{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T01:47:29Z","timestamp":1782092849701,"version":"3.54.5"},"reference-count":65,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":56,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Colorectal cancer (CRC) is a major health concern globally, with lymph node metastasis being a key factor in its spread. The lymph node ratio (LNR), defined as the ratio of pathologically positive lymph nodes to the total number of examined nodes, has been proposed as a prognostic marker in CRC. However, data from prospective cohort studies remain limited. This study aimed to evaluate the association between LNR and overall survival (OS) in patients with colon cancer in a prospective multicentre cohort. A prospective cohort study was conducted across seven Polish surgical centers enrolling 445 patients with primary colon cancer. The study collected survival data until September 30, 2022, focusing on patients aged 18\u201375 years eligible for radical surgery. Preoperative assessments included demographic information, Body Mass Index (BMI) and histopathological evaluation according to AJCC 8th edition. Surgical complications were graded using the Clavien-Dindo scale. The association between OS and LNR was analysed using a multivariable Cox proportional hazards model adjusting for selected clinical and surgical covariates. In the multivariable Cox model, LNR, BMI, and grade III or higher postoperative complications were independently associated with overall survival. For LNR, a 0.1-unit increase was associated with a 26% increase in the hazard of death (hazard ratio 1.26, 95% CI 1.07\u20131.48;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.006). In this prospective multicentre cohort, lymph node ratio was associated with overall survival in patients with colon cancer, alongside body mass index and the severity of postoperative complications. These findings suggest that LNR may represent a clinically relevant prognostic marker and warrant further investigation in studies specifically designed to compare its prognostic performance with established nodal staging systems.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-50360-1","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T05:07:00Z","timestamp":1777266420000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lymph node ratio and overall survival in patients with colon cancer: a prospective multicentre cohort study"],"prefix":"10.1038","volume":"16","author":[{"given":"Marcin","family":"Ekman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elzbieta","family":"Jod\u0142owska-Siewert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Urbanowicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Berut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Grabowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bartosz","family":"Kapturkiewicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u0142","family":"Nycz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u0142","family":"Putko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arkadiusz","family":"Szarmach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Dudzic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Jastrz\u0119bski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"50360_CR1","first-page":"167","volume":"8","author":"U Wojciechowska","year":"2023","unstructured":"Wojciechowska, U., Bara\u0144ska, K., Miklewska, M. & Didkowska, J. A. Cancer incidence and mortality in Poland in 2020. Biul. Pol. Tow Onkol Nowotw. 8, 167\u2013183 (2023).","journal-title":"Biul. Pol. Tow Onkol Nowotw"},{"key":"50360_CR2","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1245\/s10434-018-6462-1","volume":"25","author":"MR Weiser","year":"2018","unstructured":"Weiser, M. R. AJCC 8th Edition: Colorectal Cancer. Ann. Surg. Oncol. 25, 1454\u20131455 (2018).","journal-title":"Ann. Surg. Oncol."},{"key":"50360_CR3","doi-asserted-by":"publisher","first-page":"329","DOI":"10.6004\/jnccn.2021.0012","volume":"19","author":"AB Benson","year":"2021","unstructured":"Benson, A. B. et al. