Correlation between pathological response to neoadjuvant immunotherapy and long-term survival in locally advanced rectal cancer: A real-world study

doi:10.4240/wjgs.121168

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World Journal of Gastrointestinal Surgery

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1948-9366

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

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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 Surg. Oct 27, 2026; 18(10): 121168
Published online Oct 27, 2026. doi: 10.4240/wjgs.121168

Table 1 Baseline characteristics of patients in different pathological response groups, n (%)/median (interquartile rage)

Baseline characteristics	Total (n = 130)	pCR group (n = 30)	MPR group (n = 30)	Non-MPR group (n = 70)	χ²/t/Z	P value
Sex					0.582	0.747
Male	78 (60.0)	19 (63.3)	17 (56.7)	42 (60.0)
Female	52 (40.0)	11 (36.7)	13 (43.3)	28 (40.0)
Age (years)	56 (48-65)	54 (45-63)	55 (46-64)	58 (50-66)	2.135	0.344
ECOG performance status					1.852	0.396
0	89 (68.5)	23 (76.7)	21 (70.0)	45 (64.3)
1	41 (31.5)	7 (23.3)	9 (30.0)	25 (35.7)
Distance from tumor to anal verge					2.018	0.365
≤ 5 cm	53 (40.8)	11 (36.7)	10 (33.3)	32 (45.7)
> 5 cm	77 (59.2)	19 (63.3)	20 (66.7)	38 (54.3)
Maximum tumor diameter (cm)	4.5 (3.2-5.8)	3.8 (2.9-5.1)	4.2 (3.1-5.5)	4.9 (3.5-6.2)	6.842	0.033
Preoperative imaging T stage					10.258	0.006
T3	82 (63.1)	25 (83.3)	22 (73.3)	35 (50.0)
T4	48 (36.9)	5 (16.7)	8 (26.7)	35 (50.0)
Preoperative imaging N stage					12.369	0.002
N0	35 (26.9)	12 (40.0)	10 (33.3)	13 (18.6)
N1	58 (44.6)	15 (50.0)	16 (53.3)	27 (38.6)
N2	37 (28.5)	3 (10.0)	4 (13.4)	30 (42.8)
Hypertension	32 (24.6)	6 (20.0)	7 (23.3)	19 (27.1)	0.658	0.720
Diabetes mellitus	21 (16.2)	4 (13.3)	5 (16.7)	12 (17.1)	0.285	0.867
Treatment regimen					8.925	0.011
Immunotherapy monotherapy	53 (40.8)	8 (26.7)	10 (33.3)	35 (50.0)
Combination immunotherapy	77 (59.2)	22 (73.3)	20 (66.7)	35 (50.0)

ECOG: Eastern Cooperative Oncology Group; pCR: Pathological complete response; MPR: Major pathological response.

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Table 2 Comparison of pathological response rates among different treatment regimens, n (%)

Treatment regimen	Number of patients	pCR (TRG 0)	MPR (TRG 1)	Non-MPR (TRGs 2 and 3)	Overall pathological response rate (TRGs 0 and 1)	χ²	P value
Immunotherapy monotherapy	53	6 (11.3)	11 (20.8)	36 (67.9)	17 (32.1)	10.362	< 0.001
Combination immunotherapy	77	24 (31.2)	20 (25.9)	33 (42.9)	44 (57.1)
Total	130	30 (23.1)	31 (23.8)	69 (53.1)	61 (46.9)

pCR: Pathological complete response; TRG: Tumor regression grade; MPR: Major pathological response.

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Table 3 Comparison of survival outcomes between patients with pathological remission, n (%)

Response	Number of patients	Recurrence or metastasis	Deaths	1-year DFS (%)	1-year OS (%)	Log-rank χ² (DFS)	P value (DFS)	Log-rank χ² (OS)	P value (OS)
pCR group (TRG 0)	30	1 (3.3)	0 (0.0)	96.7	100.0	28.652	< 0.001	25.321	< 0.001
MPR group (TRG 1)	30	4 (13.3)	2 (6.7)	88.3	95.0
Non-MPR group (TRGs 2 and 3)	70	14 (20.0)	8 (11.4)	65.0	77.5
Total	130	19 (14.6)	10 (7.7)	85.4	92.3

pCR: Pathological complete response; TRG: Tumor regression grade; MPR: Major pathological response; DFS: Disease-free survival; OS: Overall survival.

