Development and Validation of Nomogram Models Incorporating the Inflammatory Nutritional Index CALLY for Predicting...

Patients with locally advanced rectal cancer (LARC) have considerable rates of postoperative recurrence and metastasis, and existing scoring systems lack specificity. This study aims to establish and validate a prognostic model using inflammatory nutritional index CALLY for overall survival (OS) and progression-free survival (PFS) in patients with LARC following neoadjuvant chemoradiotherapy (NACRT), with the goal of enabling early risk assessment and intervention in LARC patients.

One hundred and thirty-one LARC patients were analyzed undergoing NACRT followed by surgery (January 2020-May 2024). The median follow-up was 27 months. LASSO regression and multivariate Cox analysis identified prognostic factors. Nomograms for 2-/3-year OS and PFS were constructed and validated using KM, time-dependent ROC curves, calibration plots, and decision curve analysis (DCA). Bootstrap method was used to internally verify the nomogram model.

The study's multifactorial analysis revealed high CALLY were independently associated with improved OS (HR = 0.344, 95% CI: 0.133-0.893; P = 0.028) and PFS (HR = 0.492, 95% CI: 0.266-0.912; P = 0.024). OS nomogram (CALLY/CEA/CCI) achieved AUCs of 0.83 (2-year) and 0.76 (3-year). PFS nomogram (CALLY/PLR/CEA/CA724/vascular invasion) showed superior 3-year accuracy (AUC = 0.81) but lower 2-year accuracy (AUC = 0.71). Calibration curves confirmed good prediction-observation agreement. DCA revealed wider clinical applicability for 3-year PFS. Survival KM curve for OS suggested that high-risk patients had 8.25-fold higher mortality (95% CI: 3.05-22.30).

A prognostic nomogram of LARC patients after NACRT in terms of OS and PFS was established based on the inflammatory nutritional Index CALLY, in which the PFS model showed excellent long-term predictive accuracy and clinical utility, providing individualized risk stratification and advance intervention to guide adjuvant therapy.