A new prognostic model combines tumor regression grading and yptnm staging to better predict outcomes in locally advanced rectal cancer after neoadjuvant therapy.

• The novel trg-yptnm model outperformed the traditional yptnm system in both training (1,046 patients) and validation (354 patients) cohorts.
• Trg and yptnm are independent prognostic factors, enhancing risk stratification for surgical candidates.

This model can guide surgical decision-making by better identifying patients at higher risk for poor outcomes.

• Calibration and decision curve analysis confirmed its clinical utility.