{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T21:08:33Z","timestamp":1789420113087,"version":"build-2803163510"},"reference-count":47,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Preoperative chemoradiotherapy (CRT) is administered for locally advanced rectal cancer (LARC); however, its efficacy and toxicity vary among patients. This study aimed to elucidate the relationship between the gut microbiota and the effectiveness and adverse events of CRT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective study included 21 patients with LARC with no history of antibiotic or probiotic administration for 6\u2009months. Tumour mucosa, non\u2010tumour mucosa and faecal samples were collected before and after CRT, and bacterial DNA was extracted. Metataxonomic analysis targeting the V3 and V4 regions of the 16S rRNA gene was conducted to determine the diversity and composition of the microbiota. Linear discriminant analysis effect size (LEfSe) was used to explore potential bacterial taxa predicting pathological complete response (pCR) and treatment\u2010associated diarrhoea, which are major adverse events of CRT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 21 patients, five achieved <jats:styled-content style=\"fixed-case\">pCR<\/jats:styled-content> and seven experienced severe treatment\u2010associated diarrhoea. There were no significant differences in \u03b1\u2010diversity and \u03b2\u2010diversity of the microbiota between the groups at any sampling sites before or after <jats:styled-content style=\"fixed-case\">CRT<\/jats:styled-content>. Exploratory analysis using <jats:styled-content style=\"fixed-case\">LEfSe<\/jats:styled-content> identified <jats:italic>Peptostreptococcus<\/jats:italic>, <jats:italic>Coprococcus<\/jats:italic> and <jats:italic>Phoceaicola<\/jats:italic> in the tumour mucosa before <jats:styled-content style=\"fixed-case\">CRT<\/jats:styled-content> as significant indicators for achieving <jats:styled-content style=\"fixed-case\">pCR<\/jats:styled-content>. Additionally, <jats:italic>Collinsella<\/jats:italic>, <jats:italic>Haemophilus<\/jats:italic> and <jats:italic>Desulfovibrionaceae<\/jats:italic> are associated with treatment\u2010associated diarrhoea. Microbiome composition changed before and after <jats:styled-content style=\"fixed-case\">CRT<\/jats:styled-content>, with a notable decrease in the genus <jats:italic>Fusobacterium_C<\/jats:italic> and other taxa. \u03b2\u2010diversity in the tumour area also changed significantly (<jats:italic>P<\/jats:italic>\u2009=\u20090.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study suggests an association between the gut microbiota, the therapeutic effectiveness of CRT and the occurrence of treatment\u2010associated diarrhoea in rectal cancer. 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