Due to the impact of nodal metastasis on colon cancer prognosis, adequate regional lymph node resection and accurate pathological evaluation are required. The ratio of metastatic to examined nodes may bring an additional prognostic value to the actual staging system. This study analyzes the identification of factors influencing a high lymph node yield and its impact on survival. The lymph node ratio was determined in patients with fewer than 12 or at least 12 evaluated nodes. The study included patients after radical colon cancer resection in UICC stages II and III. For the lymph node ratio (LNR) analysis, node-positive patients were divided into four categories: i.e., LNR 1 (<0.05), LNR 2 (≥0.05; <0.2), LNR 3 (≥0.2; <0.4), and LNR 4 (≥0.4), and classified into two groups: i.e., those with <12 and ≥12 evaluated nodes. The study was conducted on 7012 patients who met the set criteria and were included in the data analysis. The mean number of examined lymph nodes was 22.08 (SD 10.64, median 20). Among the study subjects, 94.5% had 12 or more nodes evaluated. These patients were more likely to be younger, women, with a lower ASA classification, pT3 and pN2 categories. Also, they had no risk factors and frequently had a right-sided tumor. In the multivariate analysis, a younger age, ASA classification of II and III, high pT and pN categories, absence of risk factors, and right-sided location remained independent predictors for a lymph node yield ≥12. The univariate survival analysis of the entire cohort demonstrated a better five-year overall survival (OS) in patients with at least 12 lymph nodes examined (68% vs. 63%,p= 0.027). The LNR groups showed a significant association with OS, reaching from 75.5% for LNR 1 to 33.1% for LNR 4 (p< 0.001) in the ≥12 cohort, and from 74.8% for LNR2 to 49.3% for LNR4 (p= 0.007) in the <12 cohort. This influence remained significant and independent in multivariate analyses. The hazard ratios ranged from 1.016 to 2.698 for patients with less than 12 nodes, and from 1.248 to 3.615 for those with at least 12 nodes. The LNR allowed for a more precise estimation of the OS compared with the pN classification system. The metastatic lymph node ratio is an independent predictor for survival and should be included in current staging and therapeutic decision-making processes.
由于淋巴结转移对结肠癌预后的影响，需要进行充分的区域淋巴结清扫和准确的病理学评估。转移淋巴结与检出淋巴结的比值可能为现有分期体系提供额外的预后价值。本研究旨在分析影响淋巴结高检出率的因素及其对生存的影响。研究分别在淋巴结检出数少于12枚和至少12枚的患者中确定淋巴结转移比率。研究对象为UICC II期和III期接受根治性结肠癌切除术后的患者。在淋巴结转移比率分析中，淋巴结阳性患者被分为四类：LNR 1（<0.05）、LNR 2（≥0.05；<0.2）、LNR 3（≥0.2；<0.4）和LNR 4（≥0.4），并按照淋巴结检出数分为两组：检出数<12枚组和≥12枚组。研究共纳入7012例符合设定标准并参与数据分析的患者。淋巴结检出平均数为22.08枚（标准差10.64，中位数20枚）。研究对象中94.5%的患者淋巴结检出数达到或超过12枚。这些患者更可能具有以下特征：年龄较轻、女性、ASA分级较低、pT3和pN2分期。同时，他们无危险因素且肿瘤多位于右半结肠。多变量分析显示，年龄较轻、ASA II级和III级、高pT和pN分期、无危险因素以及右半结肠位置是淋巴结检出数≥12枚的独立预测因素。对整个队列的单变量生存分析显示，淋巴结检出数至少12枚的患者五年总生存率更优（68% vs. 63%，p=0.027）。在淋巴结检出数≥12枚的队列中，LNR分组与总生存率显著相关，从LNR 1组的75.5%到LNR 4组的33.1%（p<0.001）；在检出数<12枚的队列中，从LNR 2组的74.8%到LNR 4组的49.3%（p=0.007）。这种影响在多变量分析中仍保持显著性和独立性。对于淋巴结检出数少于12枚的患者，风险比范围为1.016至2.698；对于至少检出12枚的患者，风险比范围为1.248至3.615。与pN分期系统相比，LNR能更精确地评估总生存率。转移淋巴结比率是生存的独立预测因子，应纳入当前分期和治疗决策流程。
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