Zhang K, Li ZJ. Correlation between pathological response to neoadjuvant immunotherapy and long-term survival in locally advanced rectal cancer: A real-world study. World J Gastrointest Surg 2026; 18(10): 121168 [DOI: 10.4240/wjgs.121168]
Corresponding Author of This Article
Zi-Jun Li, Research Fellow, Department of Medical Oncology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No. 1 People’s Hospital, No. 48 Taling South Road, Xunyang District, Jiujiang 332000, Jiangxi Province, China. ziyuan_0727@163.com
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Zhang K, Li ZJ. Correlation between pathological response to neoadjuvant immunotherapy and long-term survival in locally advanced rectal cancer: A real-world study. World J Gastrointest Surg 2026; 18(10): 121168 [DOI: 10.4240/wjgs.121168]
World J Gastrointest Surg. Oct 27, 2026; 18(10): 121168 Published online Oct 27, 2026. doi: 10.4240/wjgs.121168
Correlation between pathological response to neoadjuvant immunotherapy and long-term survival in locally advanced rectal cancer: A real-world study
Ke Zhang, Zi-Jun Li
Ke Zhang, General Surgery Center, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
Zi-Jun Li, Department of Medical Oncology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
Author contributions: Zhang K responsible for research design, data collection, statistical analysis, and manuscript drafting; Li ZJ guided the research, reviewed, finalized the manuscript, and took overall responsibility for the study. All authors approved the final version of the manuscript.
AI contribution statement: The authors declare that no AI tools were used in the development or writing of this manuscript and take full responsibility for its integrity, accuracy, and originality.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Jiujiang No. 1 People’s Hospital (Approval No. JJSDYRMYY-YXLL-115).
Informed consent statement: All individuals who participated in this study provided written informed consent prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Corresponding author: Zi-Jun Li, Research Fellow, Department of Medical Oncology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No. 1 People’s Hospital, No. 48 Taling South Road, Xunyang District, Jiujiang 332000, Jiangxi Province, China. ziyuan_0727@163.com
Received: April 24, 2026 Revised: June 2, 2026 Accepted: July 3, 2026 Published online: October 27, 2026 Processing time: 177 Days and 5.3 Hours
Abstract
BACKGROUND
Conventional treatment for locally advanced rectal cancer (LARC) is associated with several limitations, and neoadjuvant immunotherapy has been proposed to address these current clinical dilemmas. However, the correlation between pathological response and long-term survival remains unclear. Most existing studies are derived from clinical trials, with a lack of real-world evidence. Therefore, this real-world study was conducted to analyze the correlation between the two indicators.
AIM
To investigate the correlation between pathological response to neoadjuvant immunotherapy and long-term survival in patients with LARC using real-world data.
METHODS
Clinical data of 130 LARC patients who received neoadjuvant immunotherapy combined with radical surgery in our hospital from March 2022 to March 2025 were retrospectively collected. All patients were administered neoadjuvant immunotherapy regimens based on anti-programmed cell death protein 1/programmed death-ligand 1 inhibitors, and laparoscopic or open radical resection of rectal cancer was performed 4-6 weeks after the end of treatment. Tumor regression grade (TRG) was used to evaluate the degree of pathological response, which was classified into pathological complete response (pCR; TRG grade 0), major pathological response (MPR; TRG grade 1), and non-MPR (TRG grades 2-3). The Kaplan-Meier method was adopted for survival analysis, and the log-rank test was used to compare disease-free survival and overall survival among patients with different pathological response grades. The Cox proportional hazards regression model was applied to identify the independent risk factors for long-term survival in these patients.
RESULTS
Among the 130 patients with LARC who received neoadjuvant immunotherapy followed by radical surgery, 30 patients achieved pCR, 30 achieved MPR, and 70 were classified as non-MPR. Significant differences were observed among the groups in maximum tumor diameter, preoperative imaging T stage, preoperative imaging N stage, and treatment regimen (all P < 0.05). Patients with better pathological response demonstrated more favorable survival outcomes than those without MPR. In addition, neoadjuvant immunotherapy exhibited an acceptable safety profile, and treatment-related adverse events were generally manageable.
CONCLUSION
Neoadjuvant immunotherapy yields a high pathological response rate in LARC patients, and the pathological response is closely correlated with long-term survival outcomes. Patients achieving pCR/MPR have superior disease-free survival and overall survival.
Core Tip: This real-world retrospective study evaluated the association between pathological response and long-term survival outcomes in patients with locally advanced rectal cancer receiving neoadjuvant immunotherapy. Results demonstrated high pathological response rates and suggested that better pathological regression may correlate with improved disease-free survival. These findings provide clinically relevant evidence supporting the prognostic value of pathological response following neoadjuvant immunotherapy in locally advanced rectal cancer.