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Canc Netw. 19, 329\u2013359 (2021).","journal-title":"J. Natl. Compr. Canc Netw."},{"key":"50360_CR4","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1016\/j.annonc.2020.06.022","volume":"31","author":"G Argil\u00e9s","year":"2020","unstructured":"Argil\u00e9s, G. et al. Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 31, 1291\u20131305 (2020).","journal-title":"Ann. Oncol."},{"key":"50360_CR5","first-page":"1","volume":"8","author":"H Ji","year":"2023","unstructured":"Ji, H. et al. Lymph node metastasis in cancer progression: molecular mechanisms, clinical significance and therapeutic interventions. Signal. Transduct. Target. Ther. 8, 1\u201333 (2023).","journal-title":"Signal. Transduct. Target. Ther."},{"key":"50360_CR6","doi-asserted-by":"publisher","first-page":"627","DOI":"10.3390\/cells10030627","volume":"10","author":"H Zhou","year":"2021","unstructured":"Zhou, H., Lei, P. & Padera, T. P. Progression of metastasis through lymphatic system. Cells 10, 627 (2021).","journal-title":"Cells"},{"key":"50360_CR7","unstructured":"Amin, M. B. et al. (eds) AJCC Cancer Staging Manual (Springer: Cham,, 2017)."},{"key":"50360_CR8","first-page":"435","volume":"28","author":"K Yamashita","year":"2008","unstructured":"Yamashita, K. et al. Lymph node metastasis density factor association with malignant degree and ND40 as non-curative factor in gastric cancer. Anticancer Res. 28, 435\u2013441 (2008).","journal-title":"Anticancer Res."},{"key":"50360_CR9","doi-asserted-by":"publisher","first-page":"1702","DOI":"10.7150\/jca.38180","volume":"11","author":"Q-W Zhang","year":"2020","unstructured":"Zhang, Q-W. et al. Prognosis of colorectal cancer patients is associated with the novel log odds of positive lymph nodes scheme. J. Cancer. 11, 1702\u20131711 (2020).","journal-title":"J. Cancer"},{"key":"50360_CR10","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1097\/SLA.0b013e3181ffa780","volume":"253","author":"SL Chen","year":"2011","unstructured":"Chen, S. L. et al. Lymph node ratio as a quality and prognostic indicator in stage III colon cancer. Ann. Surg. 253, 82\u201387 (2011).","journal-title":"Ann. Surg."},{"key":"50360_CR11","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1111\/jebm.12289","volume":"11","author":"C Jin","year":"2018","unstructured":"Jin, C. et al. Lymph node ratio as an independent prognostic factor for rectal cancer after neoadjuvant therapy: a meta-analysis. J. Evid. Based Med. 11, 169\u2013175 (2018).","journal-title":"J. Evid. Based Med."},{"key":"50360_CR12","doi-asserted-by":"publisher","first-page":"1337","DOI":"10.1007\/s11605-009-0919-2","volume":"13","author":"H Riediger","year":"2009","unstructured":"Riediger, H. et al. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J. Gastrointest. Surg. 13, 1337\u20131344 (2009).","journal-title":"J. Gastrointest. Surg."},{"key":"50360_CR13","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1017\/S0022215117002250","volume":"132","author":"J Mansour","year":"2018","unstructured":"Mansour, J., Sagiv, D., Alon, E. & Talmi, Y. Prognostic value of lymph node ratio in metastatic papillary thyroid carcinoma. J. Laryngol Otol. 132, 8\u201313 (2018).","journal-title":"J. Laryngol Otol"},{"key":"50360_CR14","doi-asserted-by":"publisher","first-page":"5842","DOI":"10.3390\/cancers13225842","volume":"13","author":"J Kim","year":"2021","unstructured":"Kim, J. et al. Metastatic lymph node ratio for predicting recurrence in medullary thyroid cancer. Cancers 13, 5842 (2021).","journal-title":"Cancers"},{"key":"50360_CR15","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1093\/jjco\/hyz120","volume":"50","author":"J Zhou","year":"2020","unstructured":"Zhou, J. et al. Prognostic value of lymph node ratio in non-small-cell lung cancer: a meta-analysis. Jpn J. Clin. Oncol. 50, 44\u201357 (2020).","journal-title":"Jpn J. Clin. Oncol."