营养控制状态评分联合预后营养指数评估老年结直肠癌患者合并贫血风险的临床应用价值

doi:10.3969/j.issn.1006-5725.2025.17.013

Abstract

Abstract:

Objective This study aimed to assess the clinical utility of combining the Controlling Nutritional Status （CONUT） score with the Prognostic Nutritional Index （PNI） for evaluating anemia risk in elderly colorectal cancer patients and to establish a risk prediction model. Methods A total of 661 elderly colorectal cancer patients treated at Xinjiang Uygur Autonomous Region People's Hospital from July 2018 to March 2025 were included in this retrospective study. Patients were categorized into anemic and non-anemic groups and randomly assigned to a training set and validation set at a 7∶3 ratio. The XGBoost algorithm was applied to develop a predictive model for anemia risk， and its performance was assessed using the receiver operating characteristic （ROC） curve. SHAP value visualization， and other methods. Results Among the 661 patients， 257 （38.9%） were diagnosed with anemia. Compared with the non-anemic group， patients in the anemic group had significantly lower levels of PNI and albumin， but higher CONUT scores and blood urea nitrogen levels. Additionally， the anemic group had higher proportions of tumor diameter ≥ 5 cm， poorly differentiated tumors， and stage Ⅲ?Ⅳ disease （all P < 0.05）. The XGBoost model demonstrated good discriminatory ability， with an AUC of 0.897 （95%CI：0.868 ~ 0.925）. SHAP value analysis identified PNI， CONUT score， albumin， blood urea nitrogen， TNM stage， tumor differentiation， and tumor size as major contributing variables. PNI and albumin were protective factors， whereas CONUT score， blood urea nitrogen， and tumor-related features were risk factors. Conclusion Nutritional indicators such as PNI and CONUT score， along with tumor characteristics， can effectively predict the risk of anemia in elderly patients with colorectal cancer. The XGBoost-based predictive model demonstrates high discriminatory power and good interpretability， providing valuable support for early screening of high-risk patients and guiding individualized nutritional interventions and anemia management.

Key words: colorectal cancer, anemia, prognostic nutritional index, controlling nutritional status score, XGBoost, machine learning, predictive model

CLC Number:

R735.3

Cuicui WANG,Wantong QIAO,Junying YAO,Qian LI,Weige GAO,Min FAN. Clinical application value of nutritional control status score combined with prognostic nutritional index in evaluating the risk of anemia in elderly colorectal cancer patients[J]. The Journal of Practical Medicine, 2025, 41(17): 2696-2704.

Figures/Tables 8

Fig.1

Tab.1

Comparison of Clinical Characteristics Between the Anemia Group and the Control Group in Elderly Patients with Colorectal Cancer"

项目	对照组（n = 404）	贫血组（n = 257）	t/χ²/Z值	P值
性别/［例（%）］			0.292	0.111
男	226（55.94）	133（51.75）
女	178（44.06）	124（48.25）
年龄（x ± s）/岁	72.21 ± 5.25	71.89 ± 5.38	0.752	0.452
民族/［例（%）］			4.487	0.213
汉族	323（79.95）	197（76.65）
回族	13（3.22）	17（6.61）
维吾尔族	46（11.39）	27（10.51）
其他	22（5.45）	16（6.23）
BMI（x ± s）/（kg/m²）	25.45 ± 3.81	25.18 ± 3.40	0.923	0.356
糖尿病/［例（%）］			2.863	0.091
是	64（15.84）	54（21.01）
否	340（84.16）	203（78.99）
高血压/［例（%）］			2.735	0.098
是	195（48.27）	141（54.86）
否	209（51.73）	116（45.14）
肿瘤部位/［例（%）］			2.745	0.098
直肠	153（37.87）	114（44.36）
结肠	251（62.13）	143（55.64）
肿瘤最大径/［例（%）］			4.432	0.035
< 5 cm	267（66.09）	149（57.98）
≥ 5 cm	137（33.91）	108（42.02）
组织分级/［例（%）］			5.278	0.022
低	210（51.98）	157（61.09）
高	194（48.02）	100（38.91）
TNM分期/［例（%）］			9.694	0.008
Ⅰ—Ⅱ期	212（52.48）	103（40.08）
Ⅲ期	141（34.90）	114（44.36）
Ⅳ期	51（12.62）	40（15.56）
手术方式/［例（%）］			1.314	0.252
腹腔镜	243（60.15）	166（64.59）
开腹	161（39.85）	91（35.41）
手术时间/［例（%）］			0.298	0.585
< 3 h	199（49.26）	121（47.08）
≥ 3 h	205（50.74）	136（52.92）
白蛋白［M（P₂₅，P₇₅）］/（g/L）	39.39（35.99，41.85）	37.59（35.00，40.40）	-4.035	< 0.001
总蛋白［M（P₂₅，P₇₅）］/（g/L）	67.45（62.98，71.93）	68.40（63.50，73.16）	-1.537	0.124
球蛋白［M（P₂₅，P₇₅）］/（g/L）	27.69（25.10，30.50）	27.43（23.70，31.20）	-0.185	0.853
尿素氮［M（P₂₅，P₇₅）］/（mmol/L）	5.42（4.48，6.88）	6.41（5.47，7.62）	-6.502	< 0.001
肌酐［M（P₂₅，P₇₅）］/（μmol/L）	68.75（57.08，79.41）	66.10（56.90，78.20）	-0.790	0.430
葡萄糖［M（P₂₅，P₇₅）］/（mmol/L）	5.33（4.73，6.33）	5.33（4.60，6.45）	-1.012	0.311
淋巴细胞总数（x ± s）/（× 10?/L）	1.60 ± 0.29	1.00 ± 0.31	-25.713	< 0.001
PNI（x ± s）	46.91 ± 5.05	42.62 ± 4.62	-10.768	< 0.001
CONUT（x ± s）	3.58 ± 0.65	4.58 ± 0.66	-15.538	< 0.001

Tab.1

Fig.2

Fig.3

Fig.4

Fig.5

Fig.6

Fig.7

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Clinical application value of nutritional control status score combined with prognostic nutritional index in evaluating the risk of anemia in elderly colorectal cancer patients

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