Mismatch Repair Status and Lymph Node Ratio in Survival Prediction of Stage II/III Rectal Cancer Patients: A Comprehensive Analysis of a Multi‐Center Retrospective Study
ABSTRACT Background The microsatellite status (dMMR vs. pMMR) in colorectal cancer can serve as a guiding factor for patient prognosis and treatment, where dMMR status indicates a better prognosis and often obviates the need for adjuvant chemotherapy (ACT). Conversely, a higher lymph node ratio (LNR...
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Wiley
2025-04-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.70756 |
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| author | Kailong Zhao Wenwen Pang Xinyu Liu Kemin Ni Weifeng Gao Zhiquan Tan Jun Xue Weizheng Liang Xueliang Wu Xipeng Zhang Xiaomin Su Chunze Zhang |
| author_facet | Kailong Zhao Wenwen Pang Xinyu Liu Kemin Ni Weifeng Gao Zhiquan Tan Jun Xue Weizheng Liang Xueliang Wu Xipeng Zhang Xiaomin Su Chunze Zhang |
| author_sort | Kailong Zhao |
| collection | DOAJ |
| description | ABSTRACT Background The microsatellite status (dMMR vs. pMMR) in colorectal cancer can serve as a guiding factor for patient prognosis and treatment, where dMMR status indicates a better prognosis and often obviates the need for adjuvant chemotherapy (ACT). Conversely, a higher lymph node ratio (LNR) is associated with a poorer prognosis. This study aims to elucidate the prognostic significance of LNR and MMR status in relation to ACT in stages II and III colorectal cancer. Methods A total of 1946 patients who underwent radical resection for colorectal cancer and were pathologically staged as II and III from three medical centers between 2012 and 2019 were selected. Among them, 1104 patients were included after MMR status was tested and postoperative chemotherapy was administered, along with other clinical information. MMR (mismatch repair) status was determined via pathological immunohistochemistry (IHC), and LNR was calculated. Patients were divided into three groups based on the LNR value and subjected to Kaplan–Meier and Cox regression analysis to assess the impact of MMR, LNR, and ACT on overall survival (OS) and disease‐free survival (DFS). Results A total of 6.47% of stage II and III colorectal cancers were detected as dMMR. Significant differences in OS and DFS between dMMR and pMMR patients were observed when the LNR ranged from 0.03 to 0.31, with pMMR patients showing a better prognosis. Stratified analysis with ACT revealed that postoperative chemotherapy did not affect the prognosis within the dMMR patient group. However, compared to the pMMR group, dMMR patients experienced significantly adverse effects on prognosis after receiving postoperative chemotherapy (p < 0.05). This result was more pronounced in the stratified analysis based on LNR (0.03–0.31) (p < 0.01). Conclusions Integrating LNR based on the microsatellite status of colorectal tumors provides comprehensive prognostic predictions, enhancing postoperative prognostic considerations for tumor patients. Additionally, our study suggests that patients with stage II and III colorectal cancer with dMMR status do not require any adjuvant chemotherapy postoperatively. |
| format | Article |
| id | doaj-art-4e1d3fb8f06d422f9bfd4e89b6b1113d |
| institution | OA Journals |
| issn | 2045-7634 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj-art-4e1d3fb8f06d422f9bfd4e89b6b1113d2025-08-20T02:16:13ZengWileyCancer Medicine2045-76342025-04-01147n/an/a10.1002/cam4.70756Mismatch Repair Status and Lymph Node Ratio in Survival Prediction of Stage II/III Rectal Cancer Patients: A Comprehensive Analysis of a Multi‐Center Retrospective StudyKailong Zhao0Wenwen Pang1Xinyu Liu2Kemin Ni3Weifeng Gao4Zhiquan Tan5Jun Xue6Weizheng Liang7Xueliang Wu8Xipeng Zhang9Xiaomin Su10Chunze Zhang11School of Medicine Nankai University Tianjin ChinaDepartment of Clinical Laboratory Tianjin Union Medical Center Tianjin ChinaTianjin Medical University Tianjin ChinaSchool of Medicine Nankai University Tianjin ChinaDepartment of Colorectal Surgery, Tianjin Union Medical Center The First Affiliated Hospital of Nankai University Tianjin ChinaDepartment of Information Tianjin Union Medical Center Tianjin ChinaDepartment of General Surgery The First Affiliated Hospital of Hebei North University Zhangjiakou ChinaDepartment of General Surgery The First Affiliated Hospital of Hebei North University Zhangjiakou ChinaDepartment of General Surgery The First