Abstract
<h3>Background</h3> The extent of lymph node involvement is the most significant prognostic indicator in resected locoregional colorectal cancer. This study aimed to investigate the prognostic value of the total number of lymph nodes identified and the ratio of lymph nodes in resected colorectal cancer. <h3>Methods</h3> A total of 275 patients with histologically proven resected locoregional invasive colorectal adenocarcinoma were included between 2003 and 2011. All patients were treated with standard surgical resection for their colorectal cancer. Patients with incomplete data, or unresectable tumours or distant metastases, were excluded from the study. All potential prognostic variables were evaluated for their impact on local control and disease-free and overall survival rates. <h3>Findings</h3> Of 275 patients, 162 were men and 113 were women, with a median age of 54years (range 23–84). The mean total number of lymph nodes was significantly higher in colon cancer than in rectal cancer (11 versus 7.5, <i>p</i>=0.001). In node-positive (stage III) patients, the mean lymph node ratio was 0.5 for rectal cancers and 0.37 for colon cancers, showing a non-significant trend (<i>p</i>=0.05) toward a higher lymph node ratio in rectal cancer patients. In univariate analysis, the mean total number of lymph nodes identified was a prognostic factor for 5-year disease-free (<i>p</i>=0.04) and overall survival (<i>p</i>=0.02) rates. In node-positive patients, the lymph node ratio was a prognostic factor for 5-year local control (<i>p</i>=0.04), disease-free survival (<i>p</i>=0.01), and overall survival (<i>p</i>=0.01) rates. On multivariate analysis, advanced primary tumour stage, rectal primary site, and the presence of perineural invasion were independent adverse prognostic factors for overall survival. <h3>Interpretation</h3> The total number of lymph nodes identified and ratio of lymph nodes are associated with oncological outcomes in patients with colorectal cancer.
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