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Updated: Jul 10, 2026

Comparison of Predictive Performance of Three Lymph Node Staging Systems in Colorectal Signet Ring Cell Carcinoma Based on Machine Learning Model
Published on: April 18, 2025
The metastatic lymph node ratio predicts survival in colon cancer
Paul Schumacher1, Sean Dineen, Carlton Barnett
1Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC-9155, Dallas, TX 75390-9155, USA.
Background:
Lymph node metastases are the most important predictor of survival in non-stage IV colon cancer. Recent studies of gastric cancer have shown a prognostic significance of a lymph node ratio (number of positive nodes divided by total number harvested). Our goal was to determine whether a lymph node ratio (LNR) would predict disease-free survival (DFS) and overall survival (OS) in a tertiary care Veterans Affairs medical center.
Methods:
A retrospective review of a prospectively collected database of colon cancer patients was performed to determine the effect of LNR on DFS and OS. A cohort of 232 patients with non-stage IV colon cancer was eligible for analysis. Survival curves were constructed using the Kaplan-Meier method.
Results:
For all patients, a LNR of .08 was identified as a breakpoint for predicting OS and DFS. Specific analysis of stage III patients revealed that a LNR of .18 was predictive of DFS.
Conclusions:
This study showed the prognostic significance of ratio-based staging for colon cancer and may aid in future staging systems.
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