Prognostic Value of Metastatic Lymph Node Ratio and Its Effect on Disease-Free Survival in Colon Cancer

Background and Objective: The metastatic lymph node ratio (MLNR) has emerged as a significant prognostic marker in colon cancer (CC). This study evaluated the impact of MLNR on disease-free survival (DFS), overall survival (OS), and recurrence, comparing it to TNM staging. Materials and Methods:A retrospective analysis included CC patients who underwent surgical treatment. The prognostic value of MLNR was analyzed using Kaplan-Meier survival analysis and multivariate regression, alongside clinical factors such as age, tumor localization, and type of surgery. The relationship between MLNR and the efficacy of adjuvant chemotherapy was also investigated. Results:Patients with an MLNR > 0.125 showed a significantly higher risk of disease recurrence (hazard ratio [HR]: 7.0, p< 0.001) and shorter DFS. Kaplan-Meier analysis demonstrated that lower MLNR was associated with significantly longer DFS (p< 0.001). MLNR was found to be an independent prognostic factor, outperforming TNLC in predicting OS and DFS (p< 0.001). Patients receiving adjuvant therapy had a significantly lower risk of disease recurrence compared to those who did not (p=0.015). Multivariate analysis identified adjuvant therapy and MLNR as independent prognostic factors. The reduced recurrence risk observed in patients receiving adjuvant therapy (Exp(B): 0.234, p=0.038) underscores the efficacy of this treatment. Emergency surgery was significantly associated with worse survival (p=0.023). Conclusion:MLNR is a valuable prognostic marker in colon cancer and can complement the TNM staging system to refine survival predictions.Our findings suggest that MLNR can guide adjuvant treatment decisions, supporting more personalized therapeutic approaches.Larger prospective studies are needed to validate the optimal MLNR cut-off value and further assess its clinical utility.