The role of tumor characteristics and biomarkers in predicting long-term survival rates of rectal cancer patients

Rectal cancer (RC) is a significant global health burden with distinct anatomical and prognostic challenges compared to colon cancer. Despite advancements in treatment, postoperative recurrence and poor survival rates remain prevalent, particularly in advanced-stage cases. This study aims to evaluate the prognostic value of systemic inflammatory biomarkers, including hemoglobin, albumin, lymphocyte, and platelet, LCR, prognostic nutritional index, CAR, NLR, and SII, in predicting long-term survival outcomes in RC patients. A retrospective cohort study was conducted on 637 patients who underwent low anterior resection for RC at Sakarya Training and Research Hospital between 2015 and 2023. Inclusion criteria were adult patients with complete clinicopathological and follow-up data. Inflammatory biomarkers were calculated using standard biochemical parameters. Overall survival (OS) was assessed through Kaplan-Meier analysis, and the prognostic significance of variables was determined via Cox regression and ROC analysis. Age, follow-up duration, hemoglobin, albumin, CRP levels, and inflammatory markers significantly influenced survival (P < .05). Elevated CRP/Albumin ratios, NLR, and SII values correlated with poor prognosis, while higher hemoglobin, albumin, lymphocyte, and platelet and prognostic nutritional index scores were associated with improved outcomes. Advanced tumor stage (T3/T4) and lymph node metastasis significantly reduced OS (P = .002). ROC analysis identified optimal biomarker cutoffs, with AUC values ranging from 0.7 to 0.9, indicating moderate to good predictive accuracy. Inflammation-based biomarkers provide valuable prognostic insights in RC, facilitating personalized treatment planning and follow-up. Future multicenter studies are needed to validate these findings and refine biomarker utility in clinical practice.