Changes Of Blood Lipids And Predictive Analysis Of PCR After Neoadjuvant Radiotherapy And Chemotherapy In Stage Ⅲ Rectal Cancer

Objective: To investigate the changes of blood lipids in patients with rectal cancer who is clinical stage Ⅲafter after neoadjuvant chemradiotherapy and its value in predicting pCR.Methods: The clinical stage Ⅲrectal cancer patients who received neoadjuvant chemradiotherapy in the our hospital from July 2017 to May 2019 were analyzed retrospectively.The levels of total cholesterol,triglyceride,high density lipoprotein and low density lipoprotein before and after treatment were reviewed,and the changes between them were compared.According to the postoperative pathological results,the patients were divided into pCR group and non-pCR group.The relevant clinical indexes before treatment were reviewed and the predictive factors related to pCR were analyzed.Chi-square test was used to compare the general data between the two groups and the level of blood lipids before and after neoadjuvant therapy.For the changes of blood lipids before and after the patients,paired t-test was used to match the normal distribution,and paired Wilcoxon test was used to disaccord with the normal distribution.For the comparison of the blood lipid levels of the patients divided into pCR group and npCR group,the data consistent with normal distribution were tested by t-test,and those that did not accord with normal distribution were tested by Mann-Whitney U test.Multivariate analysis using Logistic multivariate regression analysis,p<0.05 has statistical significance.Results: 1.A total of 328 patients were included in the study.Postoperative pathology showed that complete pathological remission was achieved in 86 cases(26.22%).two.2.After neoadjuvant chemoradiotherapy,the levels of total cholesterol,triglyceride,high density lipoprotein and low density lipoprotein were significantly higher than those before treatment(All p <0.001).Comparing the complete pathological remission group with the incomplete pathological remission group,the level of high density lipoprotein in the complete pathological remission group was higher before and after treatment(All p <0.001).3.In univariate analysis,gender,clinical stage before neoadjuvant therapy,chemotherapy regimen,periphery ratio of tumor occupying intestinal lumen,extramural vascular invasion suggested by MR before treatment(p <0.001),hyperuricemia and CEA level before neoadjuvant therapy were associated with pCR.4.The results of multivariate analysis showed that the circumferential ratio of tumor to intestinal lumen(p=0.011),MR suggested extramural vascular invasion before treatment(p<0.001)and high density lipoprotein level after treatment(p= 0.001)were statistically significant.Conclusion: After neoadjuvant chemoradiotherapy,the levels of blood lipids,including total cholesterol,triglyceride,high density lipoprotein and low density lipoprotein,increased to some extent in patients with locally advanced rectal cancer.For the patients who achieved pCR,higher levels of high density lipoprotein after treatment,tumor-to-intestinal circumferential ratio ≤ 1 / 2 and no extramural vascular invasion in MRI before treatment were all independent predictors of pCR.