Smirnova OV, Sinyakov AA, Kasparov EV. Letter to the Editor: Lymph node regression grade in rectal cancer: Comments on prognostic utility and unresolved questions. World J Gastrointest Oncol 2026; 18(11): 123926 [DOI: 10.4251/wjgo.123926]
Corresponding Author of This Article
Olga V Smirnova, Professor, Laboratory of Clinical Pathophysiology, Federal Research Center “Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences”, Separate Subdivision Research Institute for Medical Problems of the North, Partizana Zheleznyaka Street 3G, Krasnoyarsk 660022, Russia. ovsmirnova71@mail.ru
Research Domain of This Article
Oncology
Article-Type of This Article
letter
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Smirnova OV, Sinyakov AA, Kasparov EV. Letter to the Editor: Lymph node regression grade in rectal cancer: Comments on prognostic utility and unresolved questions. World J Gastrointest Oncol 2026; 18(11): 123926 [DOI: 10.4251/wjgo.123926]
World J Gastrointest Oncol. Nov 15, 2026; 18(11): 123926 Published online Nov 15, 2026. doi: 10.4251/wjgo.123926
Letter to the Editor: Lymph node regression grade in rectal cancer: Comments on prognostic utility and unresolved questions
Olga V Smirnova, Aleksander A Sinyakov, Edward V Kasparov
Olga V Smirnova, Aleksander A Sinyakov, Laboratory of Clinical Pathophysiology, Federal Research Center “Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences”, Separate Subdivision Research Institute for Medical Problems of the North, Krasnoyarsk 660022, Russia
Edward V Kasparov, Department of Administration, Federal Research Center “Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences”, Separate Subdivision Research Institute for Medical Problems of the North, Krasnoyarsk 660022, Russia
Author contributions: Smirnova OV wrote the original draft; Sinyakov AA contributed to conceptualization, writing, reviewing and editing; Kasparov EV participated in manuscript drafting. All the authors have read and approved the final version of the manuscript.
AI contribution statement: We gratefully acknowledge DeepSeek Chat for providing assistance in refining the grammar and style of this manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Olga V Smirnova, Professor, Laboratory of Clinical Pathophysiology, Federal Research Center “Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences”, Separate Subdivision Research Institute for Medical Problems of the North, Partizana Zheleznyaka Street 3G, Krasnoyarsk 660022, Russia. ovsmirnova71@mail.ru
Received: June 4, 2026 Revised: July 27, 2026 Accepted: August 5, 2026 Published online: November 15, 2026 Processing time: 147 Days and 20.6 Hours
Abstract
The assessment of lymph node status following neoadjuvant therapy is a cornerstone of prognosis in locally advanced rectal cancer, yet current staging captures only the presence or absence of residual tumor, overlooking the biological spectrum of treatment response within involved nodes. The recent study by Shi et al, published in the World Journal of Gastroenterology, introduces a six-tier lymph node regression grade (LRG) system and demonstrates its independent prognostic value for overall survival in patients with residual nodal disease. This commentary critically examines the methodological strengths and limitations of the LRG system, with particular attention to the unresolved histopathological challenge of distinguishing a true negative node from a pathological complete response. A framework for integrating LRG with established prognostic tools, including tumor regression grade and circulating tumor DNA, is proposed to guide adjuvant therapy decisions and future clinical trial design.
Core Tip: The lymph node regression grade system by Shi et al advances post-neoadjuvant assessment of rectal cancer and enables prognostic stratification in ypN+ patients. However, its clinical use is limited by the difficulty of distinguishing fibrosis from sterilized metastasis vs uninvolved node architecture. Integrating cytokeratin immunohistochemistry, molecular profiling of treatment response, and oxidative stress biomarkers could improve lymph node regression grade objectivity and reproducibility. Such a refined tool may help tailor adjuvant chemotherapy decisions, supporting more personalized treatment strategies for rectal cancer patients.
