Background: The prognostic utility of inflammatory and tumor biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and carcinoembryonic antigen (CEA), in rectal cancer has been increasingly studied, but results remain inconsistent. This study evaluates the prognostic significance of pre- and post-chemoradiotherapy (CRT) levels and dynamic changes in NLR, PLR, and CEA for predicting overall survival (OS) and disease-free survival (DFS) in locally advanced rectal cancer (LARC). Methods: This retrospective study included 261 LARC patients treated with neoadjuvant CRT followed by curative surgery. Pre- and post-CRT NLR, PLR, and CEA were collected. Survival analyses were performed using Kaplan–Meier curves and Cox proportional hazards models. ROC curves assessed predictive performance, and patients were stratified by cut-offs and biomarker changes (delta values). Results: The cohort had a mean age of 55.5 years; 55.9% were male, and 93.5% had clinical stage III disease. Post-CRT NLR (HR: 1.05,p= 0.007) and CEA (HR: 1.00,p< 0.001) were independently associated with OS, while post-CRT CEA and AJCC stage III were predictors of DFS (HR: 4.12,p= 0.009). ROC analysis showed improved accuracy when combining NLR (AUC = 0.66) and CEA (AUC = 0.70), yielding a combined AUC of 0.84 for OS. Patients with decreases in both NLR and CEA had the most favorable outcomes, whereas increases in both markers indicated poor prognosis (OSp< 0.0001; DFSp= 0.00019). Conclusions: Post-CRT levels and dynamic changes in NLR and CEA are independent prognostic markers in rectal cancer. Their combined assessment enhances survival prediction and may guide personalized postoperative surveillance and treatment strategies.
背景：炎症及肿瘤标志物如中性粒细胞-淋巴细胞比值（NLR）、血小板-淋巴细胞比值（PLR）和癌胚抗原（CEA）在直肠癌预后评估中的应用价值日益受到关注，但研究结论尚不一致。本研究旨在评估局部进展期直肠癌（LARC）患者在新辅助放化疗（CRT）前后NLR、PLR和CEA的水平及其动态变化对总生存期（OS）和无病生存期（DFS）的预测意义。方法：这项回顾性研究纳入261例接受新辅助放化疗后根治性手术的LARC患者。收集患者CRT前后的NLR、PLR和CEA数据。采用Kaplan-Meier曲线和Cox比例风险模型进行生存分析，通过ROC曲线评估预测效能，并根据截断值和标志物变化（Δ值）对患者进行分层。结果：研究队列平均年龄55.5岁，男性占55.9%，93.5%为临床III期。多因素分析显示，CRT后NLR（HR: 1.05, p=0.007）和CEA（HR: 1.00, p<0.001）是OS的独立预测因子，而CRT后CEA和AJCC III期是DFS的预测因子（HR: 4.12, p=0.009）。ROC分析表明，联合NLR（AUC=0.66）与CEA（AUC=0.70）可显著提升预测准确性，对OS的联合AUC达0.84。NLR与CEA同步下降的患者预后最佳，而两者同步升高者预后最差（OS p<0.0001；DFS p=0.00019）。结论：CRT后NLR和CEA水平及其动态变化是直肠癌的独立预后标志物。联合评估可显著提升生存预测效能，有望为个体化术后监测和治疗策略制定提供依据。
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