An observational study in Rectal Neoplasms, sponsored by Fujian Medical University Union Hospital. Recruiting at 1 site in China. Per ClinicalTrials.gov, last updated 2026-11-06.
Sponsored by Fujian Medical University Union Hospital · Observational
This prospective observational study characterises the tumour immune microenvironment and microbial ecology of locally advanced rectal cancer before and during neoadjuvant therapy. Tumour tissue and peripheral blood are profiled by whole-genome sequencing, single-cell RNA sequencing with paired T-cell and B-cell receptor repertoire sequencing, spatial transcriptomics of formalin-fixed paraffin-embedded sections, multiplex immunofluorescence, and blood-based proteomic, cytokine and bulk T-cell receptor analyses. The study examines how immune and stromal states change during treatment and how they relate to major pathological response.
Locally advanced rectal cancer is increasingly treated with total neoadjuvant therapy combining short-course radiotherapy, chemotherapy and programmed cell death protein 1 (PD-1) blockade, but the effect of treatment sequence on the tumour microenvironment is unresolved, and few patients have been profiled with matched pre- and on-treatment single-cell data. In this observational study, we collect tumour tissue and peripheral blood from patients with locally advanced rectal cancer at baseline, before any neoadjuvant treatment, and again after completion of short-course hypofractionated radiotherapy (5 Gy in 5 fractions) followed by one cycle of chemo-immunotherapy, together with archival formalin-fixed paraffin-embedded tissue where available. Additional formalin-fixed paraffin-embedded specimens from treatment-naive patients undergoing primary surgery, and from end-of-treatment biopsies, are used as controls for the spatial analyses. Fresh tumour tissue is analysed by whole-genome sequencing and by single-cell RNA sequencing with paired T-cell and B-cell receptor repertoire sequencing. Formalin-fixed paraffin-embedded tissue is analysed by spatial transcriptomics and multiplex immunofluorescence. Peripheral blood mononuclear cells are analysed by bulk T-cell receptor repertoire sequencing, and plasma or serum by proteomic and cytokine profiling where material permits. The principal clinical endpoint is major pathological response (mPR) at resection. We examine changes in immune and stromal populations between baseline and the on-treatment time point, features of the immune microenvironment associated with mPR, and, as exploratory analyses, the tumour microbial ecology associated with response together with differences between neoadjuvant treatment sequences. Analyses are descriptive and hypothesis-generating; no intervention, treatment assignment or change in clinical care is involved. The study was approved by the Ethics Committee of Fujian Medical University Union Hospital (2024KY297, approved 30 December 2024; and 2024KJCX060, approved 18 September 2024); archival specimens are used under a waiver of additional informed consent, and fresh biopsy or surgical tissue and blood are collected with written informed consent.
2,400 studies on the registry are indexed under Rectal Neoplasms; 587 are open to participants now.
This study's planned enrollment of 100 is below the median of 161 across 498 observational studies indexed under Rectal Neoplasms.
Browse Rectal Neoplasms studies →Fujian Medical University Union Hospital is the lead sponsor of 109 studies on the registry; 79 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Patients with locally advanced rectal adenocarcinoma treated at Fujian Medical University Union Hospital, China, from whom tumour tissue and peripheral blood were collected before and during neoadjuvant therapy.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.
Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.
The diagnosis was confirmed by looking at a sample under a microscope: tissue from a biopsy or surgery (histology), or cells from a fluid or needle sample (cytology).
Your pathology report is the document that shows this.
Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.
Neoadjuvant treatment is given before the main treatment (usually surgery), often to shrink a tumour. Adjuvant treatment is given after it, to lower the chance of the cancer coming back.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.
Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.
Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.
Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.
ECOG performance status
A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.
Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Histologically or cytologically confirmed
The diagnosis was confirmed by looking at a sample under a microscope: tissue from a biopsy or surgery (histology), or cells from a fluid or needle sample (cytology).
Your pathology report is the document that shows this.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Metastases
Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Adjuvant and neoadjuvant
Neoadjuvant treatment is given before the main treatment (usually surgery), often to shrink a tumour. Adjuvant treatment is given after it, to lower the chance of the cancer coming back.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Biopsy and archival tissue
A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.
Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Cancer (malignancy)
Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.
Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Patients whose resection specimen showed a pathological complete response (ypT0N0) or who achieved a sustained clinical complete response, from whom pre-treatment and on-treatment tissue and blood were profiled.
Patients with residual viable tumour at resection or without a sustained clinical complete response, from whom pre-treatment and on-treatment tissue and blood were profiled.
Change in immune and stromal cell composition in tumour tissue during neoadjuvant therapy
Cell-type composition and transcriptional states of T, natural killer (NK), B and myeloid populations and of stromal subsets before treatment and during neoadjuvant therapy, determined by single-cell RNA sequencing.
Time frame: Baseline (before treatment) and week 4 after treatment initiation
Major pathological response (mPR) and its association with immune microenvironment features
Proportion of patients achieving major pathological response, defined as 10% or less residual viable tumour at resection, and the association of pre-treatment and on-treatment immune microenvironment features with mPR.
Time frame: Through study completion, an average of 4 years
Transcriptional states of immune populations before and during treatment
Exhaustion, activation and memory programmes of T and NK cells and B-cell states, determined by single-cell RNA sequencing with paired T-cell and B-cell receptor repertoire sequencing.
Time frame: Baseline (before treatment) and week 4 after treatment initiation
Spatial organisation of tumour and immune compartments before and during treatment
Spatial distribution of tumour, immune and stromal compartments determined by spatial transcriptomics of formalin-fixed paraffin-embedded sections and multiplex immunofluorescence, compared with specimens from treatment-naive patients undergoing primary surgery and from end-of-treatment biopsies as controls.
Time frame: Baseline (before treatment) and week 4 after treatment initiation
Comparison of microenvironment remodelling between neoadjuvant treatment sequences
Between-group comparison of the change in tumour microenvironment composition between baseline and week 4, expressed as the percentage of cluster of differentiation 8 (CD8)-positive T cells, NK cells, B cells and plasma cells among all cells measured by single-cell RNA sequencing, in patients receiving radiotherapy before versus after chemo-immunotherapy.
Time frame: Through study completion, an average of 4 years
Somatic genomic alterations associated with response to neoadjuvant therapy
Somatic mutations, copy-number alterations and mutational signatures determined by whole-genome sequencing of tumour tissue before and during neoadjuvant therapy.
Time frame: Baseline (before treatment) and week 4 after treatment initiation
Clonal diversity of the peripheral blood T-cell receptor repertoire
Diversity and distribution of T-cell receptor clonotypes in peripheral blood mononuclear cells, expressed as the Shannon diversity index and the proportion of expanded clonotypes, measured by bulk T-cell receptor repertoire sequencing.
Time frame: Baseline (before treatment) and week 4 after treatment initiation
Correlation of tumour microbial composition with major pathological response
Correlation between the relative abundance of tumour-associated bacterial taxa, expressed as the percentage of sequencing reads assigned to each taxon measured by small-subunit ribosomal RNA gene sequencing or shotgun metagenomic sequencing of tumour tissue, and major pathological response, expressed as the percentage of patients with 10% or less residual viable tumour at resection (exploratory).
Time frame: Baseline (before treatment) and week 4 after treatment initiation
Plasma protein and cytokine concentrations before and during neoadjuvant therapy
Concentrations of plasma or serum proteins and cytokines, expressed in pg/mL, measured by multiplex proteomic and cytokine assays.
Time frame: Baseline (before treatment) and week 4 after treatment initiation
Plan to share: No — Individual participant data, including clinical records and sample-level identifiers, will not be shared. De-identified single-cell, bulk RNA sequencing and spatial transcriptomic data will be deposited in the Genome Sequence Archive for Human (GSA-Human), National Genomics Data Center, China, and will be made available for research use through the repository according to its access policy after publication.
No publications or documents are linked to this record.
Started Jan 2025 (actual). Primary completion is estimated for Dec 2028, 47 months after the start.
Of 213 non-industry observational studies under Rectal Neoplasms, half reached primary completion within 47 months of starting (the median), counting those still running; a quarter within 24 and three quarters within 116. This study's planned 47 months is close to that.
Counting every sponsor, half of 228 studies reached it within 45 months; a quarter within 24 and three quarters within 116.
How these figures are worked out, and which studies are left out of them.
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
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Fujian Medical University Union Hospital →