Preoperative albumin to carcinoembryonic antigen ratio predicts clinicopathological features and survival in colorectal cancer: a prognostic nomogram study

Aim This study examined the association between the preoperative albumin-to-carcinoembryonic antigen ratio (ACR) and clinicopathological characteristics in colorectal cancer (CRC) patients and developed and validated a prognostic model incorporating ACR for patient risk stratification. Methods A retrospective analysis was performed on the clinical and pathological data of CRC patients who underwent radical surgery at Shanxi Province Cancer Hospital between January 2017 and December 2017. Patient follow-up was conducted, and the Cox proportional hazards model was employed to identify factors influencing overall survival (OS) and disease-free survival (DFS). Additionally, an ACR-based nomogram was developed and its predictive performance was assessed using the concordance index (C-index) and calibration curves. Comparative analyses with the traditional TNM staging system were performed using discriminant indices. Results A total of 966 patients with CRC were included in the study, of whom 146 (15.1%) were categorized into the low ACR group and 820 (84.9%) into the high ACR group. The low ACR levels were significantly associated with adverse clinicopathological characteristics and an unfavorable prognosis in patients with CRC. The survival analysis demonstrated that OS ( P 0.001) and DFS ( P 0.001) were significantly worse in the low ACR group compared to the high ACR group. Multivariate analysis further revealed that high ACR served as an independent protective factor for both OS (HR = 0.433, 95% CI: 0.332 - 0.566; P 0.001) and DFS (HR = 0.545, 95% CI: 0.407- 0.730; P 0.001) among patients with CRC. The ACR-based nomogram demonstrated superior predictive performance, with C-index values of 0.786 for OS and 0.772 for DFS, outperforming the traditional TNM staging system. Conclusion Preoperative low ACR is significantly correlated with aggressive tumor characteristics and unfavorable prognosis in CRC patients. The ACR-based nomogram exhibits good predictive accuracy, offering a valuable tool for risk stratification in clinical practice.