},{"key":"50360_CR16","doi-asserted-by":"publisher","first-page":"E184","DOI":"10.1002\/lary.28689","volume":"131","author":"DD Bu","year":"2021","unstructured":"Bu, D. D. et al. Lymph node ratio in HPV-associated oropharyngeal cancer. Laryngoscope 131, E184\u2013E189 (2021).","journal-title":"Laryngoscope"},{"key":"50360_CR17","doi-asserted-by":"publisher","first-page":"1600","DOI":"10.1245\/s10434-007-9716-x","volume":"15","author":"J Wang","year":"2008","unstructured":"Wang, J., Hassett, J. M., Dayton, M. T. & Kulaylat, M. N. Lymph node ratio: role in staging of node-positive colon cancer. Ann. Surg. Oncol. 15, 1600\u20131608 (2008).","journal-title":"Ann. Surg. Oncol."},{"key":"50360_CR18","doi-asserted-by":"publisher","first-page":"2847","DOI":"10.1245\/s10434-010-1158-1","volume":"17","author":"W Ceelen","year":"2010","unstructured":"Ceelen, W., Van Nieuwenhove, Y. & Pattyn, P. Prognostic value of the lymph node ratio in stage III colorectal cancer: a systematic review. Ann. Surg. Oncol. 17, 2847\u20132855 (2010).","journal-title":"Ann. Surg. Oncol."},{"key":"50360_CR19","doi-asserted-by":"publisher","first-page":"8706","DOI":"10.1200\/JCO.2005.02.8852","volume":"23","author":"AC Berger","year":"2005","unstructured":"Berger, A. C. et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J. Clin. Oncol. 23, 8706\u20138712 (2005).","journal-title":"J. Clin. Oncol."},{"key":"50360_CR20","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1002\/jso.21273","volume":"100","author":"IJ Park","year":"2009","unstructured":"Park, I. J., Choi, G-S. & Jun, S. H. Nodal stage of stage III colon cancer: impact of metastatic lymph node ratio. J. Surg. Oncol. 100, 240\u2013243 (2009).","journal-title":"J. Surg. Oncol."},{"key":"50360_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/08941939.2017.1369605","volume":"32","author":"G Li Destri","year":"2019","unstructured":"Li Destri, G. et al. Predictive value of harvested lymph nodes and lymph node ratio in stage II\u2013III colorectal cancer. J. Investig Surg. 32, 1\u20137 (2019).","journal-title":"J. Investig Surg."},{"key":"50360_CR22","doi-asserted-by":"publisher","first-page":"1370","DOI":"10.1007\/s00595-010-4446-2","volume":"41","author":"M Shimomura","year":"2011","unstructured":"Shimomura, M. et al. Adequate lymph node examination is essential for prognostic value of LNR. Surg. Today. 41, 1370\u20131379 (2011).","journal-title":"Surg. Today"},{"key":"50360_CR23","doi-asserted-by":"publisher","first-page":"344","DOI":"10.9738\/INTSURG-D-13-00052.1","volume":"99","author":"C Sabbagh","year":"2014","unstructured":"Sabbagh, C. et al. A lymph node ratio of 10% predicts survival in stage III colon cancer. Int. Surg. 99, 344\u2013353 (2014).","journal-title":"Int. Surg."},{"key":"50360_CR24","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1093\/jnci\/djk092","volume":"99","author":"TE Le Voyer","year":"2007","unstructured":"Le Voyer, T. E. et al. Lymph node evaluation and survival after curative resection of colon cancer. J. Natl. Cancer Inst. 99, 433\u2013441 (2007).","journal-title":"J. Natl. Cancer Inst."},{"key":"50360_CR25","doi-asserted-by":"publisher","first-page":"1649","DOI":"10.1007\/s00384-016-2624-4","volume":"31","author":"MR Freund","year":"2016","unstructured":"Freund, M. R., Edden, Y., Reissman, P. & Dagan, A. Iatrogenic superior mesenteric vein injury. Int. J. Colorectal Dis. 31, 1649\u20131651 (2016).","journal-title":"Int. J. Colorectal Dis."},{"key":"50360_CR26","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1007\/s10151-020-02239-0","volume":"24","author":"NPM Brouwer","year":"2020","unstructured":"Brouwer, N. P. M., Hugen, N. & Nagtegaal, I. D. More extensive lymphadenectomy in colon cancer. Tech. Coloproctol. 24, 761\u2013764 (2020).","journal-title":"Tech. Coloproctol"},{"key":"50360_CR27","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1002\/bjs.10083","volume":"103","author":"CA Bertelsen","year":"2016","unstructured":"Bertelsen, C. A. et al. Short-term outcomes after complete mesocolic excision. Br. J. Surg. 103, 581\u2013589 (2016).","journal-title":"Br. J. Surg."},{"key":"50360_CR28","doi-asserted-by":"publisher","first-page":"znac181007","DOI":"10.1093\/bjs\/znac181.007","volume":"109","author":"M Cathomas","year":"2022","unstructured":"Cathomas, M. et al. Right hemicolectomy with or without CME. Br. J. Surg. 109, znac181007 (2022).","journal-title":"Br. J. Surg."