{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T23:55:12Z","timestamp":1788998112987,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: The management of rectal cancer has evolved toward response-adapted strategies, including organ preservation in selected patients achieving a clinical complete response (cCR) after neoadjuvant treatment. However, most available evidence derives from clinical trials, and data from real-world clinical practice remain limited. Methods: We conducted a retrospective observational cohort study including consecutive patients with rectal adenocarcinoma treated at a tertiary referral center between January 2021 and December 2025. Baseline clinical, tumor-related, and treatment characteristics were collected. Tumor response was assessed using clinical, endoscopic, and radiological criteria. The primary endpoint was the rate of clinical complete response and the implementation of watch-and-wait strategies. Secondary endpoints included recurrence patterns and exploratory oncologic outcomes according to baseline tumor characteristics. Results: A total of 229 patients were identified, of whom 148 were evaluable for treatment response. Clinical complete response was documented in 56 patients (37.8%), and a watch-and-wait strategy was implemented in 42 patients (28.4%). Higher cCR rates were observed in patients with stage I\u2013II disease and in tumors measuring &lt; 4 cm on baseline magnetic resonance imaging, with cCR rates exceeding 55% in this subgroup. Tumors \u2265 4 cm showed substantially lower response rates. Clinical complete responses were observed across both short-course radiotherapy plus chemotherapy and long-course chemoradiotherapy regimens in patients with small tumors and early-stage disease. Tumor distance from the anal verge was not consistently associated with response. With a median follow-up of 26 months in the watch-and-wait group, five recurrences were observed, including three local recurrences. Conclusions: In this real-world cohort, baseline tumor size and clinical stage were the main determinants of clinical complete response and eligibility for organ-preservation strategies in rectal cancer. Small tumors (&lt;4 cm) showed high response rates regardless of neoadjuvant regimen. These findings support response-adapted, individualized treatment strategies and highlight the importance of tumor burden in selecting candidates for non-operative management in routine clinical practice.<\/jats:p>","DOI":"10.3390\/cancers18050763","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T10:41:02Z","timestamp":1772188862000},"page":"763","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Complete Response and Organ Preservation Strategies in Rectal Cancer: A Real-World Single-Center Experience Clinical Complete Response and Organ Preservation in Rectal Cancer"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1463-9326","authenticated-orcid":false,"given":"J. A.","family":"Encarnaci\u00f3n","sequence":"first","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"},{"name":"Department of Radiation Oncology, Virgen De La Arrixaca University Clinical Hospital, Carretera Madrid-Cartagena s\/n, 30120 Murcia, Spain"},{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB), Carretera Madrid-Cartagena s\/n, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8920-9606","authenticated-orcid":false,"given":"N.","family":"Ib\u00e1\u00f1ez","sequence":"additional","affiliation":[{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB), Carretera Madrid-Cartagena s\/n, 30120 Murcia, Spain"},{"name":"Department of General Surgery, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"De la Fuente","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"},{"name":"Department of Radiation Oncology, Virgen De La Arrixaca University Clinical Hospital, Carretera Madrid-Cartagena s\/n, 30120 Murcia, Spain"},{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB), Carretera Madrid-Cartagena s\/n, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1388-2706","authenticated-orcid":false,"given":"P.","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"},{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB), Carretera Madrid-Cartagena s\/n, 30120 Murcia, Spain"},{"name":"Department of Medical Oncology, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5806-4854","authenticated-orcid":false,"given":"B.","family":"Quiles","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Bautista","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. A.","family":"Nadal","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9366-8410","authenticated-orcid":false,"given":"M.","family":"Mar\u00edn","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"},{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB), Carretera Madrid-Cartagena s\/n, 30120 Murcia, Spain"},{"name":"Department of Medical Oncology, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Mar\u00edn-Zafra","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"},{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB), Carretera Madrid-Cartagena s\/n, 30120 Murcia, Spain"},{"name":"Department of Medical Oncology, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Guirao","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"},{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB), Carretera Madrid-Cartagena s\/n, 30120 Murcia, Spain"},{"name":"Department of Medical Oncology, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4883-8462","authenticated-orcid":false,"given":"Q.","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Abrisqueta","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Abell\u00e1n","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Montoya","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Carbonell","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnostic, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Frutos","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Department of Pathological Anatomy, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Manso","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2898-2312","authenticated-orcid":false,"given":"M.","family":"Royo-Villanova","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-2096","authenticated-orcid":false,"given":"J. L.","family":"Alonso-Romero","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, University of Murcia, 30100 Murcia, Spain"},{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB), Carretera Madrid-Cartagena s\/n, 30120 Murcia, Spain"},{"name":"Department of General Surgery, Virgen De La Arrixaca University Clinical Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"ref_1","first-page":"17","article-title":"Cancer statistics, 2023","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1002\/bjs.4034","article-title":"Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging","volume":"90","author":"Brown","year":"2003","journal-title":"Br. J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1038\/nrgastro.2014.41","article-title":"MRI for assessing and predicting response to neoadjuvant treatment in rectal cancer","volume":"11","author":"Beets","year":"2014","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1056\/NEJMoa040694","article-title":"Preoperative versus postoperative chemoradiotherapy for rectal cancer","volume":"351","author":"Sauer","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e403","DOI":"10.1016\/S1470-2045(12)70236-X","article-title":"Anterior