Analyse The Relationship Between Neoadjuvant Therapy And Curative Effect For Rectal Carcinoma

Objective : To investigate the correlation between neoadjuvant therapy and tumor regression grades(TRG)in rectal cancer patients.The factors related to the efficacy of neoadjuvant therapy include leukocyte,neutrophils,lymphocyte,platelet,neutrophil lymphocyte ratio(NLR),platelet lymphocyte ratio(PLR),and carcinoembryonic antigen(CEA),CA199 and clinical pathological features.Methods: 167 patients with locally advanced and preoperative radiotherapy were treated in the Department of colorectal surgery and radiotherapy in the Cancer Hospital of Liaoning Province during the period between January 2014 and December 2017.Preoperative tumor condition,treatment plan and postoperative pathological condition were recorded.The patients were divided into group TRG1-2 and group TRG3-5(group TRG1-2 was a large number of tumor tissue retraction group,and TRG3-5 group was part or no tumor tissue withdrawal group)by the postoperative tumor specimens were evaluated accurately according to the TRG(Mandard score standard).The indexes of leukocyte,platelet,neutrophils,lymphocytes,platelets,CEA and CA199 were recorded before and after neoadjuvant therapy.Analyze the relationship between hematological parameters,postoperative pathological features and the curative effect of rectal cancer before and after neoadjuvant therapy.The statistical analysis was carried out by SPSS22.0 software.The Mann-Whitney U test was used between the measurement data groups.The chi square test or the Fisher exact probability method were used for comparison between the enumeration data groups.Cox proportional hazards model was used for univariate and multivariate analysis,and p<0.05 was statistically significant.Results:1.Analyze the general information of the patient,divided into TRG1-2 group and TRG3-5 group,compared with gender,age,tumor from the anal margin distance,radiation pattern,synchronous radiotherapy and chemotherapy and therapy cycle,new adjuvant chemotherapy and therapy cycle,postoperative adjuvant chemotherapy,operation type influence factors TRG staging after operation,the results showed that only preoperative neoadjuvant therapy for concurrent chemoradiotherapy compared with other schemes,tumor regression and pathological response significantly,with statistical difference(p=0.007),other indicators of the two groups were not statistically significant.2.The leukocytes,neutrophils,lymphocytes,platelets,NLR,PLR and CA199 in group TRG1-2 and group TRG3-5 were not significantly different before and after the treatment.There was no significant difference in leucocyte change rate,neutrophils change rate,lymphocyte change rate,platelet change rate and CA199 change rate after neoadjuvant therapy.But there is a significant correlation between CEA change and TRG grouping(p=0.017).The lower CEA change rate,the better therapy efficiency of neoadjuvant therapy.3.According to the postoperative pathological data,compare tumor size,T stage,lymph node metastasis,Circumferential degree,combined with vascular invasion and neural invasion effect of TRG grade after operation between two groups,the results showed that the two groups are associated with Tumor size(p=0.005),T stage(p<0.001),and lymph node metastasis(p<0.001),and has a statistically significant difference..4.The results of single factor analysis showed that CEA change rate(p=0.018,OR=2.298),synchronous radiotherapy and chemotherapy(p=0.01,OR=3.429),tumor size(p=0.006,OR=2.475),T staging(p<0.001,OR=3.376),and lymph node metastasis(p<0.001,OR=4.025)were related to the TRG group.5.Multiple factor Logistic regression analysis showed that the CEA change rate(p=0.027,OR=2.272),tumor size(p=0.038,OR=0.446),T staging(p=0.003,OR=2.989)and lymph node metastasis(p=0.006,OR=3.423)were independent risk factors for the therapeutic effect of neoadjuvant therapy.Conclusions: CEA,NLR and PLR can be used to predict the sensitivity of chemoradiotherapy.Neoadjuvant chemoradiotherapy of rectal cancer can make tumor regression more obvious and lower TRG grade after operation,so as to further improve the therapeutic effect.Lymph node metastasis,tumor size over 3cm and high T stage were independent risk factors for tumor chemoradiation and tumor regression.