The prognostic significance of the metastatic lymph node ratio in Dukes stage C colorectal cancer in a district general hospital

Aim Our aim was to determine if the lymph node ratio would predict overall survival and disease-free survival in Dukes C colorectal cancer in a district general hospital setting in the UK. Method Fifty-six patients were analysed from a prospectively maintained colorectal cancer database. The lymph node ratio was defined as the number of positive lymph nodes divided by the total number of nodes harvested. Comparison was made between the lymph node ratio, TNM nodal status and number of positive lymph nodes by the Kaplan-Meier method. An analysis of covariates was performed by a Cox proportional hazard regression analysis. Results A lymph node ratio of > 0.25 is prognostically significant for overall survival (P = 0.03) and disease-free survival (P = 0.0003). The lymph node ratio was the strongest covariate in the multivariate regression analysis for recurrence (P = 0.003). Conclusion The lymph node ratio may help clinicians determine which patients have a more aggressive tumour biology and direct appropriate more aggressive chemotherapy regimes towards these patients.