title: Lymph-node ratio is an independent prognostic factor in patients with stage III colorectal cancer: a retrospective study from the Middle East.
abstract: BACKGROUND
  In this retrospective study, we evaluated the prognostic effect of positive lymph-node ratio (pLNR) on patients with stage III colorectal cancer (CRC). Our paper is the first analysis, to our knowledge, to deal with such data from the Middle East.
  
  
  METHODS
  We analyzed the clinicopathological data of 535 patients diagnosed with colorectal cancer at our institution between 1983 and 2003. The 164 patients diagnosed with stage III disease were divided into two categories based on lymph-node ratio (LNR) being the ratio of positive lymph nodes over total lymph nodes dissected: LNR ≤ 0.4 and LNR >0.4. We used Kaplan-Meier and Cox proportional hazard models to evaluate the prognostic effect of pLNR.
  
  
  RESULTS
  The 10-year survival rate for the patients with stage IIIA, IIIB and IIIC cancers were 76%, 56% and 0% respectively (P = 0.014). Using pLNR of 0.4 as the cutoff point was found to yield clinically and significant results, with a significant difference in the outcomes of patients with pLNR ≤ 0.4 compared to those with pLNR >0.4 (hazard ratio = 5.25, 95% confidence interval = 1.2 to 22.1, P = 0.02).
  
  
  CONCLUSIONS
  The ratio-based staging (pLNR) of CRC is a more accurate and clinically useful prognostic method than the number of positive LNs resected or the total number of LNs retrieved for predicting the course of patients with stage III CRC.
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut, Riad El-Solh, Beirut, 1107 2020, Lebanon.
authors.forename: Elias
authors.initials: E
authors.lastname: Elias
authors.forename: Deborah
authors.initials: D
authors.lastname: Mukherji
authors.forename: Walid
authors.initials: W
authors.lastname: Faraj
authors.forename: Mohammad
authors.initials: M
authors.lastname: Khalife
authors.forename: Hani
authors.initials: H
authors.lastname: Dimassi
authors.forename: Mohamad
authors.initials: M
authors.lastname: Eloubeidi
authors.forename: Hasan
authors.initials: H
authors.lastname: Hattoum
authors.forename: Ghassan K
authors.initials: GK
authors.lastname: Abou-Alfa
authors.forename: Ahmad
authors.initials: A
authors.lastname: Saleh
authors.forename: Ali
authors.initials: A
authors.lastname: Shamseddine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D008877:Middle East; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult