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Development and validation of a prognostic nomogram incorporating preoperative NLR, CEA and CA19‑9 for overall survival in colorectal cancer

  • Authors:
    • Bo Shi
    • Haoran Guo
    • Junjie Chen
    • Zhijian Peng
    • Suo Wang
    • Guoliang Chen
    • Qingliang Tai
    • Xinyu Shi
    • Songbing He
  • View Affiliations / Copyright

    Affiliations: Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China, Department of Central Laboratory, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, Jiangsu 223800, P.R. China, Department of General Surgery, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215200, P.R. China, Department of Oncological Surgery, Kunshan Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Kunshan, Jiangsu 215300, P.R. China, Department of Gastrointestinal Surgery, Changshu No. 1 Hospital, Suzhou, Jiangsu 215500, P.R. China
    Copyright: © Shi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 318
    |
    Published online on: May 29, 2026
       https://doi.org/10.3892/ol.2026.15673
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Abstract

Reliable evaluation methods serve an important role in improving the prognosis of patients with colorectal cancer (CRC), guiding the development of treatment plans and prolonging patient survival. In the present study, several preoperative inflammatory indicators and tumor markers were evaluated for their ability to predict CRC prognosis. A total of 224 eligible patients with CRC were enrolled and divided into the training (n=150) and validation (n=74) groups. The training group underwent both Least Absolute Shrinkage and Selection Operator (LASSO) regression and Cox regression analyses to discern pivotal prognostic factors, to formulate a nomogram for overall survival prediction. The results showed that LASSO regression, along with univariate and multivariate Cox regression analyses, identified neutrophil‑lymphocyte ratio (NLR), carbohydrate antigen 19‑9 (CA19‑9) and carcinoembryonic antigen (CEA) as effective risk factors for CRC. The concordance index of the nomogram was 0.716 in the training group and 0.700 in the validation group. The areas under the curve for predicting 3‑year survival were 0.748 and 0.776 in the training and validation groups, respectively, and for 5‑year survival were 0.749 and 0.731, respectively. In conclusion, NLR, CA19‑9 and CEA may serve as effective additions to traditional clinical assessment methods and a nomogram incorporating these three preoperative indicators could be used efficiently to predict the prognosis of patients with CRC.
View Figures

Figure 1

Filtering process for patient
inclusion.

Figure 2

Prognostic factors and nomogram
development for CRC. (A) LASSO coefficient profiles of 34
preoperative indicators and clinicopathological factors associated
with CRC. (B) 10-fold cross-validation used for tuning parameter
selection in the LASSO model. (C) Forest plot displaying the HRs of
prognostic factors identified through univariate Cox analysis of
the training group. (D) Forest plot illustrating the HRs of
prognostic factors identified through multivariate Cox analysis of
the training group. (E) Nomogram designed for predicting 3- and
5-year survival rates for patients in the training group. The
nomogram was constructed based on the training group data and
integrated NLR, CA19-9, CEA and TNM staging information. HR, hazard
ratio; NLR, neutrophil-lymphocyte ratio; CA19-9, carbohydrate
antigen 19-9; CEA, carcinoembryonic antigen; TNM, tumor-lymph
node-metastasis; CRC, colorectal cancer; CI, confidence interval;
LASSO, Least Absolute Shrinkage and Selection Operator; vars,
variables.

Figure 3

Time-dependent ROC analysis for
predicting the 3- and 5-year OS rates of patients with resected
colorectal cancer in the training and validation groups, and
calibrations of the nomogram for 3- and 5-year OS in the training
group. (A) Time-dependent ROC analysis in the training group. (B)
Time-dependent ROC analysis in the validation group. (C)
Calibration curve of the training group. (D) Calibration curve of
the validation group. ROC, receiver operating characteristic; OS,
overall survival; AUC, area under the receiver operating
characteristic curve.