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Table 4 Univariate analysis of factors affecting long-term survival in locally advanced rectal cancer patients

Variable	Coding	DFS (HR, 95%CI)	P value (DFS)	OS (HR, 95%CI)	P value (OS)
Sex	Male = 1, female = 0	1.025 (0.562-1.868)	0.941	1.125 (0.521-2.428)	0.765
Age (years)	≥ 60 = 1, < 60 = 0	1.258 (0.682-2.325)	0.458	1.321 (0.625-2.798)	0.468
ECOG performance status	1 = 1, 0 = 0	1.365 (0.752-2.478)	0.305	1.425 (0.712-2.852)	0.321
Tumor location	≤ 5 cm = 1, > 5 cm = 0	1.182 (0.652-2.145)	0.585	1.258 (0.652-2.425)	0.501
Maximum tumor diameter (cm)	> 4.5 = 1, ≤ 4.5 = 0	2.352 (1.201-4.598)	0.012	1.895 (0.952-3.772)	0.068
Preoperative imaging T stage	T4 = 1, T3 = 0	2.563 (1.382-4.751)	0.003	2.418 (1.215-4.812)	0.012
Preoperative imaging N stage	N2 = 1, N0-1 = 0	3.125 (1.682-5.798)	< 0.001	3.521 (1.852-6.698)	< 0.001
Hypertension	Yes = 1, No = 0	1.082 (0.582-2.015)	0.812	1.152 (0.568-2.335)	0.698
Diabetes mellitus	Yes = 1, No = 0	1.215 (0.625-2.368)	0.568	1.325 (0.632-2.778)	0.465
Treatment regimen	Immunotherapy monotherapy = 1, combination immunotherapy = 0	2.018 (1.082-3.765)	0.028	1.985 (1.012-3.895)	0.046
Pathological response	Non-MPR = 1, MPR/pCR = 0	4.256 (2.382-7.615)	< 0.001	4.892 (2.582-9.275)	< 0.001

ECOG: Eastern Cooperative Oncology Group; MPR: Major pathological response; pCR: Pathological complete response; DFS: Disease-free survival; HR: Hazard ratio; CI: Confidence interval; OS: Overall survival.

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Table 5 Multivariate analysis of factors affecting long-term survival in patients with locally advanced rectal cancer

Variable	Coding	DFS (HR, 95%CI)	P value (DFS)	OS (HR, 95%CI)	P value (OS)
Maximum tumor diameter (cm)	> 4.5 = 1, ≤ 4.5 = 0	1.521 (0.802-2.885)	0.198	1.485 (0.752-2.932)	0.256
Preoperative imaging T stage	T4 = 1, T3 = 0	2.157 (1.203-3.876)	0.009	1.892 (0.985-3.635)	0.056
Preoperative imaging N stage	N2 = 1, N0-1 = 0	2.841 (1.562-5.167)	0.001	3.012 (1.583-5.731)	0.001
Treatment regimen	Immunotherapy monotherapy = 1, combination immunotherapy = 0	1.452 (0.782-2.695)	0.235	1.385 (0.721-2.662)	0.321
Pathological response	Non-MPR = 1, MPR/pCR = 0	0.324 (0.186-0.564)	< 0.001	0.289 (0.145-0.576)	< 0.001

MPR: Major pathological response; pCR: Pathological complete response; DFS: Disease-free survival; HR: Hazard ratio; CI: Confidence interval; OS: Overall survival.

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Table 6 Safety analysis table, n (%)

Type of adverse event	Grade 1	Grade 2	Grade 3	Grade 4	Overall incidence
Skin disorders	18 (13.8)	13 (10.0)	3 (2.3)	0 (0.0)	34 (26.2)
Gastrointestinal disorders	15 (11.5)	9 (6.9)	2 (1.5)	0 (0.0)	26 (20.0)
Endocrine disorders	12 (9.2)	8 (6.2)	2 (1.5)	0 (0.0)	22 (16.9)
Respiratory disorders	5 (3.8)	3 (2.3)	0 (0.0)	1 (0.8)	9 (6.9)
Hepatic function impairment	4 (3.1)	2 (1.5)	0 (0.0)	2 (1.5)	8 (6.2)
Fatigue	10 (7.7)	5 (3.8)	0 (0.0)	0 (0.0)	15 (11.5)
Other	6 (4.6)	3 (2.3)	0 (0.0)	0 (0.0)	9 (6.9)
Total	70 (53.8)	50 (38.5)	7 (5.4)	3 (2.3)	130 (100.0)

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Citation: 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
URL: https://www.wjgnet.com/1948-9366/full/v18/i10/121168.htm
DOI: https://dx.doi.org/10.4240/wjgs.121168

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]

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