准确评估术前局部晚期直肠癌（LARC）患者的复发风险对于制定治疗策略至关重要。本研究旨在开发基于核磁共振成像的评分系统，以预测LARC患者的复发风险。这是一项多中心观察性研究，招募了接受新辅助化疗放疗的参与者。为了评估这些患者的复发风险，我们开发了mrDEC评分系统，并评估了读者间的一致性。此外，我们绘制了Kaplan-Meier曲线，比较了具有不同mrDEC评分的患者的3年无病生存（DFS）率和5年总生存（OS）率。 本研究纳入了1287例LARC患者。我们观察到mrDEC的读者间一致性较高。根据0至3的mrDEC评分将患者分为四组。这些组的3年DFS率分别为91.0％、79.5％、65.5％和44.0％（P＜0.0001），而5年OS率分别为92.9％、87.1％、74.8％和44.5％（P＜0.0001）。 mrDEC评分系统被证明是预测LARC患者预后的有效工具，可以帮助临床医生进行临床决策。 © 2023. 作者或作者授权Springer Nature Limited将独家许可。

Accurately assessing the risk of recurrence in patients with locally advanced rectal cancer (LARC) before treatment is important for the development of treatment strategies. The purpose of this study is to develop an MRI-based scoring system to predict the risk of recurrence in patients with LARC.This was a multicenter observational study that enrolled participants who underwent neoadjuvant chemoradiotherapy. To evaluate the risk of recurrence in these patients, we developed the mrDEC scoring system and assessed inter-reader agreement. Additionally, we plotted Kaplan-Meier curves to compare the 3-year disease-free survival (DFS) and 5-year overall survival (OS) rates among patients with different mrDEC scores.A total of 1287 patients with LARC were included in this study. We observed substantial inter-reader agreement for mrDEC. Based on the mrDEC scores ranging from 0 to 3, the patients were categorized into four groups. The 3-year DFS rates for the groups were 91.0%, 79.5%, 65.5%, and 44.0% (P < 0.0001), respectively, and the 5-year OS rates were 92.9%, 87.1%, 74.8%, and 44.5%, respectively (P < 0.0001).The mrDEC scoring system proved to be an effective tool for predicting the prognosis of patients with LARC and can assist clinicians in clinical decision-making.© 2023. The Author(s), under exclusive licence to Springer Nature Limited.