Introduction: The metastatic lymph node ratio (MLNR) has been proposed as a meaningful prognostic indicator in colon cancer (CC). This study aimed to assess the prognostic relevance of MLNR by investigating its association with disease-free survival (DFS), overall survival (OS), and recurrence, and to compare its predictive value with traditional parameters, including the TNM classification and total lymph node count (TNLC).Materials and methods: This retrospective, single-center study included patients who underwent surgical resection for colon cancer. Survival outcomes were analyzed using Kaplan-Meier survival curves and multivariate logistic regression. MLNR was evaluated in relation to demographic and clinical factors, including age, tumor location, surgical type, and the administration of adjuvant chemotherapy. The optimal MLNR cut-off value for predicting recurrence was determined via receiver operating characteristic (ROC) curve analysis.Results: A total of 122 patients were analyzed. MLNR >0.125 was significantly associated with increased recurrence risk (adjusted HR: 7.0, p<0.001) and reduced DFS. Patients with an MLNR ≤0.125 demonstrated significantly longer DFS (p<0.001). MLNR emerged as an independent prognostic factor, offering potential prognostic benefit compared to TNLC in predicting both DFS and OS. Additionally, adjuvant chemotherapy was independently associated with a lower recurrence risk (Exp(B):0.234, p=0.038). Emergency surgery was found to be significantly correlated with poorer survival outcomes (p=0.023).Conclusion: MLNR contributes additional prognostic information to the TNM staging system and may support more individualized risk stratification and decision-making regarding adjuvant therapy in colon cancer. Further large-scale prospective studies are warranted to validate these findings and to establish a clinically applicable MLNR threshold.

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.

Background: Risk stratification after colorectal cancer surgery remains challenging. We evaluated whether a perioperative ratio combining immediate postoperative lactate with preoperative albumin is associated with in-hospital mortality after elective colorectal resection. Methods: In this single-center retrospective cohort, 282 patients underwent open elective colorectal resection. The perioperative lactate-to-albumin ratio (LAR) was calculated as arterial lactate (mmol/L) divided by serum albumin (g/dL), and discrimination was assessed by receiver operating characteristic (ROC) analysis with age-adjusted association by Firth’s penalized logistic regression and fixed-model bootstrap validation. Results: Seventeen patients (6.0%) died in hospital, and mortality rose across LAR tertiles (2.1%, 5.3%, and 10.6%; p = 0.014). LAR showed moderate discrimination (AUC 0.73; 95% CI 0.58–0.87; optimism-corrected AUC 0.78), with no evidence of better discrimination than lactate or albumin alone. At the Youden threshold of 0.555, sensitivity was 76.5% and specificity 61.1%. The age-adjusted Firth odds ratio was 1.19 per 0.1-unit increase (95% CI 1.09–1.29). Conclusions: The perioperative lactate-to-albumin ratio was associated with in-hospital mortality after age adjustment in this single-center cohort. Given the small number of deaths and absence of external validation, LAR should be regarded as a candidate marker requiring prospective multicenter validation before clinical application.