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已发表论文
纳入炎症营养指数 CALLY 的列线图模型的开发与验证：用于预测新辅助放化疗后局部晚期直肠癌患者的生存情况
Authors Zhang Y, Yang Z, Feng Y, Shi Y, Shen X, Gao S, Guo T, Cui J, Bao C
Received 7 August 2025
Accepted for publication 19 November 2025
Published 1 December 2025 Volume 2025:17 Pages 2961—2975
DOI https://doi.org/10.2147/CMAR.S555346
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Chien-Feng Li
Yichen Zhang,1,2,* Zenghui Yang,2,* Yuzhou Feng,1,2,* Yifan Shi,2 Xiaoming Shen,2 Sen Gao,2 Tao Guo,1,2 Jing Cui,1,2 Chuanqing Bao1,2
1Wuxi School of Medicine, Jiangnan University, Wuxi, 214000, People’s Republic of China; 2Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, Wuxi, 214000, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Chuanqing Bao, Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, Wuxi, 214000, People’s Republic of China, Email wxbaocq@126.com
Background: 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.
Methods: 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.
Results: 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).
Conclusion: 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.
Keywords: locally advanced rectal cancer, neoadjuvant chemoradiotherapy, prognostic model, inflammatory nutritional indices, nomogram
1Wuxi School of Medicine, Jiangnan University, Wuxi, 214000, People’s Republic of China; 2Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, Wuxi, 214000, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Chuanqing Bao, Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, Wuxi, 214000, People’s Republic of China, Email wxbaocq@126.com
Background: 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.
Methods: 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.
Results: 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).
Conclusion: 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.
Keywords: locally advanced rectal cancer, neoadjuvant chemoradiotherapy, prognostic model, inflammatory nutritional indices, nomogram