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Introduction <p>The heterogeneous treatment response of lateral lymph nodes (LLN) and mesorectal lymph nodes (MLN) to neoadjuvant chemoradiotherapy (NCRT) in locally advanced rectal cancer (LARC) remains poorly understood. This study investigates imaging regression patterns, pathological lymph node regression grade (LRG), and prognostic implications in patients with LARC undergoing radical resection and lateral lymph node dissection (LLND) after NCRT.</p> Patients and Methods <p>A total of 110 patients with LARC undergoing radical resection and LLND after NCRT (2018–2024) were enrolled. Visible MLNs and LLNs on initial magnetic resonance imaging (MRI) were matched node-by-node on post-NCRT MRI, and short-axis (SA) diameter regression was calculated. Pathological LRG scores, including LRG-max, LRG-sum, and LRG-ratio, were assessed on the basis of tumor cell proportion and fibrosis. Differences in radiological and pathological regression between MLNs and LLNs were analyzed at lymph node (LN) and patient levels. </p> Results <p>MRI assessed 1744 LNs (811 MLNs, 933 LLNs pre-NCRT; 546 MLNs, 969 LLNs post-NCRT). MLNs exhibited higher disappearance rates (32.7% versus 2.4%, <i>P</i> &lt; 0.0001) and greater SA regression (0.596 ± 0.333 versus 0.214 ± 0.242, <i>P</i> &lt; 0.0001) than LLNs. Histopathological re-evaluation of 2108 LNs (916 MLNs, 1192 LLNs) revealed LLNs had higher LRG-max (37.13 versus 21.37, <i>P</i> = 0.011) and LRG-ratio (3.45 ± 1.29 versus 2.47 ± 0.96, <i>P</i> = 0.0003). LRG-sum was an independent prognostic factor for both MLNs and LLNs.</p> Conclusions <p>LLNs demonstrated lower imaging regression, higher pathological residual cancer, and poorer treatment response compared with MLNs, indicating greater NCRT tolerance.</p>

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Discrepancies in the Reactivity of Mesorectal versus Lateral Lymph Nodes Post-Neoadjuvant Chemoradiotherapy for Rectal Cancer: Insights from Radiological and Pathological Perspectives

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月10日

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  • Zixuan Zhuang,
  • Xuyang Yang,
  • Yang Zhang,
  • Xiangbing Deng,
  • Mingtian Wei,
  • Ziqiang Wang

摘要

Introduction

The heterogeneous treatment response of lateral lymph nodes (LLN) and mesorectal lymph nodes (MLN) to neoadjuvant chemoradiotherapy (NCRT) in locally advanced rectal cancer (LARC) remains poorly understood. This study investigates imaging regression patterns, pathological lymph node regression grade (LRG), and prognostic implications in patients with LARC undergoing radical resection and lateral lymph node dissection (LLND) after NCRT.

Patients and Methods

A total of 110 patients with LARC undergoing radical resection and LLND after NCRT (2018–2024) were enrolled. Visible MLNs and LLNs on initial magnetic resonance imaging (MRI) were matched node-by-node on post-NCRT MRI, and short-axis (SA) diameter regression was calculated. Pathological LRG scores, including LRG-max, LRG-sum, and LRG-ratio, were assessed on the basis of tumor cell proportion and fibrosis. Differences in radiological and pathological regression between MLNs and LLNs were analyzed at lymph node (LN) and patient levels.

Results

MRI assessed 1744 LNs (811 MLNs, 933 LLNs pre-NCRT; 546 MLNs, 969 LLNs post-NCRT). MLNs exhibited higher disappearance rates (32.7% versus 2.4%, P < 0.0001) and greater SA regression (0.596 ± 0.333 versus 0.214 ± 0.242, P < 0.0001) than LLNs. Histopathological re-evaluation of 2108 LNs (916 MLNs, 1192 LLNs) revealed LLNs had higher LRG-max (37.13 versus 21.37, P = 0.011) and LRG-ratio (3.45 ± 1.29 versus 2.47 ± 0.96, P = 0.0003). LRG-sum was an independent prognostic factor for both MLNs and LLNs.

Conclusions

LLNs demonstrated lower imaging regression, higher pathological residual cancer, and poorer treatment response compared with MLNs, indicating greater NCRT tolerance.