A new predictive classifier and staging system for obstructive colorectal cancer (OCC) outperforms traditional methods in predicting patient outcomes.

• Patients in the integrative superior group had a median overall survival of 31.4 months versus 19.3 months for the inferior group (p < 0.001).
• The new system significantly improved prognosis discrimination compared to the TNM stage (p < 0.001).

Surgeons should consider integrating this new staging approach and the insights on lymphovascular invasion to better select and counsel patients for surgical interventions.

• An advanced classifier using CEA and radiomics features showed an AUC of 0.85 for predicting outcomes.