Observational studyTechniques in coloproctology2024
Lymph node ratio prognosticates overall survival in patients with stage IV colorectal cancer.
Observational study in Techniques in coloproctology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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5 citing papers in PubMed.
- A SEER based SHAP interpretable prognostic nomogram for overall survival in surgically treated patients with colorectal cancer and synchronous liver metastasis.Translational cancer research · 2026Article
- Development of a prognostic nomogram for colorectal cancer with peritoneal metastasis: a SEER database analysis.Translational cancer research · 2026Article
- Stratifying prognosis in stage III colorectal cancer patients: the role of tumor deposits and lymph node ratio.Translational cancer research · 2025Article
- Lymph node yield does not affect the cancer-specific survival of patients with T1 colorectal cancer: a population-based retrospective study of the U.S. database and a Chinese registry.International journal of colorectal disease · 2025Article
- Advancing Prognostic Accuracy Beyond Classical N Staging in Colorectal Cancer: An Observational Cohort Study to Define a Lymph Node Ratio Based Risk Score.Cancer management and research · 2025Article
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Abstract
backgroundLymph node ratio (LNR) is suggested to address the shortcomings of using only lymph node yield (LNY) or status in colorectal cancer (CRC) prognosis. This study explores how LNR affects survival in patients with metastatic colorectal cancer (mCRC), seeking to provide clearer insights into its application.
methodsThis observational cohort study investigated stage IV patients with CRC (1995-2021) who underwent an upfront resection of their primary tumour at Concord Hospital, Sydney. Clinicopathological data were extracted from a prospective database, and LNR was calculated both continuously and dichotomously (LNR of 0 and LNR > 0). The primary endpoint was overall survival (OS). The associations between LNR and various clinicopathological variables were tested using regression analyses. Kaplan-Meier and Cox regression analyses estimated OS in univariate and multivariate survival models.
resultsA total of 464 patients who underwent a primary CRC resection with clear margins (mean age 68.1 years [SD 13.4]; 58.0% M; colon cancer [n = 339,73.1%]) had AJCC stage IV disease. The median LNR was 0.18 (IQR 0.05-0.42) for colon cancer (CC) resections and 0.21 (IQR 0.09-0.47) for rectal cancer (RC) resections. A total of 84 patients had an LNR = 0 (CC = 66 patients; RC = 18 patients). The 5-year OS for the CC cohort was 10.5% (95% CI 8.7-12.3) and 11.5% (95% CI 8.4-14.6) for RC. Increasing LNR demonstrated a decline in OS in both CC (P < 0.001) and RC (P < 0.001). In patients with non-lymphatic dissemination only (LNR = 0 or N0 status), there was better survival compared with those with lymphatic spread (CC aHR1.50 [1.08-2.07;P = 0.02], RC aHR 2.21 [1.16-4.24;P = 0.02]).
conclusionsLNR is worthy of consideration in patients with mCRC. An LNR of 0 indicates patients have a better prognosis, underscoring the need for adequate lymphadenectomy to facilitate precise mCRC staging.
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