Nomogram development and evaluation for resectable colorectal cancer based on preoperative hemoglobin levels and lymphocyte to monocyte ratio：a retrospective cohort study

Abstract Background: The impact of lymphocyte to monocyte ratio (LMR) and hemoglobin (Hb) level on the prognosis of solid tumors and hematological malignancies was reported. Therefore, we sought to investigate the prognostic value of LMR-Hb based biomarker in resectable colorectal cancer (CRC). Methods: Clinical data from 700 CRC patients received radical surgery at Hubei Cancer Hospital from 2013 to 2016 were retrospectively analyzed. To evaluate the connection between clinical outcomes and elements regarding demographics, pathological and laboratory index, we conducted Multivariate Cox regression. A novel nomogram was developed, and its performance was evaluated by its discrimination, calibration, and clinical usefulness. Results: Kaplan-Meier method demonstrated that poorer overall survival (OS) and disease-free survival (DFS) was associated with higher Hb-LMR Score (P < 0.0001). Multivariate Cox regression illustrated that age at surgery greater than or equal to 65 years, female, the rate of lymph nodes metastasis reaching 0.077 or more, invasion of circumferential resection margin, TNM staging in III-IV, and Hb-LMR score of 2 were independent risk factors for poor OS or DFS. The area under the time-dependent receiver operating characteristic curve, the calibration curve along with decision curve analysis were performed and revealed that the nomogram was excellent in discrimination, calibration and efficacy. The concordance index illustrated that the nomogram has more accurate predictive ability for OS and DFS than TNM stage alone. Conclusion: Based on preoperative Hb and LMR, we successfully developed a novel and easily accessible prognostic score which had a good performance in predicting clinical outcomes in CRC patients.