ORIGINAL RESEARCH article
Front. Med.
Sec. Gastroenterology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1640469
This article is part of the Research TopicEnhancing outcomes in colorectal cancer: Multidisciplinary approaches to therapy and pain managementView all 12 articles
Analysis of Risk Factors and Prognostic Prediction in Advanced Colorectal Cancer Undergoing Immunotherapy Combined with Targeted Therapy
Provisionally accepted
- First Affiliated Hospital of Military Medical University, Chongqing, China
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Background: The prognostic implications of systemic inflammatory markers in mismatch repair-proficient (pMMR) advanced colorectal cancer (CRC) treated with immunotherapy combined with targeted therapy remain unclear. This study aimed to identify key clinical and inflammatory markers predictive of overall survival (OS) and progression-free survival (PFS), and to construct a nomogram for individualized outcome prediction. Methods: This retrospective study included 216 pMMR advanced CRC patients treated with camrelizumab plus bevacizumab between January 2020 and December 2022. Baseline clinical variables and inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), cancer-inflammation prognostic index (CIPI), and systemic immune-inflammation index (SII), were analyzed. Patients were randomly assigned to a training set (n = 139) or a validation set (n = 77). Independent prognostic factors for OS and PFS were identified via multivariable Cox regression. A nomogram was constructed and internally validated using bootstrap resampling (1,000 iterations). Results: Elevated body mass index (≥25 kg/m²) was independently associated with improved OS (hazard ratio [HR]=0.430; 95% CI: 0.185–0.980; p=0.047), while elevated CIPI (>828.8) and carcinoembryonic antigen (>5 ng/mL) were associated with poorer OS (HR=1.810, p=0.045; HR=2.440, p=0.025, respectively). For PFS, SII ≥663.9 predicted worse outcomes (HR=2.720; 95% CI: 1.200–6.200; p=0.016). The nomograms demonstrated moderate discrimination with optimism-adjusted C-indices of 0.610 (PFS) and 0.650 (OS), and calibration curves showed good agreement. Kaplan-Meier analysis confirmed significantly poorer OS and PFS in high-risk groups defined by nomogram scores (p<0.001 for both). Conclusions: This study highlights the prognostic significance of both clinical and inflammatory markers in pMMR advanced colorectal cancer undergoing immunotherapy combined with targeted therapy. The developed nomogram facilitates individualized survival prediction, offering clinicians a practical tool to tailor treatment and follow-up strategies for improved patient management.
Keywords: Advanced colorectal cancer, Immunotherapy, targeted therapy, Proficientmismatch repair, Prognostic prediction, nomogram
Received: 03 Jun 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Yuan, Chen, Liu, Hu, Hao and Dai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xin-Yan Dai, xinyand0123@163.com
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