Beyond the Node Count: Metastatic Lymph Node Ratio as a Prognostic Marker in Locally Advanced Colorectal Cancer
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.
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Article Information
- Article Type Research Article
- Submitted April 2, 2026
- Accepted May 4, 2026
- Published May 9, 2026
- Issue 2026: Online First
- Section Research Article
- Categories
