Analysis Of Neoadjuvant Radiotherapy And Chemotherapy For Three-year Survival Rate And Quality Of Life Of Patients With Locally Advanced Rectal Cancer

Objective: To investigate the effect of neoadjuvant radiotherapy and chemotherapy on the efficacy and quality of life of patients with locally advanced and R0 resectable rectal cancer.Methods: a total of 158 patients with middle and low rectal cancer who were treated in our hospital from 2015 to 2018 were retrospectively collected.They were divided into neoadjuvant group and operation group according to whether they received neoadjuvant chemoradiotherapy or not.In the neoadjuvant group,84 patients were treated with FOLFOX,XELOX or single drug oral chemotherapy,and radiotherapy with 5000 c Gy / 25 F.The operation was completed 8-10 weeks after neoadjuvant chemoradiotherapy.In the operation group,74 cases were operated within 4 weeks after diagnosis.The curative effect,quality of life,frequency of anal defecation and ability to control defecation of the two groups were analyzed.Results: 1.The follow-up time was up to May 31,2020,the median follow-up time was 32 months.The 3-year OS of neoadjuvant group and operation group were 87.2% and 74.9%(P = 0.124),3-year PFS were 76.1%and 73.3%(P = 0.939).2.Subgroup analysis was performed according to whether there was lymph node metastasis in preoperative imaging.The 3-year OS of N0 and N1-2group was 92.2% and 75.9%(P = 0.036),and the 3-year PFS of N0 and N1-2group was 83.4% and 70.1%(P = 0.136).In patients with N0,the 3-year OS of neoadjuvant group and operation group were 88.1% and 92.6%(P = 0.273),the3-year PFS were 76.9% and 89.3%(P = 0.092).In patients with N+,the 3-year OS of neoadjuvant group and operation group were 87.0% and 61.1%(P=0.007),the 3-year PFS were 76.1% and 61.0%(P =0.197).3.Cox multivariate analysis based on gender,age,T staging,N staging,and whether to undergo neoadjuvant radiotherapy and chemotherapy.The results showed that N stage was an independent prognostic factor for 3-year OS(HR 0.348,95% CI 0.137-0.881,P = 0.026).In the N + subgroup,neoadjuvant chemoradiotherapy was an independent prognostic factor for 3-year OS(HR0.341,95% CI 0.136-0.857,P = 0.022).4.The quality of life in the neoadjuvant chemoradiotherapy group was worse than that in the direct operation group(P = 0.046),The frequency of defecation in neoadjuvant chemoradiotherapy group was more than that in direct operation group(P < 0.001),and the feces control ability of the neoadjuvant chemoradiotherapy group was worse than that of the direct operation group(P = 0.018).There was no significant difference in anal distension(P > 0.05)and anal pain(P > 0.05)between the two groups.Conclusion: 1.For patients with stage II rectal cancer without lymph node metastasis and negative circumferential margins,neoadjuvant radiotherapy and chemotherapy failed to affect the three-year survival rate of the patients.2.Neoadjuvant chemoradiotherapy improves 3-year overall survival in patients with stage III rectal cancer.3.Neoadjuvant radiotherapy and chemotherapy can reduce the quality of life,affect the anal function,increase the frequency of defecation and decrease the ability of defecation control.