AUTHOR=Cao Yu-Dan , Sun Hong-Wei , Li Tian-Ci , Xie Jia-Rui , Shi Xin-Ran , Chen Qian , Chen Yue , Peng Zi-Yang , Qiu Quan-Peng , Niu Nuo-Xuan , She Jun-Jun , Li Xiang 

TITLE=Validated nomograms for non-metastatic colorectal cancer prognosis prediction: a population-based study

JOURNAL=Frontiers in Oncology

VOLUME=Volume 15 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2025.1691693

DOI=10.3389/fonc.2025.1691693

ISSN=2234-943X

ABSTRACT=IntroductionThe 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.MethodsThis 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).ResultsMultivariable 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.ConclusionsThe 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.