{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T02:53:40Z","timestamp":1780628020755,"version":"3.54.1"},"reference-count":47,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006606","name":"Natural Science Foundation of Tianjin Municipality","doi-asserted-by":"publisher","award":["21JCYBJC00180"],"award-info":[{"award-number":["21JCYBJC00180"]}],"id":[{"id":"10.13039\/501100006606","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The microsatellite status (dMMR vs. pMMR) in colorectal cancer can serve as a guiding factor for patient prognosis and treatment, where dMMR status indicates a better prognosis and often obviates the need for adjuvant chemotherapy (ACT). Conversely, a higher lymph node ratio (LNR) is associated with a poorer prognosis. This study aims to elucidate the prognostic significance of LNR and MMR status in relation to ACT in stages II and III colorectal cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 1946 patients who underwent radical resection for colorectal cancer and were pathologically staged as II and III from three medical centers between 2012 and 2019 were selected. Among them, 1104 patients were included after MMR status was tested and postoperative chemotherapy was administered, along with other clinical information. MMR (mismatch repair) status was determined via pathological immunohistochemistry (IHC), and LNR was calculated. Patients were divided into three groups based on the LNR value and subjected to Kaplan\u2013Meier and Cox regression analysis to assess the impact of MMR, LNR, and ACT on overall survival (OS) and disease\u2010free survival (DFS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 6.47% of stage II and III colorectal cancers were detected as dMMR. Significant differences in OS and DFS between dMMR and pMMR patients were observed when the LNR ranged from 0.03 to 0.31, with pMMR patients showing a better prognosis. Stratified analysis with ACT revealed that postoperative chemotherapy did not affect the prognosis within the dMMR patient group. However, compared to the pMMR group, dMMR patients experienced significantly adverse effects on prognosis after receiving postoperative chemotherapy (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). This result was more pronounced in the stratified analysis based on LNR (0.03\u20130.31) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Integrating LNR based on the microsatellite status of colorectal tumors provides comprehensive prognostic predictions, enhancing postoperative prognostic considerations for tumor patients. Additionally, our study suggests that patients with stage II and III colorectal cancer with dMMR status do not require any adjuvant chemotherapy postoperatively.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.70756","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T17:49:40Z","timestamp":1743788980000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mismatch Repair Status and Lymph Node Ratio in Survival Prediction of Stage <scp>II<\/scp>\/<scp>III<\/scp> Rectal Cancer Patients: A Comprehensive Analysis of a Multi\u2010Center Retrospective Study"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5173-5749","authenticated-orcid":false,"given":"Kailong","family":"Zhao","sequence":"first","affiliation":[{"name":"School of Medicine Nankai University  Tianjin China"},{"name":"Department of Colorectal Surgery, Tianjin Union Medical Center The\u00a0First\u00a0Affiliated\u00a0Hospital\u00a0of\u00a0Nankai\u00a0University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenwen","family":"Pang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory Tianjin Union Medical Center  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Medical University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kemin","family":"Ni","sequence":"additional","affiliation":[{"name":"School of Medicine Nankai University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weifeng","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Tianjin Union Medical Center The\u00a0First\u00a0Affiliated\u00a0Hospital\u00a0of\u00a0Nankai\u00a0University  Tianjin China"},{"name":"The Institute of Translational Medicine Tianjin Union Medical Center  Tianjin China"},{"name":"Tianjin Institute of Coloproctology  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiquan","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Information Tianjin Union Medical Center  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of General Surgery The First Affiliated Hospital of Hebei North University  Zhangjiakou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weizheng","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of General Surgery The First Affiliated Hospital of Hebei North University  Zhangjiakou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueliang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of General Surgery The First Affiliated Hospital of Hebei North University  Zhangjiakou China"},{"name":"Institute of Cancer, the First Affiliated Hospital of Hebei North University  Zhangjiakou Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xipeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Tianjin Union Medical Center The\u00a0First\u00a0Affiliated\u00a0Hospital\u00a0of\u00a0Nankai\u00a0University  Tianjin China"},{"name":"The Institute of Translational Medicine Tianjin Union Medical Center  Tianjin China"},{"name":"Tianjin Institute of Coloproctology  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomin","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Immunology Nankai University School of Medicine, Nankai University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2063-5631","authenticated-orcid":false,"given":"Chunze","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Tianjin Union Medical Center The\u00a0First\u00a0Affiliated\u00a0Hospital\u00a0of\u00a0Nankai\u00a0University  Tianjin China"},{"name":"The Institute of Translational Medicine Tianjin Union Medical Center  Tianjin China"},{"name":"Tianjin Institute of Coloproctology  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(22)00270-4"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2208375"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1114635"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2015-310912"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrclinonc.2009.237"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.66.6826"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-017-3599-4"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.27.0652"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/CEJ.0000000000000620"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-023-11525-7"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41698-020-00132-5"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.26771"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.6223"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.1025"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.27.1825"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003051"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1042\/BSR20191507"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-017-2806-8"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2022.0051"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-018-01539-5"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tranon.2021.101190"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-020-07260-y"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13277-014-2484-x"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-68576-4"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-023-02440-3"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-020-09433-2"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000000546"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2018.05.009"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000000320"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181d7789d"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318190eddc"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005450"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2016.06.019"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2016.05.004"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-010-1158-1"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.2217\/fon-2020-0993"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs5.96"},{"key":"e_1_2_13_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00108-022-01413-w"},{"issue":"12","key":"e_1_2_13_41_1","first-page":"6563","article-title":"Microsatellite Instability as a Prognostic Factor in Stage II Colon Cancer Patients, a Meta\u2010Analysis of Published Literature","volume":"37","author":"Gkekas I.","year":"2017","journal-title":"Anticancer Research"},{"key":"e_1_2_13_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdu499"},{"key":"e_1_2_13_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/1878-0261.12611"},{"key":"e_1_2_13_44_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdz208"},{"key":"e_1_2_13_45_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5682-5"},{"key":"e_1_2_13_46_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-19-3728"},{"key":"e_1_2_13_47_1","doi-asserted-by":"publisher","DOI":"10.21037\/jgo.2018.10.01"},{"key":"e_1_2_13_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2022.10.018"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.70756","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T12:40:03Z","timestamp":1748349603000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.70756"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":47,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1002\/cam4.70756"],"URL":"https:\/\/doi.org\/10.1002\/cam4.70756","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"value":"2045-7634","type":"print"},{"value":"2045-7634","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2024-03-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70756"}}