Figure 4

Risk factor correlation diagrams were
generated for both the training and validation groups. (A)
Correlation visualization of risk factors in the training group.
(B) Correlation visualization of risk factors in the validation
group. The red dots represent surviving patients with CRC, while
blue dots represent deceased patients with CRC. In (A) and (B), the
dashed line represents the median risk score, with patients on the
left of the line classified into the low-risk subgroup and those on
the right into the high-risk subgroup. (C) KM 5-year OS curves for
the training group based on nomogram predictions (P<0.0001). (D)
KM 5-year OS curves for the validation group based on nomogram
predictions (P<0.0001). In (C) and (D), patients were stratified
into high- and low-risk subgroups according to the optimal cut-off
value determined by the minimum P-value approach. KM, Kaplan-Meier;
CRC, colorectal cancer; OS, overall survival.

Figure 5

ROC curves of the TNM, PNI and
nomogram for predicting the 5-year OS rate of patients with
resected CRC in the training and validation groups. (A) ROC curves
comparing the nomogram, TNM stage and PNI in the training group.
(B) ROC curves comparing the nomogram, TNM stage and PNI in the
validation group. (C) DCA comparing the nomogram, TNM stage and PNI
in the training group. (D) DCA comparing the nomogram, TNM stage
and PNI in the validation group. ROC, receiver operating
characteristic; TNM, tumor-lymph node-metastasis; CRC, colorectal
cancer; OS, overall survival; DCA, decision curve analysis; PNI,
prognostic nutritional index; AUC, area under the receiver
operating characteristic curve.
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Copy and paste a formatted citation
Spandidos Publications style
Shi B, Guo H, Chen J, Peng Z, Wang S, Chen G, Tai Q, Shi X and He S: Development and validation of a prognostic nomogram incorporating preoperative NLR, CEA and CA19‑9 for overall survival in colorectal cancer. Oncol Lett 32: 318, 2026.
APA
Shi, B., Guo, H., Chen, J., Peng, Z., Wang, S., Chen, G. ... He, S. (2026). Development and validation of a prognostic nomogram incorporating preoperative NLR, CEA and CA19‑9 for overall survival in colorectal cancer. Oncology Letters, 32, 318. https://doi.org/10.3892/ol.2026.15673
MLA
Shi, B., Guo, H., Chen, J., Peng, Z., Wang, S., Chen, G., Tai, Q., Shi, X., He, S."Development and validation of a prognostic nomogram incorporating preoperative NLR, CEA and CA19‑9 for overall survival in colorectal cancer". Oncology Letters 32.1 (2026): 318.
Chicago
Shi, B., Guo, H., Chen, J., Peng, Z., Wang, S., Chen, G., Tai, Q., Shi, X., He, S."Development and validation of a prognostic nomogram incorporating preoperative NLR, CEA and CA19‑9 for overall survival in colorectal cancer". Oncology Letters 32, no. 1 (2026): 318. https://doi.org/10.3892/ol.2026.15673
Copy and paste a formatted citation
x
Spandidos Publications style
Shi B, Guo H, Chen J, Peng Z, Wang S, Chen G, Tai Q, Shi X and He S: Development and validation of a prognostic nomogram incorporating preoperative NLR, CEA and CA19‑9 for overall survival in colorectal cancer. Oncol Lett 32: 318, 2026.
APA
Shi, B., Guo, H., Chen, J., Peng, Z., Wang, S., Chen, G. ... He, S. (2026). Development and validation of a prognostic nomogram incorporating preoperative NLR, CEA and CA19‑9 for overall survival in colorectal cancer. Oncology Letters, 32, 318. https://doi.org/10.3892/ol.2026.15673
MLA
Shi, B., Guo, H., Chen, J., Peng, Z., Wang, S., Chen, G., Tai, Q., Shi, X., He, S."Development and validation of a prognostic nomogram incorporating preoperative NLR, CEA and CA19‑9 for overall survival in colorectal cancer". Oncology Letters 32.1 (2026): 318.
Chicago
Shi, B., Guo, H., Chen, J., Peng, Z., Wang, S., Chen, G., Tai, Q., Shi, X., He, S."Development and validation of a prognostic nomogram incorporating preoperative NLR, CEA and CA19‑9 for overall survival in colorectal cancer". Oncology Letters 32, no. 1 (2026): 318. https://doi.org/10.3892/ol.2026.15673
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