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Bray F, Laversanne M, Sung H, Ferlay J, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May-Jun;74 (3):229-63.","DOI":"10.3322\/caac.21834"},{"key":"2","doi-asserted-by":"crossref","unstructured":"2. O&apos;Connell JB, Maggard MA, Ko CY. Colon Cancer Survival Rates With the New American Joint Committee on Cancer Sixth Edition Staging. J Natl Cancer Inst. 2004 Oct 6;96 (19):1420-5.","DOI":"10.1093\/jnci\/djh275"},{"key":"3","doi-asserted-by":"crossref","unstructured":"3. Wang J, Hassett JM, Dayton MT, et al. Lymph node ratio: role in the staging of node-positive colon cancer. Ann Surg Oncol. 2008 Jun;15 (6):1600-8.","DOI":"10.1245\/s10434-007-9716-x"},{"key":"4","doi-asserted-by":"crossref","unstructured":"4. Lee HY, Choi HJ, Park KJ, et al. Prognostic significance of metastatic lymph node ratio in node-positive colon carcinoma. 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The metastatic lymph node ratio predicts survival in colon cancer. Am J Surg. 2007 Dec;194 (6):827-31; discussion 31-2.","DOI":"10.1016\/j.amjsurg.2007.08.030"},{"key":"9","doi-asserted-by":"crossref","unstructured":"9. Zhang CH, Li YY, Zhang QW, et al. The Prognostic Impact of the Metastatic Lymph Nodes Ratio in Colorectal Cancer. Front Oncol. 2018 Dec 18;8:628.","DOI":"10.3389\/fonc.2018.00628"},{"key":"10","doi-asserted-by":"crossref","unstructured":"10. Gleisner AL, Mogal H, Dodson R, et al. Nodal status, number of lymph nodes examined, and lymph node ratio: what defines prognosis after resection of colon adenocarcinoma? J Am Coll Surg. 2013;217 (6):1090-100.","DOI":"10.1016\/j.jamcollsurg.2013.07.404"},{"key":"11","doi-asserted-by":"crossref","unstructured":"11. Ichhpuniani S, McKechnie T, Lee J, et al. Lymph Node Ratio as a Predictor of Survival for Colon Cancer: A Systematic Review and Meta-Analysis. 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Prognostic significance of KRAS, NRAS, BRAF, and PIK3CA mutations in stage II\/III colorectal cancer: A retrospective study and meta-analysis. PLoS One. 2025 Apr 25;20 (4):e0320783.","DOI":"10.1371\/journal.pone.0320783"},{"key":"19","doi-asserted-by":"crossref","unstructured":"19. Taieb J, Kourie HR, Emile JF, et al. Association of Prognostic Value of Primary Tumor Location in Stage III Colon Cancer With RAS and BRAF Mutational Status. JAMA Oncol. 2018 Jul 12;4 (7):e173695.","DOI":"10.1001\/jamaoncol.2017.3695"},{"key":"20","doi-asserted-by":"crossref","unstructured":"20. Kataoka K, Kanemitsu Y, Shiozawa M, et al. Lymph node classification in colorectal cancer: tumor node metastasis versus the Japanese system. The Lymphatic System in Colorectal Cancer: Elsevier; 2022. p. 107-14.","DOI":"10.1016\/B978-0-12-824297-1.00010-5"},{"key":"21","unstructured":"21. Hashiguchi Y, Muro K, Saito Y, et al. 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Int J Surg. 2013;11 (9):1016-21.","DOI":"10.1016\/j.ijsu.2013.05.031"},{"key":"25","doi-asserted-by":"crossref","unstructured":"25. Sugimoto K, Sakamoto K, Tomiki Y, et al. Proposal of new classification for stage III colon cancer based on the lymph node ratio: analysis of 4,172 patients from multi-institutional database in Japan. Ann Surg Oncol. 