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Preoperative HALP and LMR predict disease-free survival in stage III colon cancer and enable nomogram-based risk
Jiayan Xu1, Fei Qu2, Xiaoyu Wang1
1Department of Oncology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China.
Background:
Colorectal cancer remains a major cause of cancer-related mortality worldwide. Despite curative resection and standard adjuvant chemotherapy, patients with stage III colon cancer remain at considerable risk of recurrence, with marked survival heterogeneity within the same pathological stage. Systemic inflammatory and immunonutritional biomarkers, including the hemoglobin-albumin-lymphocyte-platelet (HALP) score, systemic immune-inflammation index (SII), and lymphocyte-to-monocyte ratio (LMR), may reflect host-tumor interactions. However, their combined diagnostic and prognostic value in stage III colon cancer patients have not been fully established.
Methods:
This retrospective study included 210 patients with stage III colon cancer who underwent curative resection and 220 comparable patients with benign colonic lesions. Diagnostic performance was assessed using receiver operating characteristic analysis and logistic regression. Patients with stage III disease were randomly assigned to training and validation cohorts (7:3). Independent predictors of disease-free survival (DFS) were identified using Cox regression, and a nomogram was constructed and internally validated using the concordance index (C-index), time-dependent ROC analysis, calibration curves, and decision curve analysis.
Results:
HALP, SII, and LMR showed moderate discrimination for malignancy, with AUC of 0.773, 0.758, and 0.739, respectively. Multivariable analysis identified HALP (HR = 0.384, 95% CI: 0.225-0.655), LMR (HR = 0.483, 95% CI: 0.286-0.815), tumor stage (HR = 2.435, 95% CI: 1.432-4.140), and chemotherapy cycles (HR = 0.380, 95% CI: 0.223-0.647) as independent predictors of DFS. The nomogram demonstrated good discrimination (C-index 0.759 and 0.743 in the training and validation set) with satisfactory calibration and clinical net benefit.
Conclusion:
Preoperative HALP and LMR independently predict DFS in stage III colon cancer. A nomogram integrating inflammatory biomarkers with clinicopathological variables enables individualized recurrence risk estimation and may inform postoperative risk-adapted management.
