Annals of Surgical Oncology

, Volume 22, Issue 2, pp 528–534 | Cite as

Proposal of New Classification for Stage III Colon Cancer Based on the Lymph Node Ratio: Analysis of 4,172 Patients from Multi-Institutional Database in Japan

  • Kiichi SugimotoEmail author
  • Kazuhiro Sakamoto
  • Yuichi Tomiki
  • Michitoshi Goto
  • Kenjiro Kotake
  • Kenichi Sugihara
Colorectal Cancer



We retrospectively examined the optimal lymph node ratio (LNR) cutoff value and attempted to construct a new classification using the LNR in stage III colon cancer.


The clinical and pathological data of 4,172 patients with histologically proven lymph node metastasis who underwent curative surgery for primary colon cancer at multiple institutions between 1995 and 2004 were derived from the multi-institutional database of the Japanese Society for Cancer of the Colon and Rectum (JSCCR). We determined independent prognostic factors and constructed a new classification using these factors. Finally, we compared the discriminatory ability between the new classification and the TNM seventh edition (TNM 7th) classification.


The optimal LNR cutoff value was 0.18. Multivariate analysis revealed that year of surgery, age, gender, histological type, TNM 7th T category, lymphatic invasion, venous invasion, TNM 7th N category, and LNR were found to be significant independent prognostic factors. We attempted to construct a new classification based on the combination of TNM 7th T category and LNR. As a result, the cancer-specific survivals were well stratified (P < .0001). According to the Akaike’s information criteria value, the new classification was judged to be superior to the TNM 7th classification with respect to both a better fit and lower complexity.


The optimal LNR cutoff value that was found using the Japanese multi-institutional database and the new classification using LNR are considered to be extremely significant. Therefore, these findings strongly support the application of LNR in the stage classification in stage III colon cancer.


Metastatic Lymph Node Lymph Node Ratio Tumor Node Metastasis Postoperative Adjuvant Chemotherapy Tumor Node Metastasis Classification 
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.



The authors thank Dr. Joe Matsuoka (Juntendo University, Graduate School of Medicine, Clinical Research Center) for assistance in the statistical analysis of the data.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Kiichi Sugimoto
    • 1
    Email author
  • Kazuhiro Sakamoto
    • 1
  • Yuichi Tomiki
    • 1
  • Michitoshi Goto
    • 1
  • Kenjiro Kotake
    • 2
  • Kenichi Sugihara
    • 3
  1. 1.Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
  2. 2.Department of SurgeryTochigi Cancer CenterTochigiJapan
  3. 3.Department of Surgical Oncology, Graduate SchoolTokyo Medical and Dental UniversityTokyoJapan

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