BACKGROUND: This study aimed to develop and validate a nomogram that utilized macro- and microscopic tumor characteristics at baseline, including radiomics, pathomics, and biopsy-adapted immunoscore (IS MATERIALS AND METHODS: In total, 201 patients with LARC (91 months of median follow-up) were enrolled. Radiomics features were extracted from apparent diffusion coefficient maps and T2-weighted images. Pathomics features including global pattern (features of the entire image) and local pattern (features of the tumor nuclei) were extracted from whole-slide images of hematoxylin-eosin-stained biopsy specimens. IS RESULTS: Compared with patients with moderate and high IS CONCLUSIONS: The nomogram integrating macroscopic radiological information and microscopic pathological information is effective for risk stratification at baseline in LARC treated with nCRT.