Research Papers:

Prognostic role of the lymph node ratio in node positive colorectal cancer: a meta-analysis

Ming-Ran Zhang, Tian-Hang Xie, Jun-Lin Chi, Yuan Li, Lie Yang, Yong-Yang Yu, Xiao-Feng Sun and Zong-Guang Zhou _

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Oncotarget. 2016; 7:72898-72907. https://doi.org/10.18632/oncotarget.12131

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Ming-Ran Zhang1,3,*, Tian-Hang Xie2,*, Jun-Lin Chi1,3, Yuan Li3, Lie Yang1, Yong-Yang Yu1, Xiao-Feng Sun3,4, Zong-Guang Zhou1,3

1Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China

2Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China

3Institute of Digestive Surgery and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China

4Department of Oncology, Department of Clinical and Experiment Medicine, Linköping University, Linköping, Sweden

*These authors contributed equally to this work

Correspondence to:

Zong-Guang Zhou, email: [email protected]

Keywords: colorectal cancer, lymph node, lymph node ratio, prognostic role, meta-analysis

Received: March 01, 2016     Accepted: September 13, 2016     Published: September 20, 2016


The lymph node ratio (LNR) (i.e. the number of metastatic lymph nodes divided by the number of totally resected lymph nodes) has recently emerged as an important prognostic factor in colorectal cancer (CRC). However, the tumor node metastasis (TNM) staging system for colorectal cancer does not consider it as a prognostic parameter. Therefore, we conducted a meta-analysis to evaluate the prognostic role of the LNR in node positive CRC. A systematic search was performed in PubMed, Embase and the Cochrane Library for relevant studies up to November 2015. As a result, a total of 75,838 node positive patients in 33 studies were included in this meta-analysis. Higher LNR was significantly associated with shorter overall survival (OS) (HR = 1.91; 95% CI 1.71–2.14; P = 0.0000) and disease free survival (DFS) (HR = 2.75; 95% CI: 2.14–3.53; P = 0.0000). Subgroup analysis showed similar results. Based on these results, LNR was an independent predictor of survival in colorectal cancer patients and should be considered as a parameter in future oncologic staging systems.

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