This study identifies how combining perineural invasion and lymph node ratio can improve survival predictions in stage III rectal cancer.

• Perineural invasion-positive patients have significantly lower 3-year (74.7% vs 86.7%) and 5-year survival (61.7% vs 76.0%) compared to negative patients.
• The integrated nomogram shows high accuracy (AUC 0.764-0.839) for cancer-specific survival, enhancing patient stratification.

Use this nomogram for personalized treatment decisions in your surgical practice.

• Strong prognostic impact of perineural invasion found particularly in lymph node ratio ≤0.5 subgroups.