A new predictive model enhances risk stratification in rectal adenocarcinoma, shifting from subjective MRI assessments to objective measures.

• Dynamic contrast-enhanced MRI washout and preoperative CEA levels independently predict 3-year disease-free survival.
• The model outperformed standard MRI assessments, showing AUCs of 0.757-0.819 versus 0.600-0.672.

Identifying high-risk patients early means tailored treatments and potentially better outcomes.

• T/N staging mediates some effects of CEA (17.7%) and washout (51.1%) on survival rates.