicopathological features and blood-based biomarkers, including albumin-to-globulin ratio (AGR) and NPAR, were evaluated. Independent prognostic factors were identified using least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression analyses. A nomogram incorporating these factors was constructed to predict overall survival (OS). Model performance was assessed by concordance index (C-index), area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).</p> Results <p>Nerve invasion, AGR, and NPAR were independently associated with OS (all <i>p</i> &lt; 0.001). The nomogram demonstrated strong predictive accuracy with a C-index of 0.79 (95% CI, 0.73–0.84) in the training cohort. The AUCs for 1-, 3-, and 5-year OS were 0.80, 0.84, and 0.84, respectively, and were similarly validated in the external cohort (AUCs: 0.81, 0.82, 0.80). Calibration curves showed excellent concordance between predicted and observed survival. DCA confirmed the nomogram’s clinical benefit in individualized prognostication.</p> Conclusions <p>This multicenter study establishes nerve invasion, AGR, and NPAR as potential independent prognostic biomarkers in stage I-III CRC. The developed nomogram provides a practical tool for personalized survival prediction, which may assist in risk stratification and treatment decision-making.</p>

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The prognostic role of inflammation-based hematologic markers in stage I–III colorectal cancer: a retrospective analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月25日

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  • Kejin Li,
  • Rong Zhang,
  • Jiani Zhang,
  • Ziyi Zhang,
  • Kuan Wang,
  • Youqing Lu,
  • Zeliang Zhao,
  • Yi Chen,
  • Shudong Ma

摘要

Background

Colorectal cancer (CRC) is a major global health burden with significant prognostic heterogeneity among patients with stage I-III disease. Conventional clinicopathological parameters insufficiently predict individual outcomes, highlighting the need for novel, cost-effective biomarkers. The neutrophil percentage to albumin ratio (NPAR), reflecting systemic inflammation and nutritional status, has emerged as a promising prognostic indicator, but its role in early-stage CRC remains unclear.

Methods

We conducted a retrospective multicenter study involving 691 patients with stage I-III CRC from two independent centers, divided into training (N = 484) and validation (N = 207) cohorts. Clinicopathological features and blood-based biomarkers, including albumin-to-globulin ratio (AGR) and NPAR, were evaluated. Independent prognostic factors were identified using least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression analyses. A nomogram incorporating these factors was constructed to predict overall survival (OS). Model performance was assessed by concordance index (C-index), area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).

Results

Nerve invasion, AGR, and NPAR were independently associated with OS (all p < 0.001). The nomogram demonstrated strong predictive accuracy with a C-index of 0.79 (95% CI, 0.73–0.84) in the training cohort. The AUCs for 1-, 3-, and 5-year OS were 0.80, 0.84, and 0.84, respectively, and were similarly validated in the external cohort (AUCs: 0.81, 0.82, 0.80). Calibration curves showed excellent concordance between predicted and observed survival. DCA confirmed the nomogram’s clinical benefit in individualized prognostication.

Conclusions

This multicenter study establishes nerve invasion, AGR, and NPAR as potential independent prognostic biomarkers in stage I-III CRC. The developed nomogram provides a practical tool for personalized survival prediction, which may assist in risk stratification and treatment decision-making.