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<p>In locally advanced colorectal cancer (LACRC), neoadjuvant therapy (NT) followed by total mesorectal or complete mesocolic excision is standard. Although a pathological complete response at the primary site (ypT0) predicts excellent survival, this benefit is offset when residual nodal metastasis (ypT0N<sup>+</sup>) is present. Reliable predictors of ypT0N<sup>+</sup> are lacking. We retrospectively reviewed LACRC patients (2009–2024) who received NT and achieved ypT0 after curative surgery. Clinicopathologic variables were analyzed by uni- and multivariable logistic regression. A lymph node (LN) showing fibrosis, necrosis, acellular mucin, or foamy-cell reaction without viable carcinoma was classified as a regressed LN (RLN). An external ypT1-4 cohort treated during 2022–2024 served for validation. Among 503 ypT0 patients, 29 (5.8%) were ypT0N<sup>+</sup>. RLN-positivity occurred in 38% of ypT0N<sup>+</sup> versus 10% of ypT0N0 cases (<i>p</i> &lt; 0.001). On multivariable analysis, RLN-positivity was the sole independent risk factor for ypT0N<sup>+</sup> (OR 4.11, 95% CI 1.71–9.52, <i>p</i> = 0.001). In the validation cohort (<i>n</i> = 615), RLNs remained enriched in ypN⁺ patients (21% vs 13%, <i>p</i> = 0.001), corroborating the association. RLN-positivity is a robust histologic marker of occult nodal metastasis in ypT0 LACRC. ypT0N0 should be diagnosed cautiously when RLNs are present, and such patients may require intensified adjuvant therapy and surveillance.</p>

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Histopathologic regression in lymph nodes predicts occult metastasis in ypT0 colorectal cancers after neoadjuvant therapy: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2025年9月20日

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  • Chaoyuan Xiao,
  • Yu Shen,
  • De He,
  • Hai-Ning Chen

摘要

In locally advanced colorectal cancer (LACRC), neoadjuvant therapy (NT) followed by total mesorectal or complete mesocolic excision is standard. Although a pathological complete response at the primary site (ypT0) predicts excellent survival, this benefit is offset when residual nodal metastasis (ypT0N+) is present. Reliable predictors of ypT0N+ are lacking. We retrospectively reviewed LACRC patients (2009–2024) who received NT and achieved ypT0 after curative surgery. Clinicopathologic variables were analyzed by uni- and multivariable logistic regression. A lymph node (LN) showing fibrosis, necrosis, acellular mucin, or foamy-cell reaction without viable carcinoma was classified as a regressed LN (RLN). An external ypT1-4 cohort treated during 2022–2024 served for validation. Among 503 ypT0 patients, 29 (5.8%) were ypT0N+. RLN-positivity occurred in 38% of ypT0N+ versus 10% of ypT0N0 cases (p < 0.001). On multivariable analysis, RLN-positivity was the sole independent risk factor for ypT0N+ (OR 4.11, 95% CI 1.71–9.52, p = 0.001). In the validation cohort (n = 615), RLNs remained enriched in ypN⁺ patients (21% vs 13%, p = 0.001), corroborating the association. RLN-positivity is a robust histologic marker of occult nodal metastasis in ypT0 LACRC. ypT0N0 should be diagnosed cautiously when RLNs are present, and such patients may require intensified adjuvant therapy and surveillance.