},{"key":"50360_CR29","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1097\/SLA.0b013e318190eddc","volume":"248","author":"R Rosenberg","year":"2008","unstructured":"Rosenberg, R. et al. Prognosis associated with lymph node ratio in colorectal cancer. Ann. Surg. 248, 968\u2013978 (2008).","journal-title":"Ann. Surg."},{"key":"50360_CR30","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.2217\/fon-2020-0993","volume":"17","author":"F Macedo","year":"2021","unstructured":"Macedo, F. et al. Metastatic lymph node ratio vs TNM system. Future Oncol. 17, 1519\u20131532 (2021).","journal-title":"Future Oncol."},{"key":"50360_CR31","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1097\/SLA.0b013e31818842ec","volume":"248","author":"F Peschaud","year":"2008","unstructured":"Peschaud, F. et al. Ratio of metastatic to examined lymph nodes in rectal cancer. Ann. Surg. 248, 1067\u20131073 (2008).","journal-title":"Ann. Surg."},{"key":"50360_CR32","doi-asserted-by":"publisher","first-page":"628","DOI":"10.3389\/fonc.2018.00628","volume":"8","author":"C-H Zhang","year":"2018","unstructured":"Zhang, C-H. et al. Prognostic impact of metastatic lymph nodes ratio. Front. Oncol. 8, 628 (2018).","journal-title":"Front. Oncol."},{"key":"50360_CR33","first-page":"e8047","volume":"12","author":"U Karjol","year":"2020","unstructured":"Karjol, U., Jonnada, P., Chandranath, A. & Cherukuru, S. Lymph node ratio in rectal cancer survival. Cureus 12, e8047 (2020).","journal-title":"Cureus"},{"key":"50360_CR34","doi-asserted-by":"publisher","first-page":"782","DOI":"10.3892\/mco.2017.1203","volume":"6","author":"HY Fang","year":"2017","unstructured":"Fang, H. Y. et al. Log odds of positive lymph nodes vs ratio-based systems. Mol. Clin. Oncol. 6, 782\u2013788 (2017).","journal-title":"Mol. Clin. Oncol."},{"key":"50360_CR35","doi-asserted-by":"publisher","first-page":"101190","DOI":"10.1016\/j.tranon.2021.101190","volume":"14","author":"T Li","year":"2021","unstructured":"Li, T. et al. ENE and LODDS in colorectal cancer. Transl Oncol. 14, 101190 (2021).","journal-title":"Transl Oncol."},{"key":"50360_CR36","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1186\/s12957-018-1483-6","volume":"16","author":"S Occhionorelli","year":"2018","unstructured":"Occhionorelli, S. et al. LNR and LODDS in emergency colon cancer surgery. World J. Surg. Oncol. 16, 186 (2018).","journal-title":"World J. Surg. Oncol."},{"key":"50360_CR37","doi-asserted-by":"publisher","first-page":"637","DOI":"10.21037\/atm-20-7590","volume":"9","author":"T Xu","year":"2021","unstructured":"Xu, T. et al. Log odds of positive lymph nodes after neoadjuvant therapy. Ann. Transl Med. 9, 637 (2021).","journal-title":"Ann. Transl Med."},{"key":"50360_CR38","doi-asserted-by":"publisher","first-page":"937114","DOI":"10.3389\/fonc.2022.937114","volume":"12","author":"G Arrichiello","year":"2022","unstructured":"Arrichiello, G. et al. Beyond N staging in colorectal cancer. Front. Oncol. 12, 937114 (2022).","journal-title":"Front. Oncol."},{"key":"50360_CR39","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1186\/s12885-020-07260-y","volume":"20","author":"AR Baqar","year":"2020","unstructured":"Baqar, A. R., Wilkins, S., Wang, W., Oliva, K. & McMurrick, P. LODDS vs LNR in non-metastatic colon cancer. BMC Cancer. 20, 762 (2020).","journal-title":"BMC Cancer"},{"key":"50360_CR40","doi-asserted-by":"publisher","first-page":"2534","DOI":"10.7150\/jca.29216","volume":"10","author":"C Jiang","year":"2019","unstructured":"Jiang, C. et al. LNR in stage IV colon cancer. J. Cancer. 10, 2534\u20132540 (2019).","journal-title":"J. Cancer"},{"key":"50360_CR41","doi-asserted-by":"publisher","first-page":"154","DOI":"10.21037\/hbsn.2016.08.08","volume":"6","author":"A Ahmad","year":"2017","unstructured":"Ahmad, A. et al. Primary tumor LNR and liver metastases. Hepatobiliary Surg. Nutr. 6, 154\u2013161 (2017).","journal-title":"Hepatobiliary Surg. Nutr."