Lymph node regression grade as a prognostic marker in rectal cancer after neoadjuvant therapy and radical resection

doi:10.3748/wjg.v32.i15.116026

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World Journal of Gastroenterology

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1007-9327

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Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Apr 21, 2026; 32(15): 116026
Published online Apr 21, 2026. doi: 10.3748/wjg.v32.i15.116026

Table 1 Patients characteristics, n = 155, n (%)/mean ± SD

Patient characteristics	Value
Gender
Male	106 (68.39)
Female	49 (31.61)
Age (years)	54.1 ± 13.0
< 50	61 (39.35)
≥ 50	94 (60.65)
Post-CRT CEA (ng/mL)
< 5	122 (78.71)
≥ 5	33 (21.29)
Post-CRT CA19-9 (U/mL)
< 37	142 (91.61)
≥ 37	13 (8.39)
Distance from anal verge (cm)	4.7 ± 2.4
< 5	85 (54.84)
≥ 5	70 (45.16)
Operation
LAR	102 (65.81)
APR	53 (34.19)
Well/moderate	135 (87.10)
Poor	20 (12.90)
cTNM (AJCC 7^th)
I	11 (7.10)
II	42 (27.10)
III	56 (36.12)
Unknow	46 (29.68)

CRT: Chemoradiotherapy; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; LAR: Low anterior resection; APR: Abdominoperineal resection; cTNM: Clinical tumor-node-metastasis; AJCC: American Joint Committee on Cancer.

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Table 2 Pathological characteristics of 155 specimens, n (%)

Pathological characteristics	Value
ypT
ypT0	19 (12.26)
ypT1	4 (2.58)
ypT2	35 (22.58)
ypT3	95 (61.29)
ypT4	2 (1.29)
ypN
ypN0	92 (59.35)
ypN1	35 (22.58)
ypN2	28 (18.06)
TRG
TRG1	19 (12.26)
TRG2	23 (14.84)
TRG3	57 (36.77)
TRG4	40 (25.81)
TRG5	16 (10.32)
LRG
LRG0	32 (20.65)
LRG1	60 (38.71)
LRG2	9 (5.81)
LRG3	14 (9.03)
LRG4	13 (8.39)
LRG5	27 (17.42)

TRG: Tumor regression grade; LRG: Lymph node regression grade.

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Table 3 Association of lymph node regression grade with the factors relating to survival, n = 123

