Nomogram construction for predicting the efficacy of neoadjuvant chemoradiotherapy in rectal cancer based on preoperative inflammatory-nutritional indicators and tumor markers

Yang Xi; Zhao Meijiao; Dong Jiaming

doi:10.3969/j.issn.1003-5591.2026.05.012

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Nomogram construction for predicting the efficacy of neoadjuvant chemoradiotherapy in rectal cancer based on preoperative inflammatory-nutritional indicators and tumor markers

更新时间：2026-10-22

- Nomogram construction for predicting the efficacy of neoadjuvant chemoradiotherapy in rectal cancer based on preoperative inflammatory-nutritional indicators and tumor markers
- J Abdominal Surg Vol. 39, Issue 5, Pages: 392-401(2026)
- 作者机构：
  
  1.沧州市中心医院，肿瘤内科，河北沧州 061000
  2.沧州市中心医院，放疗科，河北沧州 061000
- 作者简介：
  
  Yang Xi，Email：15931718561@163.com
- 基金信息：
- DOI：10.3969/j.issn.1003-5591.2026.05.012
  CLC： R735.3
- Received：25 December 2025，
  
  Published：22 October 2026
- 稿件说明：
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杨曦,赵美姣,董家铭.术前炎症营养指标与肿瘤标志物预测直肠癌新辅助放化疗疗效的列线图构建[J].腹部外科,2026,39(05):392-401.

Yang Xi,Zhao Meijiao,Dong Jiaming.Nomogram construction for predicting the efficacy of neoadjuvant chemoradiotherapy in rectal cancer based on preoperative inflammatory-nutritional indicators and tumor markers[J].J Abdominal Surg,2026,39(05):392-401.
杨曦,赵美姣,董家铭.术前炎症营养指标与肿瘤标志物预测直肠癌新辅助放化疗疗效的列线图构建[J].腹部外科,2026,39(05):392-401. DOI： 10.3969/j.issn.1003-5591.2026.05.012.

Yang Xi,Zhao Meijiao,Dong Jiaming.Nomogram construction for predicting the efficacy of neoadjuvant chemoradiotherapy in rectal cancer based on preoperative inflammatory-nutritional indicators and tumor markers[J].J Abdominal Surg,2026,39(05):392-401. DOI： 10.3969/j.issn.1003-5591.2026.05.012.

摘要

目的

探讨术前炎症营养指标与肿瘤标志物对直肠癌新辅助放化疗（neoadjuvant chemoradiotherapy，nCRT）疗效的预测价值，构建并验证列线图模型。

方法

回顾性分析2023年1月至2025年6月沧州市中心医院收治的296例接受nCRT后行根治性手术的直肠癌病人临床资料。收集术前炎症营养指标、肿瘤标志物及临床病理特征，根据术后病理肿瘤消退分级（tumor regression grade，TRG）评估疗效，TRG 0～1级为有效组（151例），TRG 2～3级为无效组（145例）。采用单因素和多因素logistic回归分析筛选独立预测因素，构建列线图模型，评估模型预测效能及临床应用价值。采用随机数字表法按7∶3比例将病人分为训练集（207例）和验证集（89例）进行内部验证。

结果

单因素分析显示，有效组与无效组间中性粒细胞与淋巴细胞比值（NLR）、全身炎症反应指数、预后营养指数、癌胚抗原、临床N分期及肿瘤最大径差异均有统计学意义（均

0.05）。多因素分析显示上述6项指标均为nCRT疗效的独立预测因素：NLR（

=0.542，95%

：0.368～0.798，

=0.002），全身炎症反应指数（

=0.485，95%

：0.312～0.754，

=0.001），预后营养指数（

=2.145，95%

：1.423～3.234，

0.001），癌胚抗原（

=0.612，95%

：0.432～0.867，

=0.006），临床N分期（

=0.598，95%

：0.423～0.846，

=0.004），肿瘤最大径（

=0.723，95%

：0.536～0.976，

=0.034）。在模型构建前，将训练集与验证集关键基线特征进行均衡性检验，结果表明均衡有效。基于上述指标构建的列线图模型在训练集和验证集中的曲线下面积分别为0.842和0.825，校准度良好。根据模型评分将病人分为低危、中危、高危三组，训练集中三组nCRT有效率分别为73.91%（51/69）、52.94%（36/68）和34.29%（24/70），验证集中趋势一致。

结论

基于术前炎症营养指标与肿瘤标志物构建的列线图模型能有效预测直肠癌nCRT疗效，为个体化治疗决策提供参考依据。

Abstract

Objective

To investigate the predictive value of preoperative inflammatory-nutritional indicators and tumor markers for the efficacy of neoadjuvant chemoradiotherapy（nCRT） in rectal cancer， and to construct and validate a nomogram model.

Methods

A retrospective analysis was performed on the clinical data of 296 rectal cancer patients who underwent radical surgery after nCRT at Cangzhou Central Hospital from January 2023 to June 2025. Preoperative inflammatory-nutritional indicators， tumor markers， and clinicopathological features were collected. According to postoperative tumor regression grade（TRG），the treatment response was evaluated：TRG 0–1 was classified as the effective group（151 cases）， and TRG 2–3 as the ineffective group（145 cases）. Univariate and multivariate logistic regression analyses were used to identify independent predictive factors， on the basis of which a nomogram model was developed to assess its predictive performance and clinical value. Using a random number table method， patients were assigned to a training set（207 cases） and a validation set（89 cases） at a ratio of 7∶3 for internal validation.

Results

Univariate analysis showed that the effective and ineffective groups differed significantly in neutrophil-to-lymphocyte ratio （NLR）， systemic inflammatory response index， prognostic nutritional index， carcinoembryonic antigen， clinical N stage， and maximum tumor diameter （all

0.05）. Multivariate analysis showed that all six indicators were independent predictors of nCRT efficacy：NLR （

=0.542，95%

：0.368–0.798，

=0.002），systemic inflammatory response index（

=0.485， 95%

：0.312–0.754，

=0.001）， prognostic nutritional index （

=2.145，95%

：1.423–3.234，

0.001），carcinoembryonic antigen（

=0.612，95%

：0.432–0.867，

=0.006），clinical N stage（

=0.598，95%

：0.423–0.846，

=0.004），and maximum tumor diameter（

=0.723，95%

：0.536–0.976，

=0.034）.Before model construction， baseline characteristics were balanced between the training and validation sets，and the results confirmed effective balance.The nomogram model built on these indicators achieved area under the curve values of 0.842 in the training set and 0.825 in the validation set， with good calibration. Based on the model scores，patients were stratified into low-， intermediate-，and high-risk groups. In the training set， the nCRT response rates in these three groups were 73.91%（51/69），52.94%（36/68）， and 34.29%（24/70），respectively， and a consistent trend was observed in the validation set.

Conclusion

The nomogram model constructed from preoperative inflammatory-nutritional indicators and tumor markers can effectively predict the efficacy of nCRT in rectal cancer and may provide a reference for individualized treatment decision-making.

关键词

Keywords

references

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