{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T22:45:46Z","timestamp":1791585946499,"version":"4.3.4"},"reference-count":39,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100017686","name":"Fujian Provincial Health Technology Project","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017686","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017682","name":"Construction Project of Fujian Province Minimally Invasive Medical Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017682","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC) does not eliminate tumor recurrence risk, with distant metastasis remaining a critical challenge. This study aimed to identify novel prognostic factors for risk stratification in pCR patients after nCRT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled 149 LARC patients who achieved pCR between 2016 and 2020. Acellular mucin pools (AMP) were classified by the deepest tissue layer of AMP (A0: absent; A1: within the muscularis propria; A2: exceeding the muscularis propria). The primary endpoint was disease\u2010free survival (DFS); secondary endpoints included overall survival (OS) and recurrence patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After a median follow\u2010up of 75.3\u2009months, the 5\u2010year OS and DFS rates were 95.3% and 89.9%, respectively. Among 15 recurrence events, all were distant metastases (80% pulmonary). AMP were present in 17.4% (26\/149) of patients. Multivariate analysis identified AMP exceeding the muscularis propria (HR\u2009=\u20093.996, 95% CI: 1.073\u201314.660,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.039), preoperative neutrophil\u2010to\u2010lymphocyte ratio (NLR) &gt;4.4 (HR\u2009=\u20093.658, 95% CI: 1.304\u201310.263,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.014) and tumour distance from the anal verge on pretreatment magnetic resonance imaging (MRI) (HR\u2009=\u20090.667, 95% CI: 0.481\u20130.925,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.015) as independent predictors of distant metastasis\u2010free survival (DMFS). A nomogram integrating these factors showed robust discriminative performance for 1\u2010, 3\u2010, and 5\u2010year DMFS (AUC\u2009=\u20090.689, 0.815, 0.795). Meanwhile, AMP exceeding the muscularis propria (HR\u2009=\u20096.632,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.010) and pretreatment MRI\u2010assessed tumour distance from the anal margin (HR\u2009=\u20090.614,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.018) were independent predictors for pulmonary metastasis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AMP exceeding the muscularis propria and high pretreatment NLR are complementary prognostic markers that refine risk stratification in pCR patients, enabling personalized surveillance and treatment strategies to improve outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/his.70050","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T15:34:26Z","timestamp":1763652866000},"page":"854-867","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acellular mucin pools and neutrophil\u2010to\u2010lymphocyte ratio: unveiling hidden aggressiveness in pathological complete response after chemoradiotherapy for rectal cancer"],"prefix":"10.1111","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4381-0925","authenticated-orcid":false,"given":"Zhenyu","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery Fujian Medical University, Union Hospital  Fuzhou Fujian People's Republic of 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China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9865-3741","authenticated-orcid":false,"given":"Ying","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Fujian Medical University, Union Hospital  Fuzhou Fujian People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8276-1337","authenticated-orcid":false,"given":"Pan","family":"Chi","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Fujian Medical University, Union Hospital  Fuzhou Fujian People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1419-6572","authenticated-orcid":false,"given":"Yanwu","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Fujian Medical University, Union Hospital  Fuzhou Fujian People's Republic of 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