Neutrophil-albumin ratio as a biomarker for postoperative complications and long-term prognosis in patients with colorectal cancer undergoing surgical treatment

To explore the prognostic value of the preoperative neutrophil-albumin ratio (NAR) in patients with colorectal cancer (CRC) undergoing surgical treatment. The standardized log-rank statistic was used to determine the optimal cut-off value for NAR. A logistic regression model was used to evaluate the value of NAR in predicting postoperative complications. Cox proportional hazards models were used to assess the independent association of NAR with progression-free survival (PFS) and overall survival (OS) in CRC patients. Restricted cubic splines were used to assess the relationship between continuous NAR and survival in CRC patients. The Kaplan-Meier method and log-rank test were used to compare survival differences between low and high NAR groups. NAR-based prognostic nomograms were constructed to predict the 1-5-year PFS and OS of CRC patients. The concordance index (C-index) and calibration curve were used to evaluate the prognostic accuracy of the nomograms. A total of 1,441 CRC patients were enrolled from January 2012 to December 2016. There were 904 men (62.7%) and 537 women (37.3%), with an average age of 58.12 ± 13.15 years. High NAR was closely associated with low BMI, advanced pathological stage, colon cancer, large tumors, vascular invasion, poor differentiation, high CEA levels, long hospital stay, and recurrence and metastasis. A high NAR was an independent risk factor for postoperative complications in CRC patients (OR: 2.298, 95% CI: 1.642-3.216, < 0.001). Patients with a high NAR had worse PFS (40.7 vs. 59.5%, < 0.001) and OS (42.6 vs. 62.4%, < 0.001). After adjusting for confounders, high NAR was independently associated with PFS (HR: 1.280, 95% CI: 1.031-1.589, = 0.025) and OS (HR: 1.280; 95% CI: 1.026-1.596, = 0.029) in CRC patients. The C-index and calibration curves showed that the NAR-based prognostic nomograms had good predictive accuracy. High NAR was an independent risk factor for postoperative complications and long-term prognosis of CRC patients. NAR-based research could provide references for prognostic judgment and clinical decision-making of CRC patients.