Prognostic value of the lymphocyte‑albumin‑neutrophil ratio in de novo metastatic colorectal cancer: A continuous‑variable analysis

Currently, the continuous prognostic association of the lymphocyte‑albumin‑neutrophil ratio (LANR) in de novo metastatic colorectal cancer remains uncertain. The present retrospective, single‑center prognostic study evaluated baseline LANR in 141 patients who received first‑line anti‑VEGF or anti‑EGFR treatment. Serum 25‑hydroxyvitamin D was examined as a secondary exploratory biomarker. LANR was modeled per 5‑unit increase. Cox regression models assessed associations with overall survival (OS) and progression‑free survival (PFS), and sensitivity models evaluated robustness under a clinically selected covariate set. Restricted cubic splines assessed the shape of the associations. Each 5‑unit increase in LANR was associated with lower risk of mortality [hazard ratio (HR), 0.80; 95% confidence interval (CI), 0.66‑0.96; P=0.015] and progression or mortality (HR, 0.83; 95% CI, 0.72‑0.94; P=0.005). The estimates were essentially unchanged in clinically selected models, and spline analyses showed no evidence of departure from linearity. Higher 25‑hydroxyvitamin D was associated with longer PFS but not OS in the primary model; the PFS association was attenuated to non‑significant in sensitivity analyses. Incremental discrimination was modest. In this selected treatment population, baseline LANR was associated with OS and PFS when analyzed continuously without a study‑derived threshold. These findings support external validation but do not establish current clinical or treatment‑selection utility.