},{"key":"50360_CR42","doi-asserted-by":"publisher","first-page":"2083","DOI":"10.2147\/CMAR.S169029","volume":"10","author":"Y Deng","year":"2018","unstructured":"Deng, Y. et al. LNR in colorectal liver-only metastasis. Cancer Manag Res. 10, 2083\u20132094 (2018).","journal-title":"Cancer Manag Res."},{"key":"50360_CR43","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1016\/j.ctrv.2015.06.007","volume":"41","author":"K Tamas","year":"2015","unstructured":"Tamas, K. et al. Rectal vs colon cancer. Cancer Treat. Rev. 41, 671\u2013679 (2015).","journal-title":"Cancer Treat. Rev."},{"key":"50360_CR44","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1111\/codi.15468","volume":"23","author":"B B\u00e5verud Olsson","year":"2021","unstructured":"B\u00e5verud Olsson, B. et al. Differences in management and outcome for colon and rectal carcinoma with synchronous liver metastases. Colorectal Dis. 23, 162\u2013172 (2021).","journal-title":"Colorectal Dis."},{"key":"50360_CR45","doi-asserted-by":"publisher","first-page":"929576","DOI":"10.3389\/fsurg.2022.929576","volume":"9","author":"Y Yang","year":"2022","unstructured":"Yang, Y., Wang, Y. & Wang, Z. New clinical staging system based on lymph node ratio. Front. Surg. 9, 929576 (2022).","journal-title":"Front. Surg."},{"key":"50360_CR46","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/S0261-5614(03)00098-0","volume":"22","author":"J Kondrup","year":"2003","unstructured":"Kondrup, J., Allison, S. P., Elia, M., Vellas, B. & Plauth, M. ESPEN nutrition screening 2002. Clin. Nutr. 22, 415\u2013421 (2003).","journal-title":"Clin. Nutr."},{"key":"50360_CR47","doi-asserted-by":"publisher","first-page":"2898","DOI":"10.1016\/j.clnu.2021.02.005","volume":"40","author":"M Muscaritoli","year":"2021","unstructured":"Muscaritoli, M. et al. ESPEN clinical nutrition in cancer. Clin. Nutr. 40, 2898\u20132913 (2021).","journal-title":"Clin. Nutr."},{"key":"50360_CR48","doi-asserted-by":"crossref","unstructured":"Dindo, D. The Clavien-Dindo classification of surgical complications. In: (eds Cuesta, M. A. & Bonjer, H. J.) Treatment of Postoperative Complications After Digestive Surgery. Springer, (2014).","DOI":"10.1007\/978-1-4471-4354-3_3"},{"key":"50360_CR49","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","volume":"250","author":"PA Clavien","year":"2009","unstructured":"Clavien, P. A. et al. Clavien-Dindo classification: five-year experience. Ann. Surg. 250, 187\u2013196 (2009).","journal-title":"Ann. Surg."},{"key":"50360_CR50","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v045.i03","volume":"45","author":"S van Buuren","year":"2011","unstructured":"van Buuren, S. & Groothuis-Oudshoorn, K. mice: multivariate imputation by chained equations in R. J. Stat. Softw. 45, 1\u201367 (2011).","journal-title":"J. Stat. Softw."},{"key":"50360_CR51","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1177\/0962280206074463","volume":"16","author":"S van Buuren","year":"2007","unstructured":"van Buuren, S. Multiple imputation of discrete and continuous data. Stat. Methods Med. Res. 16, 219\u2013242 (2007).","journal-title":"Stat. Methods Med. Res."},{"key":"50360_CR52","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1097\/DCR.0b013e3182a586e7","volume":"57","author":"SR Steele","year":"2014","unstructured":"Steele, S. R. et al. Impact of age on colorectal cancer outcomes. Dis. Colon Rectum. 57, 303\u2013310 (2014).","journal-title":"Dis. Colon Rectum"},{"key":"50360_CR53","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1007\/s00535-018-01539-5","volume":"54","author":"E Shinto","year":"2019","unstructured":"Shinto, E. et al. Tumor location and LNR cutoff in stage III colon cancer. J. Gastroenterol. 54, 597\u2013607 (2019).","journal-title":"J. Gastroenterol."},{"key":"50360_CR54","doi-asserted-by":"publisher","first-page":"1942","DOI":"10.1002\/ijc.30827","volume":"141","author":"Y Yang","year":"2017","unstructured":"Yang, Y. et al. Gender differences in colorectal cancer survival. Int. J. Cancer. 141, 1942\u20131949 (2017).","journal-title":"Int. J. Cancer"},{"key":"50360_CR55","first-page":"e711","volume":"17","author":"HH Samawi","year":"2018","unstructured":"Samawi, H. H., Yin, Y., Speers, C. H. & Cheung, W. Y. Sex disparities in early colorectal cancer. Clin. Colorectal Cancer. 