Patients with cT4 tumors show significantly lower chances of achieving a complete clinical response (cCR) compared to those with cT3.

• Overall cCR rate was 32.8%: 38% for cT3, 23% for cT4 (p = 0.09).
• cT4 disease reduced odds of cCR by 69% (odds ratio 0.31; 95% CI 0.11-0.88).

Surgeons should consider tumor stage when counseling patients on nonoperative management options post-TNT.

• Regrowth rates were similar: 27% for cT3 vs. 17% for cT4 (p = 0.75), with 86.8% of cCR patients opting for organ preservation.