Beyond Nodal Stage: A Clinical Study of Colorectal Cancer Outcomes at a Single Tertiary Care Center.

Introduction Colorectal cancer (CRC) continues to be one of the most frequently diagnosed cancers worldwide and a major contributor to cancer-related mortality. The ratio of the number of involved to the total number of resected lymph nodes is termed as lymph node ratio (LNR), which is an important prognostic factor in colorectal malignancies. Aim This study aims to evaluate the prognostic value of lymph node ratio (LNR) in colorectal cancer (CRC), with particular reference to its association with survival outcomes. Materials and methods A retrospective analysis of 46 patients who underwent surgery for CRC in a single tertiary care center from October 2015 to July 2019 was conducted. Data on demographic variables, tumor histology, treatment modalities, and survival outcomes were collected using a retrospective chart review. The chi-square test was used to analyze the variables. All data were recorded using a standard data form and analyzed using SPSS version 21.0 (IBM Corp., Armonk, NY). Statistical significance was defined as p<0.05. We acknowledge that the study is based on a relatively small sample from a single institution, which may limit its statistical power and introduce potential selection bias. However, the findings offer meaningful preliminary data regarding LNR as a prognostic marker in CRC and highlight the need for validation through larger, multicenter studies. Results The mean age of the study population is 56 years. The rectum was the primary cancer site involved in 25 patients (54.3%). The most common pathology was adenocarcinoma in 32 (69%) patients. Lymphovascular and perineural invasion (PNI) was present in 12 (26%) and three (6.5%) patients, respectively. Eighteen patients belonged to the T2 (39%) stage, and 20 patients (60%) had a nodal status of N0. Most patients experienced Grade II postoperative complications (n=37, 80.4%), while Grade III and IV complications were observed in seven (15.2%) and two (4.3%) patients, respectively. Fifteen patients (32%) were given treatment prior to surgery in the form of neoadjuvant chemoradiation. The mean survival period in our study is 50 months. The presence of perineural invasion (p<0.019), node positivity (p<0.005), CD score of more than or equal to 3 (p<0.001), and higher lymph node ratio (p<0.001) were determined as independent prognostic factors for survival (p<0.05). Conclusion Lymph node ratio is a powerful factor for estimating the survival of CRC patients. Good postoperative care and recovery with a low CD score and meticulous surgery with higher lymph node yield would alter the survival status in CRC patients.