Multicenter nomogram integrating clinicopathological features for prognosis in stage II-III deficient/microsatellite instability-high rectal cancer

doi:10.5306/wjco.122710

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World Journal of Clinical Oncology

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2218-4333

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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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 Clin Oncol. Jul 24, 2026; 17(7): 122710
Published online Jul 24, 2026. doi: 10.5306/wjco.122710

Multicenter nomogram integrating clinicopathological features for prognosis in stage II-III deficient/microsatellite instability-high rectal cancer

De-Yao Zhang, Yi-Jun Liao, Xin Tang, Gong Chen, Rong-Xin Zhang

De-Yao Zhang, Yi-Jun Liao, Xin Tang, Gong Chen, Rong-Xin Zhang, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China

De-Yao Zhang, Yi-Jun Liao, Xin Tang, Gong Chen, Rong-Xin Zhang, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China

Co-first authors: De-Yao Zhang and Yi-Jun Liao.

Author contributions: Zhang DY, Liao YJ, and Tang X contributed to conceptualization, data curation, methodology and manuscript drafting; Chen G and Zhang RX supervised the study and revised the manuscript; Zhang DY and Liao YJ contributed equally to this work; Zhang DY was responsible for the study design, statistical analysis (including the random forest modeling and nomogram construction); Liao YJ contributed significantly to the multi-institutional clinical data curation, patient screening, and critical revision of the manuscript, both authors discussed the results, verified the data accuracy, and approved the final version, justifying their designation as co-first authors. All authors read and approved the final manuscript.

AI contribution statement: ChatGPT was used exclusively for language polishing, including improvements in grammar, wording, clarity, and readability. No AI tool was used for data analysis, statistical analysis, or scientific interpretation. All AI-assisted revisions were carefully reviewed, edited, and approved by the authors, who take full responsibility for the accuracy and integrity of the manuscript.

Institutional review board statement: The study was approved by the Institutional Review Board of Sun Yat-sen University Cancer Center (approval No. SL-B2024-809-01).

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at zhangrx@sysucc.org.cn.

Corresponding author: Rong-Xin Zhang, MD, PhD, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou 510060, Guangdong Province, China. zhangrx@sysucc.org.cn

Received: April 28, 2026
Revised: June 10, 2026
Accepted: July 9, 2026
Published online: July 24, 2026
Processing time: 90 Days and 2.7 Hours

Abstract

BACKGROUND

Lymphovascular invasion (LVI) and perineural invasion (PNI) are commonly used prognostic markers in colorectal cancer. Their clinical relevance in mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) rectal adenocarcinoma, however, has not been well defined. This study aimed to evaluate the prognostic impact of LVI and PNI in stage II-III dMMR/MSI-H rectal cancer patients.

AIM

To assess the prognostic value of LVI and PNI in stage II-III dMMR/MSI-H rectal adenocarcinoma and to develop a preliminary nomogram to predict recurrence risk.

METHODS

We retrospectively analyzed 107 treatment-naive patients with stage II-III dMMR/MSI-H rectal adenocarcinoma who underwent radical resection. LVI and PNI were assessed histopathologically, and their associations with clinicopathological features and recurrence-free survival (RFS) were analyzed using Cox regression and random forest modeling. A prognostic nomogram integrating tumor-node-metastasis stage, LVI, PNI, and body mass index was developed and validated.

RESULTS

LVI and PNI were identified in 21.5% (23/107) and 13.1% (14/107) of cases, respectively. In multivariable analysis, LVI remained independently associated with worse RFS (hazard ratio = 3.31, 95% confidence interval: 1.23-8.91, P = 0.018), while PNI showed a non-significant trend (hazard ratio = 1.75, P = 0.305). The nomogram showed favorable apparent discrimination for 1-, 3-, and 5-year RFS (area under the curves: 0.814, 0.871, and 0.862, respectively).

CONCLUSION

LVI is an independent prognostic factor in dMMR/MSI-H rectal cancer, while PNI is not. The proposed nomogram requires validation in larger prospective cohorts before clinical application.

Keywords: Mismatch repair; Microsatellite instability; Rectal cancer; Lymphovascular invasion; Perineural invasion; Nomogram; Recurrence-free survival

Core Tip: Deficient/microsatellite instability-high rectal cancer has distinct biological features, but postoperative risk assessment is still largely based on tumor-node-metastasis stage. This multicenter exploratory cohort highlights lymphovascular invasion as an independent predictor of recurrence-free survival in stage II-III deficient/microsatellite instability-high rectal adenocarcinoma, while perineural invasion showed no independent prognostic value. A preliminary nomogram integrating tumor stage, lymphovascular invasion, perineural invasion, and body mass index offers a practical framework for recurrence risk stratification, but requires external validation before clinical use.