Patients characteristics	LRG	1	2	3	4	5	Value	P value
Gender							χ²_cmh = 0.78	0.38
Male	88	43 (48.86)	4 (4.55)	10 (11.36)	9 (10.23)	22 (25.00)
Female	35	17 (48.57)	5 (14.29)	4 (11.43)	4 (11.43)	5 (14.29)
Age (years)							χ²_cmh = 0.40	0.53
< 50	47	19 (40.43)	5 (10.64)	7 (14.89)	7 (14.89)	9 (19.15)
≥ 50	76	41 (53.95)	4 (5.26)	7 (9.21)	6 (7.89)	18 (23.68)
Post-CRT CEA (ng/mL)							χ²_cmh = 9.85	0.002
< 5	94	53 (56.38)	7 (7.45)	11 (11.70)	5 (5.32)	18 (19.15)
≥ 5	29	7 (24.14)	2 (6.90)	3 (10.34)	8 (27.59)	9 (31.03)
Post-CRT CA19-9 (U/mL)							χ²_cmh = 2.53	0.11
< 37	113	56 (49.56)	9 (7.96)	14 (12.39)	12 (10.62)	22 (19.47)
≥ 37	10	4 (40.00)	0 (0)	0 (0)	1 (10.00)	5 (50.00)
Distance from anal verge (cm)							χ²_cmh = 1.12	0.29
< 5	68	37 (54.41)	4 (5.88)	7 (10.29)	6 (8.82)	14 (20.59)
≥ 5	55	23 (41.82)	5 (9.09)	7 (12.73)	7 (12.73)	13 (23.64)
Operation							χ²_cmh = 0.20	0.66
LAR	83	39 (46.99)	6 (7.23)	11 (13.25)	8 (9.64)	19 (20.89)
APR	40	21 (52.50)	3 (7.50)	3 (7.50)	5 (12.50)	8 (20.00)
cTNM							χ²_cmh = 2.14	0.34
I	9	6 (77.78)	0 (0)	0 (0)	1 (11.11)	1 (11.11)
II	28	14 (50.00)	0 (0)	4 (14.29)	4 (14.29)	6 (21.43)
III	49	19 (38.78)	7 (14.29)	7 (14.29)	4 (8.16)	12 (24.49)
ypT							χ²_cmh = 16.33	< 0.0001
ypT0	13	10 (76.92)	1 (7.69)	1 (7.69)	1 (7.69)	0 (0)
ypT1	4	3 (75.00)	0 (0)	1 (25.00)	0 (0)	0 (0)
ypT2	27	20 (74.07)	1 (3.70)	1 (3.70)	3 (11.11)	2 (7.41)
ypT3	77	27 (35.06)	7 (9.09)	11 (14.29)	9 (11.69)	23 (29.87)
ypT4	2	0 (0)	0 (0)	0 (0)	0 (0)	2 (100.00)
ypN¹							χ²_cmh = 85.92	< 0.0001
ypN0	60	60 (100.00)	0 (0)	0 (0)	0 (0)	0 (0)
ypN1	35	0 (0)	6 (17.14)	9 (25.71)	10 (28.57)	10 (28.57)
ypN2	28	0 (0)	3 (10.71)	5 (17.86)	3 (10.71)	17 (60.71)
Tumor differentiation degree							χ²_cmh = 7.74	0.005
Well/moderate	104	56 (53.85)	7 (6.73)	11 (10.58)	12 (11.54)	18 (17.31)
Poor	19	4 (21.05)	2 (10.53)	3 (15.79)	1 (5.26)	9 (47.37)
TRG							χ²_cmh = 6.16	0.01
TRG1	13	10 (76.92)	1 (7.69)	1 (7.69)	1 (7.69)	0 (0)
TRG2	20	11 (55.00)	4 (20.00)	3 (15.00)	0 (0)	2 (10.00)
TRG3	44	18 (40.91)	3 (6.82)	6 (13.64)	4 (9.09)	13 (29.55)
TRG4	32	13 (40.63)	1 (3.13)	4 (12.50)	6 (18.75)	8 (25.00)
TRG5	14	8 (57.14)	0 (0)	0 (0)	2 (14.29)	4 (28.57)

¹Lymph node regression grade scores greatly depend on positive lymph nodes. Thus, the influence of ypN stage seems less significant in this analysis.

LRG: Lymph node regression grade; CRT: Chemoradiotherapy; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; LAR: Low anterior resection; APR: Abdominoperineal resection; cTNM: Clinical tumor-node-metastasis; TRG: Tumor regression grade; cmh: Cochran-Mantel-Haenszel.

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Table 4 Factors associated with lymph node regression grade by logistic regression analysis

Parameter	Estimate	χ²	P value	Odds ratio	95%CI
ypT	0.7669	9.6097	0.0019	2.153	1.326-3.497
Post-CRT CEA	1.1745	8.2246	0.0041	3.236	1.450-7.222
Tumor differentiation degree	1.0721	4.9144	0.0266	2.921	1.132-7.538

CI: Confidence interval; CRT: Chemoradiotherapy; CEA: Carcinoembryonic antigen.

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Table 5 Multivariate Cox proportional hazards regression analysis for overall survival and disease-free survival

	Parameter	Estimate	χ²	P value	Hazard ratio	95%CI
Overall survival	LRG	0.42720	13.7118	0.0002	1.533	1.223-1.922
Disease-free survival	LRG	0.24545	6.6966	0.010	1.278	1.061-1.539

CI: Confidence interval; LRG: Lymph node regression grade.

