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

Background/Aim: This study evaluated the association between lymph node ratio (LNR) and long-term prognosis in pathological node-positive patients with obstructive colorectal cancer (CRC) who underwent colonic stent insertion as a bridge to surgery.

Patients and Methods: This retrospective multicenter study included 75 node-positive patients with obstructive CRC treated with a colonic stent. Receiver operating characteristic analysis for 5-year relapse-free survival identified an optimal LNR cut-off of 0.125. Patients were thus classified into high-LNR (LNR-H, n=40) and low-LNR (LNR-L, n=35) groups. Clinicopathological factors, surgical outcomes, and survival were assessed.

Results: The LNR-H group had a higher median number of metastatic lymph nodes (4 vs. 1; p<0.001), and a lower lymph node yield (21 vs. 27; p=0.022). LNR-H was associated with worse 5-year relapse-free survival (32.0% vs. 60.1%; p=0.012) and overall survival (51.2% vs. 72.7%; p=0.006). Multivariate analysis identified LNR-H (relapse-free survival: hazard ratio=2.371, 95% confidence interval=1.157-4.862; p=0.018; overall survival: hazard ratio=4.301, 95% confidence interval=1.595-11.569; p=0.004) and blood loss as independent predictors of prognosis.

Conclusion: LNR appears to represent a practical biomarker, with an elevated LNR independently predicting long-term outcomes among patients with node-positive obstructive CRC undergoing stent placement before surgery.