ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Colorectal Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1691693
This article is part of the Research TopicNational Colorectal Cancer Awareness Month 2025: Current Progress and Future Prospects on Colorectal Cancer Prevention, Diagnosis and TreatmentView all 17 articles
Validated Nomograms for Non-metastatic Colorectal Cancer Prognosis Prediction: A Population-based Study
Provisionally accepted
Yu-Dan Cao1
HongWei Sun1Tian-Ci Li1Jia-Rui Xie1Xin-Ran Shi1Qian Chen2Yue Chen2
Zi-Yang Peng2Quan-Peng Qiu2Nuo-Xuan Niu2
Jun-Jun She2
Xiang Li2*- 1Xi'an Jiaotong University Health Science Center, Xi'an, China
- 2Department of Otorhinolaryngology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Introduction: The TNM staging system has limitations in predicting prognosis for colorectal cancer (CRC). This study aimed to develop and validate a nomogram incorporating the albumin-derived neutrophil-to-lymphocyte ratio (Alb-dNLR) score, a novel nutritional and inflammatory biomarker, to provide a more accurate and personalized prognostic prediction for patients with non-metastatic CRC. Methods: This retrospective study included a development cohort of 457 non-metastatic CRC patients who underwent radical colectomy, and an external validation cohort of 207 patients. Optimal cut-off values for continuous variables were determined by ROC curve analysis. Multivariable Cox and LASSO regression models were used to identify independent prognostic factors for cancer-specific survival (CSS) and to construct two nomograms. The performance of the nomograms was assessed by C-indexes, calibration plots, and decision curve analysis (DCA). Results: Multivariable analysis confirmed that a high Alb-dNLR score was an independent predictor for worse cancer-specific survival (CSS) (HR = 5.536, P < 0.001) and overall survival (OS) (HR = 4.690, P < 0.001). Both nomograms, developed from Cox and LASSO models, showed superior discrimination compared to the TNM staging system alone (C-index in development cohort: (0.785, 0.767 vs. 0.680). Calibration plots and DCA confirmed the nomograms' accuracy and clinical utility in both cohorts. Conclusions: The Alb-dNLR score is a simple and effective independent prognostic biomarker for non-metastatic CRC. The nomograms incorporating Alb-dNLR score provide a more accurate and practical tool than the TNM system for predicting patient survival, thereby facilitating personalized clinical decision-making.
Keywords: Alb-dNLR score, nomogram, non-metastatic colorectal cancer, prognosis, Inflammation, nutrition
Received: 26 Aug 2025; Accepted: 13 Oct 2025.
Copyright: © 2025 Cao, Sun, Li, Xie, Shi, Chen, Chen, Peng, Qiu, Niu, She and Li. 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: Xiang Li, lixiang001@xjtufh.edu.cn
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