Prognostic importance of lymph node count and ratio in rectal cancer after neoadjuvant chemoradiotherapy: Results from a cross-sectional study

J Surg Oncol. 2021 Sep;124(3):367-377. doi: 10.1002/jso.26522. Epub 2021 May 14.


Background: The aim of this study was to determine the prognostic value of lymph node count (LNC) and lymph node ratio (LNR) in rectal cancer after neoadjuvant chemoradiotherapy (CRT).

Methods: Patients who underwent neoadjuvant CRT and total mesorectal excision (TME) for Stage I-III rectal cancer were selected from a cross-sectional study including 71 Dutch centres. Primary outcome parameters were disease-free survival (DFS) and overall survival (OS). Prognostic significance of LNC and LNR (cut-off values 0.15, 0.20, 0.30) was tested for different (sub)groups.

Results: From 2095 registered patients, 458 were included, of which 240 patients with LNC < 12 and 218 patients with LNC ≥ 12. LNC was not significantly associated with DFS (p = 0.35) and OS (p = 0.59). In univariable analysis, LNR was significantly associated with DFS and OS in the whole cohort and LNC subgroups, but not in multivariable analysis.

Conclusions: LNC was not associated with long-term oncological outcome in rectal cancer patients treated with CRT, nor was LNR when corrected for N-stage. However, LNR might be used to identify subgroups of node-positive patients with a favourable outcome.

Keywords: chemoradiotherapy; disease-free survival; lymph nodes; rectal cancer; survival.

Publication types

  • Multicenter Study

MeSH terms

  • Cross-Sectional Studies
  • Disease-Free Survival
  • Humans
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Multivariate Analysis
  • Neoadjuvant Therapy
  • Neoplasm Staging
  • Netherlands / epidemiology
  • Prognosis
  • Rectal Neoplasms / mortality
  • Rectal Neoplasms / pathology*
  • Rectal Neoplasms / surgery
  • Rectal Neoplasms / therapy*
  • Retrospective Studies
  • Survival Rate