Table 1_Tumor-immune microenvironment and nutritional status biomarkers predict recurrence after total colectomy for locally advanced colon cancer: development and internal validation of a nomogram.docx

A nomogram was constructed from multivariable Cox regression and internally validated by 1,000-resample bootstrapping; performance was assessed by AUC, calibration, and decision curve analysis.</p>Results<p>Among 341 patients (median follow-up 36.0 months), 94 (27.6%) recurred; 3-year DFS was 72.4%. Independent predictors of inferior DFS: pMMR/MSS status (aHR = 2.84), advanced stage (aHR = 2.52), high lymph node ratio (aHR = 2.13), low TIL density (aHR = 2.21), elevated CEA (aHR = 1.88), and high NLR (aHR = 1.78; all p ≤ 0.008).

Preoperative albumin (aHR = 0.94 per 1 g/L increase, p = 0.003) and NRS 2002 >=4 (aHR = 1.58, p = 0.035) also remained independently associated with DFS. Adjuvant ICI use was associated with improved DFS (aHR = 0.48, p = 0.005). The nomogram achieved AUC = 0.841 (optimism-corrected: 0.824), good calibration (Hosmer–Lemeshow p = 0.557), and net clinical benefit across threshold probabilities 0.10–0.80.</p>Conclusion<p>A nomogram integrating MMR status, TIL density, PD-L1 CPS, NLR, CEA, tumour stage, lymph node ratio, and perioperative nutritional indicators robustly predicts 3-year recurrence after total colectomy for locally advanced colon cancer (AUC = 0.841), substantially outperforming clinical-only models.

These hypothesis-generating findings require prospective randomised validation before clinical implementation.</p>