Prognostic value of contrast-enhanced CT-derived extracellular volume fraction combined with HALP score in predicting postoperative prognosis for stage Ⅲ colorectal cancer

GAO Wang; CHEN Bin; CHEN Guanghao

doi:10.3969/j.issn.1009-0460.2025.04.010

Abstract：Objective To explore the prognostic value of contrast-enhanced CT-derived extracellular volume(ECV)fraction combined with hemoglobin,albumin,lymphocyte and platelet(HALP)score in predicting postoperative prognosis for stage Ⅲcolorectal cancer.Methods A total of 122 patients diagnosed with stage III colorectal cancer and treated at our hospital between January 2018 and January 2022 were enrolled in this study.Based on 3-year postoperative outcomes,patients were stratified into two groups:the poor prognosis group(n=55),comprising patients who experienced tumor recurrence or death within 3 years after surgery,and the good prognosis group(n=67),consisting of patients who remained recurrence-free throughout the 3-year follow-up period.Spearman correlation analysis was performed to evaluate the associations among ECV fraction,HALP score,and carcinoembryonic antigen(CEA)levels.Receiver operating characteristic curve analysis was employed to assess the combined diagnostic efficacy of ECV fraction,HALP score,and CEA level in predicting colorectal cancer prognosis.Imaging and clinicopathological data were collected from colorectal cancer patients,followed by comparison of clinical and imaging characteristics between different prognostic groups.Subsequently,multivariate Logistic regression analysis was conducted to identify potential factors influencing postoperative recurrence and metastasis.Results The poor prognosis group demonstrated significantly higher ECV fraction compared to the good prognosis group(31.09%±10.67 vs.26.57%±12.32)with significant difference(t=2.143,P=0.034).Conversely,the HALP score was significantly lower in the poor prognosis group than in the good prognosis group(30.84±13.38 vs.42.27±27.91)with significant difference(t=2.783,P=0.006).The ECV fraction showed a significant positive correlation with CEA level(r=0.565,P<0.001),whereas the HALP score demonstrated a negative correlation with CEA level(r=-0.329,P<0.001).The combined evaluation of ECV fraction,HALP score,and CEA level demonstrated superior prognostic performance in colorectal cancer patients,achieving an area under the curve of 0.894 with 89.09%sensitivity and 89.55%specificity,all significantly higher than individual parameter assessments.Multivariate Logistic regression analysis identified high ECV fraction(OR=2.512,95%CI:1.400-4.506)and low HALP score(OR=2.085,95%CI:1.131-3.842)as independent risk factors for poor prognosis in colorectal cancer patients.Conclusion CT-derived ECV fraction and HALP score are novel tumor markers for prognostic evaluation of colorectal cancer,and combined detection with CEA offers certain prognostic significance for colorectal cancer.