{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:07:47Z","timestamp":1760058467492,"version":"build-2065373602"},"reference-count":49,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009945","name":"Merck KGaA","doi-asserted-by":"publisher","award":["10.13039\/100009945"],"award-info":[{"award-number":["10.13039\/100009945"]}],"id":[{"id":"10.13039\/100009945","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Predictive tools are needed to assess the response to treatment and guide treatment decisions for locally advanced rectal cancer (LARC). This study explores the value of combining the immunoscore (IS) and magnetic resonance imaging tumor regression grade (mrTRG) with pathologic and radiologic neoadjuvant rectal (NAR) scores in predicting pathologic complete response (pCRs). Methods: The scores were assessed for patients with LARC enrolled in the Averectal study (NCT03503630), who received five fractions of short-course radiotherapy, followed by six cycles of mFOLFOX-6 plus avelumab, and total mesorectal excision. The IS was calculated using the mean density percentiles of CD3- and CD8-positive T-cells on baseline biopsy samples. Baseline and post-treatment MRIs were reviewed to measure the mrTRG. NAR scores were calculated using the pre-treatment T stage and post-treatment pathologic and radiologic N and T stages. Results: Fifteen out of thirty-five patients whose data were available achieved pCR (42.8%), and seven out of fourteen patients with mrTRG = 1 (complete response) attained pCR. In patients with both a mrTRG = 1 and high IS, the pCR rate was 66.7% (6\/9). All of the patients who achieved pCR had a low or intermediate pathologic NAR score with a significant correlation between pCR and pathologic NAR scores (p &lt; 0.0001). Both pathologic and radiologic NAR scores were correlated with overall survival and disease-free survival. Conclusions: The IS can supplement the mrTRG to better predict TNT outcomes, along with the use of the NAR score. This combination could potentially help with patient selection for non-operative management and guide treatment strategies for those with different recurrence risks.<\/jats:p>","DOI":"10.3390\/diagnostics15070913","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T16:26:31Z","timestamp":1743611191000},"page":"913","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of Immunoscore, MRI Tumor Regression Grade, and Neoadjuvant Rectal Score in Predicting Pathologic Response in Locally Advanced Rectal Cancer in the Averectal Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1976-8370","authenticated-orcid":false,"given":"Mustafa","family":"Natout","sequence":"first","affiliation":[{"name":"Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5325-7016","authenticated-orcid":false,"given":"Ahmad","family":"Machmouchi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology\/Oncology, Naef K. Basile Cancer Institute\u2014NKBCI, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hero","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Abdominal Radiology, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5333-7841","authenticated-orcid":false,"given":"Laudy","family":"Chehade","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology\/Oncology, Naef K. Basile Cancer Institute\u2014NKBCI, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2894-4524","authenticated-orcid":false,"given":"Noura","family":"Abbas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology\/Oncology, Naef K. Basile Cancer Institute\u2014NKBCI, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0962-3912","authenticated-orcid":false,"given":"Rim","family":"Turfa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology\/Oncology, King Hussein Cancer Center, Amman 11941, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Kattan","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Hotel-Dieu de France University Hospital, Beirut 166830, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8995-7946","authenticated-orcid":false,"given":"Sally","family":"Temraz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology\/Oncology, Naef K. Basile Cancer Institute\u2014NKBCI, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayman","family":"Tawil","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mousa","family":"Elkhaldi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Jaber","sequence":"additional","affiliation":[{"name":"Department of Pathology, King Hussein Cancer Center, Amman 11941, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rula","family":"Amarin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology\/Oncology, King Hussein Cancer Center, Amman 11941, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5043-7428","authenticated-orcid":false,"given":"Tala","family":"Alawabdeh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology\/Oncology, King Hussein Cancer Center, Amman 11941, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maya","family":"Charafeddine","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology\/Oncology, Naef K. Basile Cancer Institute\u2014NKBCI, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monita","family":"Al Darazi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology\/Oncology, Naef K. Basile Cancer Institute\u2014NKBCI, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3725-8403","authenticated-orcid":false,"given":"Ali","family":"Shamseddine","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology\/Oncology, Naef K. Basile Cancer Institute\u2014NKBCI, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21708","article-title":"Cancer statistics, 2022","volume":"72","author":"Siegel","year":"2022","journal-title":"CA A Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1148\/rg.2019180114","article-title":"MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management","volume":"39","author":"Horvat","year":"2019","journal-title":"RadioGraphics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.suc.2017.01.008","article-title":"New Strategies in Rectal Cancer","volume":"97","author":"Vailati","year":"2017","journal-title":"Surg. Clin. N. 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