{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:02:52Z","timestamp":1790143372999,"version":"4.0.1"},"reference-count":24,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003392","name":"Natural Science Foundation of Fujian Province","doi-asserted-by":"publisher","award":["2025J01791"],"award-info":[{"award-number":["2025J01791"]}],"id":[{"id":"10.13039\/501100003392","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003392","name":"Natural Science Foundation of Fujian Province","doi-asserted-by":"publisher","award":["2023J01099"],"award-info":[{"award-number":["2023J01099"]}],"id":[{"id":"10.13039\/501100003392","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017686","name":"Fujian Provincial Health Technology Project","doi-asserted-by":"publisher","award":["2025CXA010"],"award-info":[{"award-number":["2025CXA010"]}],"id":[{"id":"10.13039\/501100017686","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to perform a threshold analysis of residual tumour size (RTS) to identify the critical threshold influencing distant metastasis (DM), thereby enabling more precise risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicentre retrospective cohort study included patients with locally advanced rectal cancer who underwent radical surgery following neoadjuvant chemoradiotherapy (nCRT). Kaplan\u2013Meier survival curves were plotted and compared using the log\u2010rank test. Multivariable Cox proportional hazards models were used to identify independent prognostic factors. The threshold\u2010effect analysis was performed to determine the potential critical point of RTS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In this multi\u2010institutional study, threshold\u2010effect analysis identified a significant inflection point at 3\u2009cm for the association between RTS and DM risk. Below this threshold, each 1\u2010cm increase was associated with a markedly higher risk (HR\u2009=\u20091.70,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015), whereas no significant association was observed above 3\u2009cm (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.692). Patients with an RTS \u22653\u2009cm exhibited significantly poorer early (\u2264\u200924\u2009months) recurrence\u2010free survival (RFS) and disease\u2010free survival (DFS). After 24\u2009months, the pattern was reversed. RTS \u22653\u2009cm was an independent risk factor for both worse RFS (HR\u2009=\u20091.45,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033) and DM. Subgroup analyses confirmed the consistent negative prognostic impact of RTS \u22653\u2009cm across most strata.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study established an objective prognostic threshold for RTS following nCRT. This marks a shift in the understanding of this indicator\u2014from a static association between \u2018risk and size\u2019 to a dynamic association between \u2018risk and time\u2019.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.70563","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T04:01:25Z","timestamp":1787889685000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Threshold association analysis between residual tumour size and distant metastasis risk after neoadjuvant therapy for rectal cancer: A multicentre retrospective study"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8128-1049","authenticated-orcid":false,"given":"Hao","family":"Zeng","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery Fujian Medical University Union Hospital  Fujian Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5843-1004","authenticated-orcid":false,"given":"Xueyi","family":"Xue","sequence":"additional","affiliation":[{"name":"Longyan Digestive Diseases Research Center  Longyan Fujian Province China"},{"name":"Longyan Oncology Specialty Alliance  Longyan Fujian Province China"},{"name":"Department of Gastroenterology and Anorectal Surgery Longyan First Hospital, Fujian Medical University  Longyan Fujian Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongbo","family":"Chen","sequence":"additional","affiliation":[{"name":"Longyan Digestive Diseases Research Center  Longyan Fujian Province China"},{"name":"Longyan Oncology Specialty Alliance  Longyan Fujian Province China"},{"name":"Department of Gastroenterology and Anorectal Surgery Longyan First Hospital, Fujian Medical University  Longyan Fujian Province 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Key Laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated Hospital, Sun Yat\u2010sen University  Guangzhou Guangdong Province China"},{"name":"Biomedical Innovation Center The Sixth Affiliated Hospital, Sun Yat\u2010sen University  Guangzhou Guangdong Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenchang","family":"Gan","sequence":"additional","affiliation":[{"name":"Department of General Surgery Hernia and Abdominal Wall Surgery, The Sixth Affiliated Hospital, Sun Yat\u2010sen University  Guangzhou Guangdong Province China"},{"name":"Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated Hospital, Sun Yat\u2010sen University  Guangzhou Guangdong Province China"},{"name":"Biomedical Innovation Center The Sixth Affiliated Hospital, Sun Yat\u2010sen University  Guangzhou Guangdong Province 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