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

IF 3.1 2区医学 Q2 ONCOLOGY Cancer Medicine Pub Date : 2025-04-02 DOI:10.1002/cam4.70756

Kailong Zhao, Wenwen Pang, Xinyu Liu, Kemin Ni, Weifeng Gao, Zhiquan Tan, Jun Xue, Weizheng Liang, Xueliang Wu, Xipeng Zhang, Xiaomin Su, Chunze Zhang

{"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","authors":"Kailong Zhao, Wenwen Pang, Xinyu Liu, Kemin Ni, Weifeng Gao, Zhiquan Tan, Jun Xue, Weizheng Liang, Xueliang Wu, Xipeng Zhang, Xiaomin Su, Chunze Zhang","doi":"10.1002/cam4.70756","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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 (<i>p</i> < 0.05). This result was more pronounced in the stratified analysis based on LNR (0.03–0.31) (<i>p</i> < 0.01).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 7","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70756","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/cam4.70756","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

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.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

错配修复状态和淋巴结比例在II/III期直肠癌患者生存预测中的作用：一项多中心回顾性研究的综合分析

结直肠癌的微卫星状态（dMMR vs. pMMR）可以作为患者预后和治疗的指导因素，其中dMMR状态表明预后较好，通常无需辅助化疗（ACT）。相反，较高的淋巴结比例（LNR）与较差的预后相关。本研究旨在阐明LNR和MMR状态与ACT在II期和III期结直肠癌中的预后意义。方法选取2012 - 2019年在三家医疗中心行大肠癌根治术，病理分期为II、III期的患者1946例。其中，1104例患者在检测MMR状态、术后化疗及其他临床信息后纳入。通过病理免疫组化（IHC）检测错配修复（MMR）状态，计算LNR。根据LNR值将患者分为三组，进行Kaplan-Meier和Cox回归分析，评估MMR、LNR和ACT对总生存期（OS）和无病生存期（DFS）的影响。结果二、三期结直肠癌dMMR检出率为6.47%。LNR在0.03 ~ 0.31之间时，dMMR与pMMR患者的OS和DFS差异有统计学意义，pMMR患者预后更好。ACT分层分析显示，术后化疗对dMMR患者组的预后没有影响。但与pMMR组相比，dMMR患者术后化疗对预后的不良影响显著（p < 0.05）。这一结果在基于LNR的分层分析中更为明显（0.03-0.31）（p < 0.01）。结论基于结直肠肿瘤微卫星状态整合LNR可提供全面的预后预测，增强肿瘤患者术后预后考虑。此外，我们的研究表明伴有dMMR状态的II期和III期结直肠癌患者术后不需要任何辅助化疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.