Nutritional and inflammatory status was associated with prognosis in various types of malignant cancer, including colorectal cancer (CRC). This clinical research was performed to estimate the prognostic role of immune-nutritional indexes CRC in patients and to set up a survival nomogram based on the significant immune-nutritional indexes. 1024 CRC patients underwent surgical resection from Wuhan Union Hospital were enrolled and divided into the test cohort (n = 717) and validation cohort (n = 307). A total of 19 immune-nutritional indexes were included into our analysis. The Cox regression analysis was utilized to identify the informative immune-nutritional indexes which were closely associated with overall survival (OS) and disease-free survival (DFS). Survival nomograms were created in the test set and further verified in the validation set. Td-ROC was curved to estimate the predictive performance of survival nomograms for CRC patients. Body mass index (BMI), chemotherapy, TNM stage, T stage, lactate dehydrogenase (LDH)/prealbumin (PA), monocytes (MON)/albumin (ALB), and prognostic nutritional index (PNI) were seven potent prognostic biomarkers of CRC patients. We created an OS-nomogram based on the seven risk indexes, and the predictive accuracy expressed with area under curve (AUC) was 0.826 for 1-year, 0.809 for 3-year, and 0.80 for 5-year OS rates in the test set and 0.795 for 1-year, 0.749 for 3-year, and 0.647 for 5-year OS rates in the validation set. TNM stage, T stage, LDH/ALB, and MON/ALB were risk factors for unfavorable DFS in CRC patients. We further built a DFS-nomogram based on the four risk factors, and the predictive performance presented with AUC was 0.806 for 1-year, 0.763 for 3-year, and 0.82 for 5-year DFS rates in the test set, and 0.704 for 1-year, 0.692 for 3-year, and 0.692 for 5-year DFS rates in the validation set. Our survival nomogram based on immune-nutritional indexes is a useful and potential prognostic tool in CRC patients.
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