2015 Feb;22 (2):528-34.","DOI":"10.1245\/s10434-014-4015-9"},{"key":"26","doi-asserted-by":"crossref","unstructured":"26. M\u00e4rkl B, Olbrich G, Schenkirsch G, et al. Clinical Significance of International Union Against Cancer pN Staging and Lymph Node Ratio in Node-Positive Colorectal Cancer after Advanced Lymph Node Dissection. Dis Colon Rectum. 2016 May;59 (5):386-95.","DOI":"10.1097\/DCR.0000000000000569"},{"key":"27","doi-asserted-by":"crossref","unstructured":"27. Jakob MO, Guller U, Ochsner A, et al. Lymph node ratio is inferior to pN-stage in predicting outcome in colon cancer patients with high numbers of analyzed lymph nodes. BMC Surg. 2018 Oct 3;18:81.","DOI":"10.1186\/s12893-018-0417-0"},{"key":"28","doi-asserted-by":"crossref","unstructured":"28. Mohan HM, Walsh C, Kennelly R, et al. The lymph node ratio does not provide additional prognostic information compared with the N1\/N2 classification in Stage III colon cancer. Colorectal Dis. 2017 Feb;19 (2):165-71.","DOI":"10.1111\/codi.13410"},{"key":"29","doi-asserted-by":"crossref","unstructured":"29. Pyo JS, Kim JH, Lee SY, et al. Metastatic Lymph Node Ratio (mLNR) is a Useful Parameter in the Prognosis of Colorectal Cancer; A Meta-Analysis for the Prognostic Role of mLNR. Medicina. 2019 Oct 4;55 (10):673.","DOI":"10.3390\/medicina55100673"},{"key":"30","doi-asserted-by":"crossref","unstructured":"30. Shinto E, Ike H, Hida JI, et al. Marked impact of tumor location on the appropriate cutoff values and the prognostic significance of the lymph node ratio in stage III colon cancer: a multi-institutional retrospective analysis. J Gastroenterol. 2019 Jul;54 (7):597-607.","DOI":"10.1007\/s00535-018-01539-5"},{"key":"31","doi-asserted-by":"crossref","unstructured":"31. Wang J, Kulaylat M, Rockette H, et al. Should total number of lymph nodes be used as a quality of care measure for stage III colon cancer? Ann Surg. 2009 Apr;249 (4):559-63.","DOI":"10.1097\/SLA.0b013e318197f2c8"},{"key":"32","doi-asserted-by":"crossref","unstructured":"32. Scott KW, Grace RH. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg. 1989 Nov;76 (11):1165-7.","DOI":"10.1002\/bjs.1800761118"},{"key":"33","doi-asserted-by":"crossref","unstructured":"33. Lee CHA, Wilkins S, Oliva K, et al. Role of lymph node yield and lymph node ratio in predicting outcomes in non-metastatic colorectal cancer. BJS Open. 2018 Aug;3 (1):95-105.","DOI":"10.1002\/bjs5.96"},{"key":"34","doi-asserted-by":"crossref","unstructured":"34. Rosenberg R, Engel J, Bruns C, et al. 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Lymph node ratio is an independent prognostic factor in gastric cancer after curative resection (R0) regardless of the examined number of lymph nodes. Am J Clin Oncol. 2013 Aug;36 (4):325-30.","DOI":"10.1097\/COC.0b013e318246b4e9"},{"key":"38","doi-asserted-by":"crossref","unstructured":"38. Xu DZ, Geng QR, Long ZJ, et al. Positive lymph node ratio is an independent prognostic factor in gastric cancer after d2 resection regardless of the examined number of lymph nodes. Ann Surg Oncol. 2009 Feb;16 (2):319-26.","DOI":"10.1245\/s10434-008-0240-4"},{"key":"39","doi-asserted-by":"crossref","unstructured":"39. Moug SJ, Oliphant R, Balsitis M, et al. The lymph node ratio optimises staging in patients with node positive colon cancer with implications for adjuvant chemotherapy. 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