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Although surgical resection is the standard therapy for stage II/III colorectal cancer, recurrence rates exceed 30%. Circulating tumor DNA (ctNDA) detects molecular residual disease (MRD), but lacks spatial and tumor microenvironment information. Here, we develop a deep learning (DL) model to predict disease-free survival from hematoxylin & eosin stained whole slide images in stage II-IV colorectal cancer. The model is trained on the DACHS cohort (n = 1766) and validated on the GALAXY cohort (n = 1404). In GALAXY, the DL model categorizes 304 patients as DL high-risk and 1100 as low-risk (HR 2.31; p 

Original publication

DOI

10.1038/s41467-025-62910-8

Type

Journal article

Journal

Nature communications

Publication Date

08/2025

Volume

16

Addresses

Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany.

Keywords

Humans, Colorectal Neoplasms, Neoplasm Recurrence, Local, Neoplasm, Residual, Neoplasm Staging, Prognosis, Disease-Free Survival, Chemotherapy, Adjuvant, Risk Assessment, Adult, Aged, Middle Aged, Female, Male, Tumor Microenvironment, Biomarkers, Tumor, Circulating Tumor DNA, Deep Learning