ArticleFrontiers in immunology2026
An albumin-based immune-nutritional score for predicting complete response, organ preservation, and toxicity after neoadjuvant PD-1-based therapy in low rectal cancer.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Programmed death-1 (PD-1) inhibitors are increasingly used in neoadjuvant therapy for low rectal cancer, but complete response and toxicity remain heterogeneous. We developed and validated an albumin-based immune-nutritional score (ABINS) to capture host factors not reflected by tumor biomarkers. Methods: This multicenter retrospective study included 480 consecutive patients with low rectal adenocarcinoma (≤5 cm from the anal verge) treated with neoadjuvant PD-1-based therapy at three tertiary centers from 2018 to 2023. Patients were assigned to a training cohort (n=276), internal validation cohort (n=87), and geographically separate external validation cohort (n=117). ABINS assigned one point each for albumin <35 g/L, lymphocyte count <1.0×10 Results: Among 480 patients, 166 (34.6%) achieved composite complete response, 280 (58.3%) achieved organ preservation, and 225 disease-free survival events occurred over a median follow-up of 32.4 months. ABINS classified 333 patients (69.4%) as favorable, 87 (18.1%) as intermediate, and 60 (12.5%) as poor. Complete response decreased stepwise across these groups (42.9%, 20.7%, and 8.3%; P<0.001), as did organ preservation (66.4%, 51.7%, and 23.3%; P<0.001), whereas grade ≥3 toxicity increased (7.5%, 19.5%, and 23.3%; P<0.001). After multivariable adjustment, each one-point ABINS increase independently predicted lower complete response (OR 0.51, 95% CI 0.41-0.65), higher grade ≥3 toxicity (OR 1.75, 95% CI 1.37-2.23), and worse disease-free survival (HR 1.42, 95% CI 1.27-1.60; all P<0.001). Adding ABINS improved external-cohort AUC from 0.703 to 0.772 and reduced Brier score from 0.190 to 0.161. Conclusions: ABINS is a simple, inexpensive host immune-nutritional score that improves risk stratification for complete response, organ preservation, toxicity, and survival after neoadjuvant PD-1-based therapy in low rectal cancer. Prospective validation is warranted.
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