The prognostic significance of metastasis to No. 253 lymph node in stage III rectal cancer based on a bicenter retrospective study

Q: What is the main focus of the study?

The study evaluates how metastasis to No. 253 lymph node affects long-term prognosis in stage III rectal cancer and develops a dynamic prediction model based on this status.

Q: How was the comparison between No. 253-positive and No. 253-negative groups conducted?

Patients were retrospectively collected and balanced using propensity score matching (PSM) with a 1:4 ratio, reducing baseline differences between the two cohorts.

Q: Does No. 253 lymph node metastasis independently predict overall survival?

Yes. Multivariate Cox regression identified No. 253 lymph node involvement as an independent determinant of overall survival in both analyses before and after PSM, along with factors such as sex, CRM positivity, and advanced pTNM stage.

Sep 23, 2026

Uploaded by Hazel

This bicenter retrospective study assesses the prognostic value of No. 253 lymph node metastasis and builds a dynamic prediction model for stage III rectal cancer. Data from 956 patients undergoing radical resection (2016–2024) at two tertiary centers were analyzed using propensity score matching (1:4) to compare No. 253-positive and -negative cohorts. No. 253 metastasis independently predicted overall survival before and after matching, with 3-year survival differing significantly between groups. The web-based nomograms showed strong C-indices and clinical utility, enabling personalized long-term prognosis prediction.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Methods

Study design and population

Inclusion criteria

Results

Propensity score matching

Prognostic impact of No. 253 metastasis

Model development

Dynamic nomograms and prediction performance

Decision curve analysis

Discussion

[www. nature.com/scientificreports](www. nature.com/scientificreports) OPEN The prognostic significance of metastasis to No. 253 lymph node in stage III rectal cancer based on abicenter retrospective study YugangYang1,4, Jiasen Li2,4 & Guancong Wang1,3􀀍 This bicenter study evaluates the prognostic value of No.253 lymph node metastasis and establishes a dynamic prediction model for stage III rectal cancer. Retrospective analysis included 956 pTNM III stage rectal cancer patients undergoing radical resection (2016–2024) at two tertiary centers. Propensity score matching (PSM, 1:4 ratio) balanced baseline characteristics between No.253-positive (n = 78) and negative (n = 260) cohorts. Before PSM, the No.253 metastasis rate for stage III rectal cancer was 8.3%, multivariate Cox regression analysis showed that No.253 lymph node metastasis was an independent risk factor for OS (HR = 2.780, 95% CI: 1.874–4.124, P < 0.001) . Furthermore, after PSM, the median follow-up period was 32.0 months (range: 1.0 to 92.0 months). The 3-year overall survival rate was 60.6% in the positive group and 81.7% in the negative group (P < 0.001) . Multivariate Cox regression identified No.253 involvement as an independent OS determinant (HR = 3.171, 95% CI 2.016–4.986, P < 0.0011), alongside sex, circumferential resection margin (CRM) positivity and advanced pTNM stage. The developed dynamic nomograms, directly accessible at URL: [https://pcrpredict.shinyapps.i](https://pcrpredict.shinyapps.i)[o/No253/](o/No253/), showed strong predictive accuracy (1-/3-/5-year C-indices: 0.741/0.719/0.738), maintained across external validation cohorts (Zhangzhou: 0.816/0.649/0.619; Union: 0.726/0.674/0.647) . Decision curve analysis confirmed clinical utility. No.253 Lymph node status has a significant impact on longterm prognosis after surgery for stage III rectal cancer. The validated web-based model enables personalized prognosis prediction. Keywords Group No. 253 lymph nodes, Rectal cancer, Long-term prognosis, Nomogram, After PSM Rectal lymphatic reflux primarily ascends along the perirectal lymphatic vessels surrounding the superior rectal artery to the vicinity of the inferior mesenteric artery (IMA)1. According to the JSCCR 2019 guidelines, the No. 253 lymph node group corresponds to the apical lymph nodes situated at the root ofthe IMA, constituting the third-station main lymph node basin along the mesorectal and superior rectal arterial lymphatic drainage route for rectal malignancies1. Lymph node metastatic status has a significant impact on the prognosis of colorectal cancer. The current TNM staging system considers patients with stage Ⅲ rectal cancer as long as lymph node metastasis is present and postoperative adjuvant chemotherapy is needed to reduce the risk of recurrence2. However, N staging is only related to the number of lymph node metastases, but not the distribution location of the metastatic lymph nodes, and the TNM staging cannot directly reflect the prognostic impact of differentlymph node status of stage Ⅲ rectal cancer3. The probability of No. 253 group lymph node metastasis is low and depends on the tumour site, ranging from about 2.6–7.8% 4–7. In particular, the incidence is higher in left colon cancers, especially in patients with sigmoid colon8, and in rectal cancers the incidence is higher in patients with a distance of more than 9 cm from the anus9. Therefore, previous studies in this area have focused more on the left colon, and there is still a relative lack of large studies in rectal cancer. Lymph node metastasis in this group is considered to have some correlation with the prognosis of colorectal cancer, especially among left half colon cancers 5–7, 10. However, there are also findings that the relationship between lymph node clearance and prognosis in No.253 group has no significant 1Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China. 2De

FAQs

What is the main focus of the study?

The study evaluates how metastasis to No. 253 lymph node affects long-term prognosis in stage III rectal cancer and develops a dynamic prediction model based on this status.

How was the comparison between No. 253-positive and No. 253-negative groups conducted?

Patients were retrospectively collected and balanced using propensity score matching (PSM) with a 1:4 ratio, reducing baseline differences between the two cohorts.

Does No. 253 lymph node metastasis independently predict overall survival?

Yes. Multivariate Cox regression identified No. 253 lymph node involvement as an independent determinant of overall survival in both analyses before and after PSM, along with factors such as sex, CRM positivity, and advanced pTNM stage.

Sep 23, 2026

Uploaded by Hazel