Prognostic Significance of the Lymph Node Ratio in Obstructive Colorectal Cancer: A Retrospective Multicenter Study

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Obstructive colorectal cancer (CRC) poses significant treatment challenges.
• Colonic stent insertion is a bridge to surgery for these patients.
• Prognostic factors in node-positive obstructive CRC require further elucidation.

Purpose of the Study:

• To evaluate the association between lymph node ratio (LNR) and long-term prognosis.
• To assess the predictive value of LNR in node-positive obstructive CRC patients undergoing stenting.
• To identify optimal LNR cut-offs for survival prediction.

Main Methods:

• Retrospective multicenter study of 75 node-positive obstructive CRC patients treated with colonic stents.
• Receiver operating characteristic (ROC) analysis to determine the optimal LNR cut-off for 5-year relapse-free survival (0.125).
• Classification into high-LNR (LNR-H) and low-LNR (LNR-L) groups for comparative analysis of clinicopathological factors, surgical outcomes, and survival.

Main Results:

• The high-LNR group exhibited a higher median number of metastatic lymph nodes and lower lymph node yield.
• High-LNR was significantly associated with worse 5-year relapse-free survival (32.0% vs. 60.1%) and overall survival (51.2% vs. 72.7%).
• Multivariate analysis identified high-LNR and blood loss as independent predictors of poor prognosis.

Conclusions:

• Lymph node ratio (LNR) serves as a practical and independent prognostic biomarker.
• Elevated LNR is strongly associated with adverse long-term outcomes in patients with node-positive obstructive CRC.
• LNR can aid in risk stratification and treatment planning for obstructive CRC patients undergoing stenting.