Annals of Surgical Oncology

, Volume 17, Issue 11, pp 2847–2855 | Cite as

Prognostic Value of the Lymph Node Ratio in Stage III Colorectal Cancer: A Systematic Review

  • W. Ceelen
  • Y. Van Nieuwenhove
  • P. Pattyn
Colorectal Cancer



Although nodal invasion represents one of the most powerful prognostic indicators in colorectal cancer, marked heterogeneity exists within stage III patients. Recently, the lymph node ratio (LNR), defined as the ratio of the number of positive nodes over the total number of examined nodes, was proposed to stratify outcome in stage III patients.


A systematic search was performed for studies examining the prognostic significance of the LNR in colon or rectal cancer. Individual studies were assessed for methodological quality and summary data extracted. Hazard ratios from multivariate analyses were entered in a fixed-effects meta-analysis model.


In total, 16 studies were identified including 33,984 patients with stage III colon or rectal cancer. In all identified studies, the LNR was identified as an independent prognostic factor in patients with stage III cancer of the colon or rectum. The prognostic separation obtained by the LNR was superior to that of the number of positive nodes (N stage). The pooled hazard ratios for overall and disease-free survival were 2.36 (95% confidence interval, 2.14–2.61) and 3.71 (95% confidence interval, 2.56–5.38), respectively.


The LNR allows superior prognostic stratification in stage III colorectal cancer and should be validated in prospective studies.


Overall Survival Rectal Cancer Positive Node Lymph Node Ratio Rectal Cancer Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



W. Ceelen is a senior clinical investigator of the Research Foundation—Flanders (Belgium) (FWO). None of the authors has any financial disclosure to state.


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Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  1. 1.Department of Gastrointestinal SurgeryUniversity HospitalGhentBelgium

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