17, e711\u2013e717 (2018).","journal-title":"Clin. Colorectal Cancer"},{"key":"50360_CR56","doi-asserted-by":"publisher","first-page":"2410","DOI":"10.1016\/j.clnu.2020.10.039","volume":"40","author":"C Hu","year":"2021","unstructured":"Hu, C. et al. Overweight, obesity and survival in stage II\u2013III colorectal cancer. Clin. Nutr. 40, 2410\u20132419 (2021).","journal-title":"Clin. Nutr."},{"key":"50360_CR57","first-page":"190","volume":"22","author":"D Basile","year":"2023","unstructured":"Basile, D. et al. Prognostic value of BMI in stage II\u2013III colon cancer. Clin. Colorectal Cancer. 22, 190\u2013198 (2023).","journal-title":"Clin. Colorectal Cancer"},{"key":"50360_CR58","doi-asserted-by":"crossref","unstructured":"Ulanja, M. B. et al. Colon cancer sidedness and survival. J Oncol ; 2019: 4315032. (2019).","DOI":"10.1155\/2019\/4315032"},{"key":"50360_CR59","doi-asserted-by":"publisher","first-page":"zrab067","DOI":"10.1093\/bjsopen\/zrab067","volume":"5","author":"P Hansdotter","year":"2021","unstructured":"Hansdotter, P. et al. Patterns and resectability of recurrences: COLOFOL trial. BJS Open. 5, zrab067 (2021).","journal-title":"BJS Open."},{"key":"50360_CR60","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1245\/s10434-017-6142-6","volume":"25","author":"LC Duraes","year":"2018","unstructured":"Duraes, L. C. et al. Clavien-Dindo morbidity and oncologic outcomes. Ann. Surg. Oncol. 25, 188\u2013196 (2018).","journal-title":"Ann. Surg. Oncol."},{"key":"50360_CR61","doi-asserted-by":"publisher","first-page":"1573","DOI":"10.1002\/cam4.1126","volume":"6","author":"T Aoyama","year":"2017","unstructured":"Aoyama, T. et al. Postoperative complications and colorectal cancer survival. Cancer Med. 6, 1573\u20131580 (2017).","journal-title":"Cancer Med."},{"key":"50360_CR62","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1002\/ags3.12615","volume":"7","author":"A Matsuda","year":"2023","unstructured":"Matsuda, A. et al. Postoperative infectious complications and long-term survival. Ann. Gastroenterol. Surg. 7, 110\u2013112 (2023).","journal-title":"Ann. Gastroenterol. Surg."},{"key":"50360_CR63","doi-asserted-by":"publisher","first-page":"499","DOI":"10.2307\/2531021","volume":"39","author":"DA Schoenfeld","year":"1983","unstructured":"Schoenfeld, D. A. Sample-size formula for the proportional-hazards regression model. Biometrics 39, 499\u2013503 (1983).","journal-title":"Biometrics"},{"key":"50360_CR64","doi-asserted-by":"crossref","first-page":"3517","DOI":"10.1002\/1097-0258(20001130)19:22<3095::AID-SIM605>3.0.CO;2-W","volume":"19","author":"FY Hsieh","year":"2000","unstructured":"Hsieh, F. Y. & Lavori, P. W. Sample-size calculations for the Cox proportional hazards regression model with nonbinary covariates. Stat. Med. 19, 3517\u20133527 (2000).","journal-title":"Stat. Med."},{"key":"50360_CR65","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1007\/s12029-020-00525-6","volume":"52","author":"M Shetiwy","year":"2021","unstructured":"Shetiwy, M., Elalfy, A. F., Eldamshety, O., Abbas, R. & Abdelkhalek, M. The Prognostic Significance of Lymph Node Status and Lymph Node Ratio (LNR) on Survival of Right Colon Cancer Patients: a Tertiary Center Experience. J. Gastrointest. Cancer. 52, 1010\u20131015 (2021).","journal-title":"J. Gastrointest. Cancer"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-50360-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-50360-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-50360-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T01:02:30Z","timestamp":1782090150000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-50360-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":65,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["50360"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-50360-1","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-6383521\/v1","asserted-by":"object"}]},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,27]]},"assertion":[{"value":"5 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"19290"}}