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Table 6 Association of lymph node regression grade with the factors relating to survival in subgroup, n = 63

Patients characteristics	LRG	2	3	4	5	Value	P value
Gender						χ²_cmh = 3.61	0.06
Male	45	4 (8.89)	10 (22.22)	9 (20.00)	22 (48.89)
Female	18	5 (27.78)	4 (22.22)	4 (22.22)	5 (27.78)
Age (years)						χ²_cmh = 1.74	0.19
< 50	28	5 (17.86)	7 (25.00)	7 (25.00)	9 (32.14)
≥ 50	35	4 (11.43)	7 (20.00)	6 (17.14)	18 (51.43)
Post-CRT CEA (ng/mL)						χ²_cmh = 0.79	0.37
< 5	41	7 (17.07)	11 (26.83)	5 (12.20)	18 (43.90)
≥ 5	22	2 (9.09)	3 (13.64)	8 (36.36)	9 (40.91)
Post-CRT CA19-9 (U/mL)						χ²_cmh = 4.47	0.03
< 37	57	9 (15.79)	14 (24.56)	12 (21.05)	22 (38.60)
≥ 37	6	0 (0)	0 (0)	1 (16.67)	5 (83.33)
Distance from anal verge (cm)						χ²_cmh = 0.11	0.74
< 5	31	4 (12.90)	7 (22.58)	6 (19.35)	14 (45.16)
≥ 5	32	5 (15.63)	7 (21.88)	7 (21.88)	13 (40.63)
Operation						χ²_cmh = 0.02	0.90
LAR	44	6 (13.64)	11 (25.00)	8 (18.18)	19 (43.18)
APR	19	3 (15.79)	3 (15.79)	5 (26.32)	8 (42.11)
cTNM						χ²_cmh = 2.13	0.35
I	2	0 (0)	0 (0)	1 (50.00)	1 (50.00)
II	14	0 (0)	4 (28.57)	4 (28.57)	6 (42.86)
III	30	7 (23.33)	7 (23.33)	4 (13.33)	12 (40.00)
ypT						χ²_cmh = 3.65	0.06
ypT0	3	1 (33.33)	1 (33.33)	1 (33.33)	0 (0)
ypT1	1	0 (0)	1 (100.00)	0 (0)	0 (0)
ypT2	7	1 (14.29)	1 (14.29)	3 (42.86)	2 (28.57)
ypT3	50	7 (14.00)	11 (22.00)	9 (18.00)	23 (46.00)
ypT4	2	0 (0)	0 (0)	0 (0)	2 (100.00)
ypN						χ²_cmh = 3.52	0.06
ypN1	35	6 (17.14)	9 (25.71)	10 (28.57)	10 (28.57)
ypN2	28	3 (10.71)	5 (17.86)	3 (10.71)	17 (60.71)
Tumor differentiation degree						χ²_cmh = 0.72	0.40
Well/moderate	48	7 (14.58)	11 (22.92)	12 (25.00)	18 (37.50)
Poor	15	2 (13.33)	3 (20.00)	1 (6.67)	9 (60.00)
TRG						χ²_cmh = 9.32	0.002
TRG1	3	1 (33.33)	1 (33.33)	1 (33.33)	0 (0)
TRG2	9	4 (44.44)	3 (33.33)	0 (0)	2 (22.22)
TRG3	26	3 (11.54)	6 (23.08)	4 (15.38)	13 (50.00)
TRG4	19	1 (5.26)	4 (21.05)	6 (31.58)	8 (42.11)
TRG5	6	0 (0)	0 (0)	2 (33.33)	4 (66.67)

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Table 7 Multivariate Cox proportional hazards regression analysis for overall survival in subgroup

Parameter	Estimate	χ²	P value	Hazard ratio	95%CI
LRG	0.47288	3.9540	0.047	1.605	1.007-2.557
DV	1.11826	5.3168	0.02	3.060	1.183-7.915

LRG: Lymph node regression grade; DV: Distance from anal verge; CI: Confidence interval.

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Citation: Shi YJ, Duan PP, Liu QQ, Ru HY, Huang YJ, Xia W, Chen L, Li X. Lymph node regression grade as a prognostic marker in rectal cancer after neoadjuvant therapy and radical resection. World J Gastroenterol 2026; 32(15): 116026
URL: https://www.wjgnet.com/1007-9327/full/v32/i15/116026.htm
DOI: https://dx.doi.org/10.3748/wjg.v32.i15.116026