Affiliated Hospital of Hebei North University Zhangjiakou ChinaDepartment of Colorectal Surgery, Tianjin Union Medical Center The First Affiliated Hospital of Nankai University Tianjin ChinaDepartment of Immunology Nankai University School of Medicine, Nankai University Tianjin ChinaDepartment of Colorectal Surgery, Tianjin Union Medical Center The First Affiliated Hospital of Nankai University Tianjin ChinaABSTRACT Background The microsatellite status (dMMR vs. pMMR) in colorectal cancer can serve as a guiding factor for patient prognosis and treatment, where dMMR status indicates a better prognosis and often obviates the need for adjuvant chemotherapy (ACT). Conversely, a higher lymph node ratio (LNR) is associated with a poorer prognosis. This study aims to elucidate the prognostic significance of LNR and MMR status in relation to ACT in stages II and III colorectal cancer. Methods A total of 1946 patients who underwent radical resection for colorectal cancer and were pathologically staged as II and III from three medical centers between 2012 and 2019 were selected. Among them, 1104 patients were included after MMR status was tested and postoperative chemotherapy was administered, along with other clinical information. MMR (mismatch repair) status was determined via pathological immunohistochemistry (IHC), and LNR was calculated. Patients were divided into three groups based on the LNR value and subjected to Kaplan–Meier and Cox regression analysis to assess the impact of MMR, LNR, and ACT on overall survival (OS) and disease‐free survival (DFS). Results A total of 6.47% of stage II and III colorectal cancers were detected as dMMR. Significant differences in OS and DFS between dMMR and pMMR patients were observed when the LNR ranged from 0.03 to 0.31, with pMMR patients showing a better prognosis. Stratified analysis with ACT revealed that postoperative chemotherapy did not affect the prognosis within the dMMR patient group. However, compared to the pMMR group, dMMR patients experienced significantly adverse effects on prognosis after receiving postoperative chemotherapy (p < 0.05). This result was more pronounced in the stratified analysis based on LNR (0.03–0.31) (p < 0.01). Conclusions Integrating LNR based on the microsatellite status of colorectal tumors provides comprehensive prognostic predictions, enhancing postoperative prognostic considerations for tumor patients. Additionally, our study suggests that patients with stage II and III colorectal cancer with dMMR status do not require any adjuvant chemotherapy postoperatively.https://doi.org/10.1002/cam4.70756adjuvant chemotherapy (ACT)lymph node ratio (LNR)microsatellite instability (dMMR)survival |
| spellingShingle | Kailong Zhao Wenwen Pang Xinyu Liu Kemin Ni Weifeng Gao Zhiquan Tan Jun Xue Weizheng Liang Xueliang Wu Xipeng Zhang Xiaomin Su Chunze Zhang Mismatch Repair Status and Lymph Node Ratio in Survival Prediction of Stage II/III Rectal Cancer Patients: A Comprehensive Analysis of a Multi‐Center Retrospective Study Cancer Medicine adjuvant chemotherapy (ACT) lymph node ratio (LNR) microsatellite instability (dMMR) survival |
| title | Mismatch Repair Status and Lymph Node Ratio in Survival Prediction of Stage II/III Rectal Cancer Patients: A Comprehensive Analysis of a Multi‐Center Retrospective Study |
| title_full | Mismatch Repair Status and Lymph Node Ratio in Survival Prediction of Stage II/III Rectal Cancer Patients: A Comprehensive Analysis of a Multi‐Center Retrospective Study |
| title_fullStr | Mismatch Repair Status and Lymph Node Ratio in Survival Prediction of Stage II/III Rectal Cancer Patients: A Comprehensive Analysis of a Multi‐Center Retrospective Study |
| title_full_unstemmed | Mismatch Repair Status and Lymph Node Ratio in Survival Prediction of Stage II/III Rectal Cancer Patients: A Comprehensive Analysis of a Multi‐Center Retrospective Study |
| title_short | Mismatch Repair Status and Lymph Node Ratio in Survival Prediction of Stage II/III Rectal Cancer Patients: A Comprehensive Analysis of a Multi‐Center Retrospective Study |
| title_sort | mismatch repair status and lymph node ratio in survival prediction of stage ii iii rectal cancer patients a comprehensive analysis of a multi center retrospective study |
| topic | adjuvant chemotherapy (ACT) lymph node ratio (LNR) microsatellite instability (dMMR) survival |
| url | https://doi.org/10.1002/cam4.70756 |
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