{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T13:19:08Z","timestamp":1787663948098,"version":"build-2736575974"},"reference-count":39,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82560611"],"award-info":[{"award-number":["82560611"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Colorectal cancer (CRC) is a major public health burden in Hainan Province due to its high incidence and mortality, yet region\u2010specific prognostic data are lacking. This study evaluates prognostic factors in postsurgical CRC patients to guide localized prevention and treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 265 patients undergoing first\u2010time surgery for CRC between January 2015 and December 2021. Kaplan\u2013Meier estimator and log\u2010rank tests were performed to analyze the overall survival rates of CRC patients. Cox proportional hazards regression and the SHAP method were performed to determine the prognostic factors of CRC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study included 265 patients (mean age 63\u2009\u00b1\u200912.99\u2009years), with 171 survivors (64.5%) and 94 deaths (35.5%). The 1\u2010, 3\u2010 and 5\u2010year overall survival rates of CRC patients were 93.0%, 82.1%, and 73.9%, respectively, from 2015 to 2021. In multivariable analysis, factors associated with increased mortality risk included advanced age (per 1\u2009year increase: HR\u2009=\u20091.043, 95% CI: 1.018\u20131.069,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), TNM stage III (HR\u2009=\u200911.46, 95% CI: 2.611\u201350.31,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and stage IV (HR\u2009=\u200915.06, 95% CI: 3.131\u201372.46,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), increased tumor size (per 1\u2009cm increase: HR\u2009=\u20091.267, 95% CI: 1.058\u20131.519,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01), positive vascular infiltration (HR\u2009=\u20092.399, 95% CI: 1.162\u20134.951,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018), elevated CEA levels (per 1\u2009ng\/mL increase: HR\u2009=\u20091.035, 95% CI: 1.012\u20131.059,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), and increased CA125 levels (per 1\u2009U\/mL increase: HR\u2009=\u20091.013, 95% CI: 1.003\u20131.024,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014), while normal\u2010weight (HR\u2009=\u20090.385, 95% CI: 0.168\u20130.880,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024) was associated with a better survival. No association was found between the expression of MSH2, MDR1, and GST\u03c0 and the survival of the patients. The SHAP beeswarm plot highlighted TNM stage and age as the primary contributors to the model's predictions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Increased age, advanced TNM stage, larger tumor size, vascular invasion, and elevated CEA\/CA125 were linked to poorer CRC prognosis, while normal BMI was protective. Further prospective studies are needed for validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.72167","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T02:38:47Z","timestamp":1787107127000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Survival Outcomes of Patients With Colorectal Cancer After Primary Surgery: A Population\u2010Based Study in Hainan, China"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6126-9082","authenticated-orcid":false,"given":"Le","family":"Du","sequence":"first","affiliation":[{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Basic Medical Sciences, Hainan Academy of Medical Sciences Hainan Medical University  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luyao","family":"Sun","sequence":"additional","affiliation":[{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Basic Medical Sciences, Hainan Academy of Medical Sciences Hainan Medical University  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongsheng","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Hainan General Hospital Hainan Medical University Hainan Hospital  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingfa","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pathology The Second Affiliated Hospital of Hainan Medical University  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benguo","family":"Yu","sequence":"additional","affiliation":[{"name":"School of Intelligent Medicine and Technology, Big Data Research Center Hainan Medical University  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5671-1344","authenticated-orcid":false,"given":"Wenjun","family":"Yang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Basic Medical Sciences, Hainan Academy of Medical Sciences Hainan Medical University  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenlong","family":"Yang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Basic Medical Sciences, Hainan Academy of Medical Sciences Hainan Medical University  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruyuan","family":"An","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Hainan Medical University  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junchao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pathology The Second Affiliated Hospital of Hainan Medical University  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jike","family":"Zhu","sequence":"additional","affiliation":[{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Basic Medical Sciences, Hainan Academy of Medical Sciences Hainan Medical University  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaipan","family":"Wang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Hainan Medical University  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Hainan General Hospital Hainan Medical University Hainan Hospital  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenting","family":"Cao","sequence":"additional","affiliation":[{"name":"School of Public Health, Key Laboratory of Tropical Translational Medicine of Ministry of Education Hainan Medical University  Haikou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.21147\/j.issn.1000-9604.2021.01.01"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jncc.2024.01.006"},{"issue":"11","key":"e_1_2_12_5_1","first-page":"786","article-title":"Analysis of Malignant Tumor Incidence Among Different Ethnic Groups in Cancer Registration Areas of Hainan Province, 2015","volume":"29","author":"Tang R. 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