{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:45:35Z","timestamp":1791945935622,"version":"4.3.4"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Genet."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post-colectomy recurrence affects 25%\u201345% of patients with locally advanced colon cancer despite adjuvant chemotherapy. The tumor-immune microenvironment (TIME)\u2014encompassing mismatch repair (MMR) status, tumor-infiltrating lymphocyte (TIL) density, PD-L1 expression, and systemic indices such as the neutrophil-to-lymphocyte ratio (NLR)\u2014critically determines recurrence risk and immunotherapy response. Perioperative nutritional status (preoperative albumin; NRS 2002) further modulates immune competence. No validated clinical tool has integrated these multi-dimensional biomarkers for post-colectomy risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective dual-centre cohort enrolled 341 patients (stage II\u2013III colon cancer; total colectomy, 2020\u20132024). Tumour-immune biomarkers (MMR\/MSI status, PD-L1 CPS, TIL density, NLR, PLR) and nutritional indicators (albumin, NRS 2002) were assessed preoperatively. Primary endpoint: 3-year disease-free survival (DFS). A nomogram was constructed from multivariable Cox regression and internally validated by 1,000-resample bootstrapping; performance was assessed by AUC, calibration, and decision curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 341 patients (median follow-up 36.0 months), 94 (27.6%) recurred; 3-year DFS was 72.4%. Independent predictors of inferior DFS: pMMR\/MSS status (aHR = 2.84), advanced stage (aHR = 2.52), high lymph node ratio (aHR = 2.13), low TIL density (aHR = 2.21), elevated CEA (aHR = 1.88), and high NLR (aHR = 1.78; all p \u2264 0.008). Preoperative albumin (aHR = 0.94 per 1 g\/L increase, p = 0.003) and NRS 2002 &amp;gt;=4 (aHR = 1.58, p = 0.035) also remained independently associated with DFS. Adjuvant ICI use was associated with improved DFS (aHR = 0.48, p = 0.005). The nomogram achieved AUC = 0.841 (optimism-corrected: 0.824), good calibration (Hosmer\u2013Lemeshow p = 0.557), and net clinical benefit across threshold probabilities 0.10\u20130.80.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A nomogram integrating MMR status, TIL density, PD-L1 CPS, NLR, CEA, tumour stage, lymph node ratio, and perioperative nutritional indicators robustly predicts 3-year recurrence after total colectomy for locally advanced colon cancer (AUC = 0.841), substantially outperforming clinical-only models. These hypothesis-generating findings require prospective randomised validation before clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fgene.2026.1916575","type":"journal-article","created":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T22:10:17Z","timestamp":1789337417000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Tumor-immune microenvironment and nutritional status biomarkers predict recurrence after total colectomy for locally advanced colon cancer: development and internal validation of a nomogram"],"prefix":"10.3389","volume":"17","author":[{"given":"Yanhui","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Clinical Nutrition, The Second Affiliated Hospital of Harbin Medical University","place":["Harbin, Heilongjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ezhou Central Hospital","place":["Ezhou, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songchun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition, Ezhou Central Hospital","place":["Ezhou, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiong","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of General Practice, Xinchang County People\u2019s Hospital","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1056\/NEJMoa2017699","article-title":"Pembrolizumab in microsatellite-instability-high advanced colorectal cancer (KEYNOTE-177)","volume":"383","author":"Andr\u00e9","year":"2020","journal-title":"N. 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