Observational studyThe oncologist2026
Revised tumor burden score for prognostic stratification in metastatic colorectal cancer patients receiving immunotherapy: a retrospective study.
Observational study in The oncologist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundImmunotherapy has improved outcomes in metastatic colorectal cancer (mCRC), but benefits remain largely restricted to the minority with specific biomarkers like microsatellite instability-high (MSI-H). This study aims to develop and validate a revised tumor burden score (rTBS) as a prognostic model to stratify survival outcomes in mCRC patients receiving immunotherapy.
methodsWe analyzed a retrospective cohort of 339 immunotherapy-treated mCRC patients (2019-2024). Univariable and multivariable Cox regression analysis were employed to identify independent prognostic factors and construct a model for progression-free survival (PFS). rTBS was developed by integrating CEA, metastatic organ count, and target lesion count. rTBS prognostic performance was validated via bootstrapping, internal and external dataset, ROC curves, and Kaplan-Meier analysis across MSI/TMB subgroups.
resultsIndependent risk factors included TMB level, CEA, metastatic organ count, and target lesion count. The integrated rTBS outperformed TMB (AUC = 0.768 vs 0.656) and traditional metrics. Low rTBS patients showed superior PFS and overall survival (Both P < 0.0001), higher objective response rate (ORR: 37% vs 21.4%, P = 0.002) and disease control rate (DCR: 73.6% vs 51.1%, P < 0.0001). rTBS also stratified outcomes in both MSI-H/TMB-High and MSI-L/MSS/TMB-Low subgroups (both P < 0.0001). Moreover, split-sample testing, external validation, and bootstrap analysis collectively demonstrated the model's robust validity.
conclusionsThe rTBS is a robust, cost-effective prognostic model that stratifies survival in immunotherapy-treated mCRC across subtypes, particularly in the MSI-L/MSS/TMB-Low subgroup lacking reliable biomarkers. It bridges molecular heterogeneity and clinical practice, and warranting further multicenter validation.
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