Tumor-related imaging parameters predict response and survival after neoadjuvant chemoradiotherapy in rectal cancer

doi:10.4251/wjgo.v18.i6.117694

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 18, Issue 6

This Article

(6)

(4)

(0)

(36)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Journal Information of This Article

Publication Name

World Journal of Gastrointestinal Oncology

ISSN

1948-5204

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Jun 15, 2026; 18(6): 117694
Published online Jun 15, 2026. doi: 10.4251/wjgo.v18.i6.117694

Tumor-related imaging parameters predict response and survival after neoadjuvant chemoradiotherapy in rectal cancer

Ting-Ting Nie, Yu-Xia Li, Xuan Yang, Tao Liu, Xiao-Hui Niu, Xiao-Fang Guo, Yu-Lin Liu

Ting-Ting Nie, Tao Liu, Xiao-Fang Guo, Yu-Lin Liu, Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430079, Hubei Province, China

Yu-Xia Li, Xiao-Hui Niu, College of Informatics, Huazhong Agriculture University, Wuhan 430070, Hubei Province, China

Xuan Yang, Department of Radiology, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China

Co-first authors: Ting-Ting Nie and Yu-Xia Li.

Co-corresponding authors: Xiao-Fang Guo and Yu-Lin Liu.

Author contributions: Nie TT and Li YX drafted the article or revised it critically for important intellectual content, approved the version to be published, have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved as co-first authors; Li YX, Yang X, Liu T, and Niu XH have made a substantial contribution to the acquisition, analysis, or interpretation of data for the article; Guo XF and Liu YL have made a substantial contribution to the concept or design of the article as co-corresponding authors; all of the authors read and approved the final version of the manuscript to be published.

AI contribution statement: The use of ChatGPT in this study was strictly limited to language polishing of author-written content. The AI tool did not contribute to the intellectual content of the manuscript in any way.

Supported by Guiding Program of Natural Science Foundation of Hubei Province, No. 2024AFC050; Special Project of Biomedical Research Center of Hubei Cancer Hospital, No. 2022SWZX06; and Hubei Province “Chutian Talents Program” Medical and Health Personnel Project, No. CTYC001.

Institutional review board statement: This retrospective study was approved by the Institutional Review Board of Hubei Cancer Hospital in compliance with ethical principles derived from the Declaration of Helsinki and its subsequent amendments, No.[2020]KYLL(S05).

Informed consent statement: Informed consent was waived because the study was approved by the Ethics Committee with an exemption from obtaining individual informed consent. This study involved no direct contact with participants and collected only baseline clinical data from outpatient and inpatient medical records. All identifying information was removed prior to analysis to ensure confidentiality and protect personal privacy. Therefore, the study posed no more than minimal risk to the participants.

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

Data sharing statement: The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Corresponding author: Xiao-Fang Guo, MD, PhD, Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 116 Zhuodaoquan South Road, Hongshan District, Wuhan 430079, Hubei Province, China. guoxiaofang2001@163.com

Received: December 15, 2025
Revised: January 6, 2026
Accepted: February 5, 2026
Published online: June 15, 2026
Processing time: 178 Days and 2.8 Hours

Abstract

BACKGROUND

Response to neoadjuvant chemoradiotherapy (nCRT) varies substantially among patients with rectal cancer (RC). Identifying clinically accessible pretreatment predictors is essential for optimizing risk stratification and individualized treatment planning.

AIM

To investigate whether pretreatment sarcopenia and tumor-related imaging parameters assessed on magnetic resonance imaging can predict treatment response, tumor downstaging, and overall survival (OS) in patients with RC undergoing nCRT.

METHODS

This retrospective study included 137 patients with RC who underwent standard nCRT. Clinical characteristics, tumor-related imaging parameters derived from pretreatment magnetic resonance imaging, and pretreatment sarcopenia were analyzed as potential prognostic factors. Sarcopenia was assessed using the skeletal muscle index measured on computed tomography at the time of diagnosis. Univariate and multivariate logistic regression analyses were performed to identify predictors of treatment response and tumor downstaging. OS was analyzed using the Kaplan-Meier method and Cox proportional hazards regression.

RESULTS

Pretreatment sarcopenia was non-significantly associated with response to nCRT or OS. Conversely, tumor length [hazard ratio (HR) = 1.029, 95%CI: 1.011-1.056; P = 0.004] and mesorectal fascia (MRF) involvement (HR = 1.853, 95%CI: 0.873-3.970; P = 0.025) independently predicted treatment response. Clinical T stage (HR = 4.928, 95%CI: 2.170-12.340; P < 0.001) and MRF status (HR = 4.456, 95%CI: 1.881-11.532; P = 0.001) were significantly associated with tumor downstaging. Nodal status (HR = 2.655, 95%CI: 1.281-5.503; P = 0.009) and MRF status (HR = 2.149, 95%CI: 1.005-4.596; P = 0.049) were associated with OS in univariate analysis; however, they did not remain independent predictors in multivariate models.

CONCLUSION

Pretreatment sarcopenia is not an independent predictor of treatment response or survival in patients with RC undergoing nCRT. Conversely, tumor-related parameters – including tumor length, MRF involvement, and clinical staging – have greater prognostic value and may assist in pretreatment risk stratification and in the individualized management of RC.

Keywords: Sarcopenia; Rectal cancer; Neoadjuvant therapy; Response; Overall survival

Core Tip: This study evaluated the impact of pretreatment sarcopenia and tumor-related magnetic resonance imaging parameters on the response to neoadjuvant chemoradiotherapy and overall survival in rectal cancer patients. The results show that while sarcopenia was not an independent predictor of treatment response or survival, tumor-related factors such as tumor length, mesorectal fascia involvement, and clinical T/N stage were significant predictors. These findings highlight the value of tumor-related imaging parameters in pretreatment risk stratification and personalized management for rectal cancer patients undergoing neoadjuvant chemoradiotherapy.