Published online Apr 15, 2026. doi: 10.4251/wjgo.v18.i4.115687
Revised: December 11, 2025
Accepted: January 19, 2026
Published online: April 15, 2026
Processing time: 154 Days and 23 Hours
Colorectal cancer (CRC) presents a significant global health burden, with considerable variation in survival following curative surgery. Identifying patients at high risk of poor outcomes is crucial for tailored treatment and surveillance strategies. Evidence indicates that individual prognostic markers, whether tumor-associated or inflammation-based, offer limited predictive value. This study posits that a combined model integrating carcinoembryonic antigen (CEA), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) will provide a more accurate and robust prediction of postoperative survival in patients with CRC than any single biomarker alone.
To evaluate the prognostic value of combined CEA, NLR, and PLR in CRC.
This study retrospectively enrolled 120 CRC patients who underwent radical resection from July 2021 to July 2022. Based on three-year survival status, patients were classified into a mortality group (43 patients) and a survival group (77 patients). Baseline NLR, PLR, and CEA levels were compared between groups. Cox proportional hazards regression and receiver operating characteristic curve analyses were used to identify survival risk factors and evaluate prognostic utility.
Among 120 patients, 43 died within 3 years postoperatively, yielding a mortality rate of 35.83%. Comparing clinical data between groups, the deceased group displayed significantly higher serum levels of NLR, PLR, and CEA than the surviving group, along with a higher proportion of tumors > 5 cm in diameter and distant metastases (P < 0.05). Cox regression analysis demonstrated that elevated postoperative serum NLR, PLR, and CEA levels constitute risk factors for postoperative survival in CRC patients. Receiver operating characteristic curve analysis revealed that the area under the curve for predicting postoperative survival using NLR, PLR, and CEA individually were 0.896, 0.805, and 0.880, correspondingly. The integrated area under the curve for the three biomarkers was 0.977, indicating significantly higher predictive value than any single marker (P < 0.0001).
Combined assessment of inflammatory markers NLR, PLR and tumor marker CEA provides valuable prognostic information for CRC patient survival.
Core Tip: This study investigated the predictive value of the inflammatory markers neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio combined with the tumor marker carcinoembryonic antigen for postoperative survival in patients with colorectal cancer. The results showed that the combined detection of the three markers demonstrated significantly superior predictive efficacy compared to any single indicator, providing an efficient and convenient clinical tool for assessing the prognosis of colorectal cancer patients.