| Purpose:Tumor regression grade(TRG)and lymph node regression grade(LRG)are indicators used to assess the pathological response of the primary tumor and metastatic lymph nodes,respectively,in rectal cancer patients who have undergone neoadjuvant chemoradiotherapy(nCRT).Finding the relationship between TRG and LRG can help infer the treatment response of pelvic lymph nodes based on the treatment response of the primary tumor before surgery,and guide the next step of treatment strategy and prognosis.This study aims to explore the relationship and clinical significance of TRG and LRG after nCRT in patients with locally advanced rectal cancer,as well as to investigate other factors related to LRG.Methods:The study collected and retrospectively analyzed clinical data of patients diagnosed with locally advanced rectal cancer who underwent preoperative nCRT and curative surgery at Sichuan Cancer Hospital between 2018 and 2022.TRG and LRG were used to evaluate the pathological response after nCRT to primary tumors and lymph nodes,and single-factor analysis and ordinal regression analysis were performed on LRG and TRG,tumor distance from the anal margin,preoperative and postoperative T and N stages,and total number of lymph nodes after surgery.Results:This study included 101 patients with locally advanced rectal cancer who underwent nCRT and radical surgery.Analysis of LRG and TRG showed that in the univariate analysis,LRGmax and LRGsum were correlated with TRG(with P-values of 0.038 and 0.018,respectively),indicating a correlation between LRG and TRG.However,in the multivariate analysis,TRG was found to be an independent risk factor unrelated to LRG.Additionally,analysis of LRG and other clinical factors showed that in the univariate analysis,LRGmax was correlated with distance from the anal verge(P=0.016),ypT stage(P=0.015),postoperative lymph node count(P=0.039),and nerve invasion(P<0.001);LRGsum was correlated with cN stage(P=0.043),ypT stage(P=0.002),postoperative lymph node count(P=0.005),and nerve invasion(P=0.001).The multivariate analysis showed that distance from the anal verge and postoperative lymph node count were independent risk factors for LRGmax,while ypT stage,postoperative lymph node count,and nerve invasion were independent risk factors for LRGsum.Conclusion:LRG is correlated with TRG and can be used as one of the predictors of LRG,but in clinical practice,it is not solely relied upon to predict the regression of lymph nodes to nCRT based on the regression of primary tumors.In addition,LRG is associated with factors such as the distance of the tumor from the anal verge,the total number of lymph nodes after surgery,nerve infiltration,and ypT. |
