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Dear Editor, We read Wang et al.'s work on pan-immune-inflammation value (PIV) in rectal cancer with great interest [1], yet several critical confounding and methodological gaps require clarification (Figure 1). The pan-immune-inflammation value (PIV) derived from four blood cell counts warrants cautious interpretation in rectal cancer immunotherapy, as CRT cannot be disentangled from anti-PD-1 effects within the small n = 16 subgroup.
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