resection syndrome","volume":"13","author":"Bryant","year":"2012","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/S1470-2045(21)00079-6","article-title":"Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): A multicentre, randomised, open-label, phase 3 trial","volume":"22","author":"Conroy","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S1470-2045(20)30555-6","article-title":"Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): A randomised, open-label, phase 3 trial","volume":"22","author":"Bahadoer","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3212","DOI":"10.1200\/JCO.19.00308","article-title":"Randomized Phase II Trial of Chemoradiotherapy Plus Induction or Consolidation Chemotherapy as Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: CAO\/ARO\/AIO-12","volume":"37","author":"Fokas","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1097\/01.sla.0000141194.27992.32","article-title":"Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: Long-term results","volume":"240","author":"Perez","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4633","DOI":"10.1200\/JCO.2011.37.7176","article-title":"Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer","volume":"29","author":"Maas","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1016\/S0140-6736(18)31078-X","article-title":"Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): An international multicentre registry study","volume":"391","author":"Hilling","year":"2018","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Smith, J.J., Chow, O.S., Gollub, M.J., Nash, G.M., Temple, L.K., Weiser, M.R., Guillem, J.G., Paty, P.B., Avila, K., and Garcia-Aguilar, J. (2015). Organ Preservation in Rectal Adenocarcinoma: A phase II randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management. BMC Cancer, 15.","DOI":"10.1186\/s12885-015-1632-z"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/S1470-2045(15)00467-2","article-title":"Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): A propensity-score matched cohort analysis","volume":"17","author":"Renehan","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"djw171","DOI":"10.1093\/jnci\/djw171","article-title":"Long-term Outcome of an Organ Preservation Program After Neoadjuvant Treatment for Rectal Cancer","volume":"108","author":"Martens","year":"2016","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.1200\/JCO.22.00032","article-title":"Organ Preservation in Patients with Rectal Adenocarcinoma Treated with Total Neoadjuvant Therapy","volume":"40","author":"Patil","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e107","DOI":"10.1016\/j.clon.2022.12.006","article-title":"STAR-TREC: An International Three-arm Multicentre, Partially Randomised Controlled Trial Incorporating an External Pilot","volume":"35","author":"Bach","year":"2023","journal-title":"Clin. Oncol. (R. Coll. Radiol.)"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1093\/annonc\/mdw062","article-title":"Long-course oxaliplatin-based preoperative chemoradiation versus 5 \u00d7 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: Results of a randomized phase III study","volume":"27","author":"Bujko","year":"2016","journal-title":"Ann. Oncol."},{"key":"ref_18","first-page":"382","article-title":"Short-Course Radiotherapy versus Long-Course Radio-Chemotherapy as Neoadjuvant Treatment for Locally Advanced Rectal Cancer: Meta-Analysis from a Toxicity Perspective","volume":"16","author":"Liscu","year":"2021","journal-title":"Maedica"},{"key":"ref_19","first-page":"9","article-title":"Organ preservation in rectal cancer\u2014Challenges and future strategies","volume":"3","author":"Gani","year":"2017","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_20","first-page":"iv22","article-title":"Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"28","author":"Wyrwicz","year":"2017","journal-title":"Ann Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2404","DOI":"10.1200\/JCO.2004.08.170","article-title":"Improved sphincter preservation in low rectal cancer with high-dose preoperative radiotherapy: The lyon R96-02 randomized trial","volume":"22","author":"Gerard","year":"2004","journal-title":"J. Clin. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e165","DOI":"10.1016\/j.ijrobp.2011.12.002","article-title":"Correlation in rectal cancer between clinical tumor response after neoadjuvant radiotherapy and sphincter or organ preservation: 10-year results of the Lyon R 96-02 randomized trial","volume":"83","author":"Ortholan","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/S2468-1253(22)00392-2","article-title":"Neoadjuvant chemoradiotherapy with radiation dose escalation with contact x-ray brachytherapy boost or external beam radiotherapy boost for organ preservation in early cT2-cT3 rectal adenocarcinoma (OPERA): A phase 3, randomised controlled trial","volume":"8","author":"Gerard","year":"2023","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.annonc.2024.10.827","article-title":"A phase III randomised trial on the addition of a contact X-ray brachytherapy boost to standard neoadjuvant chemo-radiotherapy for organ preservation in early rectal adenocarcinoma: 5 year results of the OPERA trial","volume":"36","author":"Baron","year":"2025","journal-title":"Ann. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.canrad.2021.04.006","article-title":"Contact X-ray brachytherapy for rectal cancer: Past, present, and future","volume":"25","author":"Barbet","year":"2021","journal-title":"Cancer Radiother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"109976","DOI":"10.1016\/j.ejso.2025.109976","article-title":"Contact X-ray brachytherapy in rectal cancer: A systematic review and meta-analysis","volume":"51","author":"Powell","year":"2025","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1016\/j.ijrobp.2020.06.013","article-title":"Efficacy of Dose-Escalated Chemoradiation on Complete Tumor Response in Patients with Locally Advanced Rectal Cancer (RECTAL-BOOST): A Phase 2 Randomized Controlled Trial","volume":"108","author":"Couwenberg","year":"2020","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_28","first-page":"101014","article-title":"Radiotherapy boost to the primary tumour in locally advanced rectal cancer: Systematic review of practices and meta-analysis","volume":"54","author":"Pierrard","year":"2025","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"103039","DOI":"10.1016\/j.ctrv.2025.103039","article-title":"Mismatch repair deficiency\/microsatellite instability (dMMR\/MSI-H) in rectal cancer patients treated with standard neoadjuvant therapy: A systematic review and meta-analysis","volume":"141","author":"Ricco","year":"2025","journal-title":"Cancer Treat. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1038\/s41591-022-01930-z","article-title":"Genomic and transcriptomic determinants of response to neoadjuvant therapy in rectal cancer","volume":"28","author":"Chatila","year":"2022","journal-title":"Nat. Med."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/5\/763\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T10:53:43Z","timestamp":1772189623000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/5\/763"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["cancers18050763"],"URL":"https:\/\/doi.org\/10.3390\/cancers18050763","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]}}}