{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:47:53Z","timestamp":1785415673055,"version":"3.56.0"},"reference-count":34,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004829","name":"Department of Science and Technology of Sichuan Province","doi-asserted-by":"publisher","award":["2023NSFSC1834"],"award-info":[{"award-number":["2023NSFSC1834"]}],"id":[{"id":"10.13039\/501100004829","id-type":"DOI","asserted-by":"publisher"}]},{"award":["2023NSFSC1834"],"award-info":[{"award-number":["2023NSFSC1834"]}],"id":[{"id":"https:\/\/ror.org\/04323m874","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Curr. Oncol.","Current Oncology"],"abstract":"<jats:p>Background: Patients with stage I rectal cancer generally have favorable outcomes after curative surgery, but prognosis is not completely homogeneous. This study explored the prognostic association of preoperative inflammation\u2013nutrition indices with overall survival and developed an interpretable internally validated machine learning survival model. Methods: We retrospectively included 475 patients with primary pathological stage I rectal adenocarcinoma who underwent curative-intent radical surgery at Sichuan University West China Hospital between 2018 and 2021. Patients downstaged to ypStage I after neoadjuvant therapy or treated by local transanal excision without lymph node dissection were excluded. Candidate predictors included age, sex, carcinoembryonic antigen, and routinely available preoperative inflammation\u2013nutrition indices. LASSO-Cox regression was used for feature selection. Six survival models were developed and evaluated using 1000 bootstrap resamples with out-of-bag internal validation. Model performance was assessed at 60 months using time-dependent AUC, C-index, Brier score, calibration, and decision curve analysis. SHAP analysis was used for model interpretation. Results: During a median follow-up of 68 months, 30 deaths occurred. LASSO-Cox regression identified five predictors: age, lymphocyte-to-white blood cell ratio, fibrinogen-to-lymphocyte ratio, albumin-to-alkaline phosphatase ratio, and neutrophil-to-HDL cholesterol ratio. In bootstrap out-of-bag internal validation, XGBoost-Cox achieved the highest, although only marginally higher, discriminative performance among the evaluated models, with a 60-month time-dependent AUC of 0.783, a C-index of 0.774, and a Brier score of 0.0507. The calibration intercept and slope of XGBoost-Cox were 0.519 and 1.070, respectively. SHAP analysis identified age as the most influential predictor, followed by the selected inflammation\u2013nutrition indices. Decision curve analysis suggested potential clinical utility within threshold probabilities from 1% to 20%, although this finding remains exploratory. Conclusions: Preoperative inflammation\u2013nutrition indices may contribute to overall survival prognostic stratification in primary pathological stage I rectal cancer. External validation in larger multicenter cohorts is required before clinical application.<\/jats:p>","DOI":"10.3390\/curroncol33080446","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T08:15:56Z","timestamp":1785140156000},"page":"446","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploratory Development and Interpretation of an Internally Validated XGBoost-Cox Model Based on Preoperative Inflammation\u2013Nutrition Indices for Overall Survival in Primary Pathological Stage I Rectal Cancer"],"prefix":"10.3390","volume":"33","author":[{"given":"Ping","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal and Colorectal Surgery, West China Tianfu Hospital, Sichuan University, Chengdu 610207, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiqiong","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal and Colorectal Surgery, West China Tianfu Hospital, Sichuan University, Chengdu 610207, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2874-1535","authenticated-orcid":false,"given":"Ziqiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, China"},{"name":"Department of General Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zechuan","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal and Colorectal Surgery, West China Tianfu Hospital, Sichuan University, Chengdu 610207, China"},{"name":"Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, China"},{"name":"Department of General Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Pang, K., An, X., Song, K., Xie, F., Ding, H., Zhou, H., He, Z., Chen, H., and Wu, D. 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