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To address this critical gap, an MRI\u2010derived LNs morphological and topological structure (LNs\u2010MTS) model is developed to evaluate the immune status of LNs in rectal cancer (RC). Integrating multicenter imaging, transcriptomic, and immunohistochemical data from 1,156 stage I\u2010II RC patients, enhanced immune activation in non\u2010metastatic LNs sized \u22650.5 cm and located \u22655 cm from the primary tumor is discovered. Then two quantitative MRI\u2010derived imaging features across 7,030 radiologically annotated LNs: total LNs volume (tLNV) and total LNs drainage distance (tLND) is developed, forming the basis of the LNs\u2010MTS model risk subtypes: high\u2010risk (HRS), moderate\u2010risk (MRS), and low\u2010risk (LRS). Patients in the LRS (characterized by large tLNV and distant tLND) show robust immune cell infiltration in the tumor microenvironment and excellent 5\u2010year survival, whereas HRS (characterized by small tLNV and near tLND) show stromal dominance and poorer prognosis. Clinically, LNs\u2010MTS offers a more precise and personalized risk assessment than current guideline\u2010based risk stratification, potentially sparing stage II\u2010LRS patients from unnecessary adjuvant treatment while identifying stage I\u2010HRS individuals for more aggressive treatment, providing valuable insights for personalized treatment strategies in RC management.<\/jats:p>","DOI":"10.1002\/advs.202506523","type":"journal-article","created":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T16:45:10Z","timestamp":1756658710000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["MRI\u2010Derived Lymph Nodes Morphological and Topological Structure (LNs\u2010MTS) Model for Evaluating Immune Status and Prognosis in Rectal Cancer"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4086-5044","authenticated-orcid":false,"given":"Yunxiao","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Colorectal Cancer Surgery the Second Affiliated Hospital of Harbin Medical University  No. 246 Xuefu Road Harbin Heilongjiang 150086 China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liwen","family":"Zhang","sequence":"additional","affiliation":[{"name":"CAS Key Laboratory of Molecular Imaging and Beijing Key Laboratory of Molecular Imaging Institute of Automation Chinese Academy of Sciences  Beijing 100190 China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfen","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Radiology Shanxi Cancer Hospital\/Shanxi Hospital Affiliated to Cancer Hospital Chinese Academy of Medical Sciences\/Cancer Hospital Affiliated to Shanxi Medical University  Taiyuan 030013 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