Analysis Of Clinical Predictors For Pathological Complete Remission Of Locally Advanced Middle And Low Rectal Cancer After Neoadjuvant Therapy

Objective:For patients with locally advanced rectal cancer after neoadjuvant therapy,there are certain differences in clinical effects.some patients can achieve pathological complete response after neoadjuvant therapy,while others cannot.If we can have an effective prediction method,treatment for rectal cancer more precise may have an important meaning.More precise treatment of rectal cancer may play an important role.For this reason,we explore the relevant factors that affect the pathological complete remission of patients with locally advanced middle and low rectal cancer after neoadjuvant treatment,and provide reference for later clinical application.Methods:A retrospective analysis of 109 patients with locally advanced mid-to-low rectal cancer who underwent neoadjuvant therapy and were admitted to the China-Japan Unionhospital of jilin University from January 2015 to December 2019.All patients completed preoperative neoadjuvant Radiotherapy and chemotherapy.Then they completed mesorectal resection after 6-10 weeks of neoadjuvant radiotherapy and chemotherapy.According to the postoperative pathologic results,it can be observed in 27 patients can reach the level of pathological remission completely,namely the p CR,the remaining 82 patients are incomplete pathological remission,namely state of Non – p CR.The prognosis of patients with complete pathological remission is usually better than that of patients with incomplete pathological remission.It also fully demonstrates that neoadjuvant radiotherapy and chemotherapy can play a better role in these patients.For this reason,we explore the clinical of patients about the relationship between related factors and complete pathological remission after neoadjuvant treatment.It was analyzed by single factor and multiple factors.When p<0.05,statistical differences were considered,and the results were statistically significant.Results:Among the 109 patients included in this study,75 were males and 34 were females.The average age of the patients was(62±2.64)years,27 patients(24.8%)showed complete remission after surgery,and 82 patients had incomplete remission.(75.2%).According to the patient’s gender,age,BMI,smoking,drinking,whether merger based disease,diabetes,high blood pressure,anemia,neoadjuvant therapy before whether neoadjuvant therapy CEA levels before and after neoadjuvant therapy CEA levels,preoperative neoadjuvant therapy before the T stage,N stage,T stage,N stage after neoadjuvant therapy,neoadjuvant therapy before and after neoadjuvant therapy,circumferential resection margin(CRM),mesorectum fascia(MRF),extramural vascular invasion(EMVI),tumor invasion bowel lumen diameter,distance from tumor to anal margin,choice of neoadjuvant chemotherapy,time to operation after neoadjuvant treatment,degree of tumor differentiation and tissue types such as 26 related factors were analyzed.And the single factor analysis results indicate:Tumor from anal edge distance of 5 cm or less(p = 0.026),the circumference of the infiltrating lumen was less than 1/3(p=0.039),neoadjuvant therapy before hemoglobin(p = 0.002),and normal BMI in the normal range(p = 0.018),lower T staging before neoadjuvant therapy(p = 0.016),lymph node negative before neoadjuvant therapy(p < 0.01),lower T staging after neoadjuvant therapy(p < 0.01),lower N staging after neoadjuvant therapy(p < 0.01),Patients with CEA level ≤5ng/ml before neoadjuvant therapy(p < 0.01)and CEA level ≤5ng/ml after neoadjuvant therapy(p< 0.01)were reexamined before neoadjuvant therapy,the interval between surgery after neoadjuvant treatment is more than 8 weeks(p<0.01),and patients with better tumor differentiation(p < 0.01)had a higher probability of pathological complete response(p CR).Multivariate analysis results suggested that MRI T staging before neoadjuvant therapy(OR=0.015,P=0.022),CEA level before neoadjuvant therapy(OR=0.011,P=0.021),tumor differentiation degree(OR=10.479,P=0.012)and hemoglobin level before neoadjuvant therapy(OR=0.073,P=0.049)had important influencing factors on achieving pathological complete response after neoadjuvant therapy.Conclusion:1.Preoperative neoadjuvant chemoradiotherapy can reduce the tumor stage,and can effectively reduce the level of tumor marker CEA.2.The therapeutic effect of neoadjuvant therapy in patients with locally advanced rectal cancer was different,some of which could achieve pathological complete remission.3.Factors such as CEA level,T,N stage,tumor differentiation degree and anemia before neoadjuvant therapy may be of great significance for predicting neoadjuvant therapy to achieve pathological complete remission in locally advanced rectal cancer.