INTRODUCTION: Colorectal cancer is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related death globally. Lymph nodes ratio (LNR) is an important prognostic factor in colorectal malignancies. Ratio of number of involved to the total number of resected lymph nodes is termed as Lymph node ratio (LNR) , which is an important prognostic factor in colorectal malignancies

AIM: The primary goal of the study is to identify prognostic factors beyond positive nodal status, with a particular focus on lymph node ratio in colorectal cancer (CRC), as well as to conduct a survival analysis.

MATERIALS & METHODS: A prospective analysis of 46 patients who underwent surgery for CRC in a single tertiary care center during the period October 2015 to July 2019 was studied. Demographic details, tumor histology, and characteristics, a new concept of lymph node ratio was assessed. Chi-square test was used to analyze the variables. All data were recorded using a standard data form and analyzed using SPSS version 21.0. Statistical significance was defined as P<0.05.

RESULTS: Mean age of the study population is 56 yrs. Rectum was the primary cancer site involved in 25 patients (54.3%).The most common pathology was adenocarcinoma in 32 (69%)patients. Lymphovascular and perineural invasion was present in 12(26%) and 3(6.5%) patients respectively. 18 patients belonged to T2(39%) stage and 20 patients (60%) had nodal status of N0. Majority of patients 37(80%)had a Post operative CD score of II. 15 patients (32%) were given treatment prior to surgery in the form of Neoadjuvant chemoradiation. The mean survival period in our study is 50 months. Presence of perineural invasion (p<0.019), Node positivity(p<0.005) , CD score more than or equal to III (p<0.001) higher lymph node ratio(p<0.001) were determined as independent prognostic factors for survival (p<0.05).

CONCLUSION: Lymph node ratio is a powerful factor for estimating the survival of CRC patients. Good postoperative care and recovery with a low CD score and meticulous surgery with higher lymph node yield would alter the survival status in CRC patients.

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