AIM: To investigate the prognostic value of metastaticlymph node ratio(MLNR) in extrahepatic cholangiocarcinoma(ECC) patients undergoing radical resection.METHODS: Seventy-eight patients with ECC were enrolled.Associations between various clinicopathologic factors and prognosis were investigated by KaplanMeier analyses.The Cox proportional-hazards model was used for multivariate survival analysis.RESULTS: The overall three- and five-year survival rates were 47.26% and 23.99%, respectively.MLNR of 0, 0-0.2, 0.2-0.5, and > 0.5 corresponded to fiveyear survival rates of 28.59%, 21.60%, 18.84%, and 10.03%, respectively.Univariate analysis showed that degree of tumor differentiation, lymph node metastasis, MLNR, tumor-node-metastasis(TNM) stage, and margin status were closely associated with postoperative survival in ECC patients(P < 0.05).Multivariate analysis showed that MLNR and TNM stage were independent prognostic factors after pancreaticoduodenectomy(HR = 2.13, 95%CI: 1.45-3.11; P < 0.01; and HR = 1.97, 95%CI: 1.17-3.31; P = 0.01, respectively).The median survival time for MLNR > 0.5, 0.2-0.5, 0-0.2, and 0 was 15 mo, 24 mo, 23 mo, and 35.5 mo, respectively.There were statistical differences in survival time between patients with different MLNR(χ2 = 15.38; P < 0.01).CONCLUSION: MLNR is an independent prognostic factor for ECC patients after radical resection and is useful for predicting postoperative survival. AIM: To investigate the prognostic value of metastatic lymph node ratio (MLNR) in extrahepatic cholangiocarcinoma (ECC) patients undergoing radical resection. METHHODS: Seventy-eight patients with ECC were enrolled. Associations between various clinicopathologic factors and prognosis were investigated by Kaplan Meier analyzes Cox proportional-hazards model was used for multivariate survival analysis .RESULTS: The overall three- and five-year survival rates were 47.26% and 23.99%, respectively. MLNR of 0, 0-0.2, 0.2-0.5, and> 0.5 corresponded to Fiveyear survival rates were 28.59%, 21.60%, 18.84%, and 10.03%, respectively. Univariate analysis showed that degree of tumor differentiation, lymph node metastasis, MLNR, tumor-node-metastasis (TNM) stage, and margin status were closely associated with postoperative survival in ECC patients (P <0.05) .Multivariate analysis showed that MLNR and TNM stages were independent prognostic factors after pancreaticoduodenectomy (HR = 2.13, 95% CI: 1.45-3.11; P <0 .01; and HR = 1.97, 95% CI: 1.17-3.31; P = 0.01, respectively) .The median survival time for MLNR> 0.5, 0.2-0.5, 0-0.2, and 0 was 15 mo, 24 mo, 23 were statistically independent of survival time between patients with different MLNR (χ2 = 15.38; P <0.01) .CONCLUSION: MLNR is an independent prognostic factor for ECC patients after radical resection and is useful for predicting postoperative survival.