Prognostic value of the lymphocyte‑albumin‑neutrophil ratio in de novo metastatic colorectal cancer: A continuous‑variable analysis

Currently, the continuous prognostic association of the lymphocyte-albumin-neutrophil ratio (LANR) in de novo metastatic colorectal cancer remains uncertain.The present retrospective, single-center prognostic study evaluated baseline LANR in 141 patients who received first-line anti-VEGF or anti-EGFR treatment.Serum 25-hydroxyvitamin D was examined as a secondary exploratory biomarker.LANR was modeled per 5-unit increase.Cox regression models assessed associations with overall survival (OS) and progression-free survival (PFS), and sensitivity models evaluated robustness under a clinically selected covariate set.Restricted cubic splines assessed the shape of the associations.Each 5-unit increase in LANR was associated with lower risk of mortality [hazard ratio (HR), 0.80; 95% confidence interval (CI), 0.66-0.96;P=0.015] and progression or mortality (HR, 0.83; 95% CI, 0.72-0.94;P=0.005).The estimates were essentially unchanged in clinically selected models, and spline analyses showed no evidence of departure from linearity.Higher 25-hydroxyvitamin D was associated with longer PFS but not OS in the primary model; the PFS association was attenuated to non-significant in sensitivity analyses.Incremental discrimination was modest.In this selected treatment population, baseline LANR was associated with OS and PFS when analyzed continuously without a study-derived threshold.These findings support external validation but do not establish current clinical or treatment-selection utility.