| Background and Objection:Rectal cancer is one of the most common malignancies in the world and poses a serious threat to human health.It is estimated that there are 400,000 new colorectal cancer patients every year in the world[1],accounting for 5%of adult cancer patients.Previous studies have found that for local advanced period In patients with rectal cancer,the rate of local recurrence after total mesorectal excision remains high.To reduce local recurrence,patients with locally advanced rectal cancer are usually treated with preoperative neoadjuvant chemoradiation followed by surgery and postoperative chemotherapy.Therefore,neoadjuvant chemoradiation is currently considered as the standard protocol for the treatment of locally advanced rectal cancer（LARC）.After preoperative neoadjuvant chemoradiation,surgery,and postoperative chemotherapy,the local recurrence rate of rectal cancer decreased significantly.However,there are still some locally advanced rectal cancer patients（LARC）with distant metastasis.Therefore,to understand the neoadjuvant synthesis of patients with rectal cancer Risk factors for relapse after treatment can help clinicians to determine prognosis and intensive follow-up of high-risk patients,early intervention,and reduce recurrence.Therefore,this study collected the clinicopathological data of neoadjuvant comprehensive treatment of rectal cancer patients in gastrointestinal surgery of the First People’s Hospital of Guangzhou in the past five years to investigate the risk factors for recurrence and metastasis,and provide corresponding theories for early postoperative detection and systemic treatment.in accordance with.MethodsRetrospective analysis of the clinicopathological data of patients with rectal cancer admitted to the Department of Gastrointestinal Surgery,Guangzhou First People’s Hospital from 2012 to 2017,according to preoperative imaging,serology,intraoperative exploration,postoperative pathology,and follow-up results.Patients who meet the requirements will be divided into the metastasis group and the non-metastatic group.The age,sex,tumor location,size,pathological type,differentiation,ypT stage,ypN stage,number of surgical lymph node dissections,distal incision distance from the tumor,and tumor marker preoperative carcinoembryonic antigen（CEA）were compared between the two groups.),serum carbohydrate antigen 19-9（CA19-9）,serum carbohydrate antigen12-5（CA12-5）,serum carbohydrate antigen 15-3（CA15-3）,serum carbohydrate antigen72-4（Differences in CA72-4）,looking for risk factors for metastasis and recurrence of rectal cancer after neoadjuvant comprehensive treatment.By comparing the differences between the two groups of patients,ypTMN stage,tumor size,number of positive lymph nodes,and finding risk factors that may be associated with recurrence and metastasis.ReasultUnivariate analysis:age≥60 years,CEA≥5 ng/mL,CA199≥37 U/mL,degree of tumor infiltration after neoadjuvant chemoradiation,lymph node metastasis after neoadjuvant chemoradiation,pathological stage after neoadjuvant radiotherapy and chemotherapy,tumor Longer diameter is a risk factor for local recurrence and distant metastasis in neoadjuvant rectal cancer patients.1.The average age of the metastatic group was 57.19±6.43 years old,while the non-metastatic group was 59.48±10.29 years old.The difference in the incidence of metastasis among different age groups was statistically significant(c（17）=8.154,P=0.017<0.05).2.The average length of the tumor in the metastatic group was 4.95±1.96cm,and 3.92±2.11cm in the non-metastasis group.The difference was statistically significant(c（17）=10.122,P=0.002).3.The mean concentration of CEA in the metastatic group was 30.11±32.94ng/mL,and 11.41±14.34ng/mL in the non-metastasis group.The difference was statistically significant(c（17）=9.58,P=0.008).4.The mean serum glucose antigen 19-9（CA19-9）concentration was 94.41±239.752U/mL in the metastatic group,and 38.78±96.239 U/mL in the non-metastasis group(c（17）=5.953,P=0.025).With the T2 staging as the boundary,ypT2 and ypT3-ypT4 were divided into 2 groups.The difference in infiltration of ypN between the two groups was statistically significant(c（17）=7.244,P=0.008).6.With the ypN1 stage as the limit,the following ypN0 and ypN1-ypN2 were divided into two groups.The difference between the two groups was statistically significant(c（17）=7.866,P=0.012).The difference between the ypTMN staging and the ypTMN staging in patients with metastasis was statistically significant(c（17）=5.327,P=0.024).Multivariate analysis:CEA≥5ng/mL,lymph node metastasis after neoadjuvant chemoradiation,and tumor length were risk factors for local recurrence and distant metastasis in neoadjuvant rectal cancer patients.According to Binary Logistic analysis,tumor length（P=0.024,OR=4.304）and long diameter≥5cm were 4.304 times longer than5cm;ypN（P=0.044,OR=3.956）,ypN1-N2 was The ypN0 group had 3.956 times the probability of metastasis and recurrence;CEA（P=0.048,OR=4.474）and CEA≥5ng/mL were 4.474 times of CEA<5ng/mL.The tumor length,ypN,and CEA were statistically significant in the multivariate analysis.CEA≥5ng/mL is an independent factor that influences the prognosis... |
