Serum ferritin as a potential biomarker for distinguishing advanced-stage colorectal cancer: a retrospective cohort study

Background Colorectal cancer (CRC) stage plays a major role in treatment decisions and prognosis. This study investigates whether Serum Ferritin can improve CRC staging and compares its performance to standard markers like carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). Methods We analyzed data from 419 CRC patients at Jiujiang College Affiliated Hospital, dividing them into early-stage (I–II, 245 patients) and late-stage (III–IV, 174 patients) groups. Logistic regression and receiver operating characteristic (ROC) curves were used to assess the usefulness of serum ferritin compared with traditional markers. Results Serum Ferritin was significantly higher in late-stage CRC ( P < 0.001). ROC analysis showed Serum Ferritin had a numerically higher area under the curve (AUC) (0.795) compared to CA 19-9 (0.745) and CEA (0.744) at distinguishing between early and advanced stages. The combined model yielded an AUC of 0.890. Conclusion Serum Ferritin could be a useful addition to CRC staging, showing a numerically higher AUC than current markers. Adding it to clinical practice may help refine stage assessment and guide treatment decisions. This study supports its potential as a supplementary tool for stage assessment in CRC management.