Beyond the Node Count: Metastatic Lymph Node Ratio as a Prognostic Marker in Locally Advanced Colorectal Cancer
The European Research Journal, cilt.12, sa.8, ss.813-823, 2026 (TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 12 Sayı: 8
- Basım Tarihi: 2026
- Doi Numarası: 10.18621/eurj.1283
- Dergi Adı: The European Research Journal
- Derginin Tarandığı İndeksler: EMBASE, TR DİZİN (ULAKBİM), Academic Search Ultimate (EBSCO)
- Sayfa Sayıları: ss.813-823
- Trakya Üniversitesi Adresli: Evet
Özet
Objective: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality, and staging based on the number of metastatic nodes may not fully reflect nodal tumor burden. The metastatic lymph node ratio (mLNR) has been proposed as a more informative prognostic marker, but its role in locally advanced CRC is unclear. This study aimed to evaluate the prognostic value of mLNR in patients with locally advanced (T3– T4), non-metastatic CRC and to identify an optimal cut-off for recurrence prediction. Methods: We retrospectively analysed 225 patients with T3–T4, non-metastatic CRC who underwent curative resection between 2015 and 2019. Disease-free survival (DFS) and overall survival (OS) were estimated using Kaplan–Meier analysis. Associations between mLNR, recurrence, stage and survival were examined with standard statistical tests. An optimal mLNR cut-off for recurrence was derived by receiver operating characteristic (ROC) analysis. Results: Patients with recurrence had significantly higher mLNR than recurrence-free patients. mLNR correlated inversely with DFS but not with OS. Higher mLNR was associated with T4 tumors and with higher AJCC stage. ROC analysis identified an mLNR cut-off of 0.1846 (area under the curve 0.643). Patients with mLNR ≥ 0.1846 had significantly shorter DFS and OS. A lymph node yield ≥12 was associated with longer DFS but not OS. Conclusion: mLNR is associated with recurrence, tumor stage and survival in locally advanced CRC, and a threshold around 0.18 may improve risk stratification beyond conventional node counts.