| Objective: To investigate the value of different adjuvant therapy and the prognostic factors of patients with locally advanced rectal cancer(LARC).Methods: A total of 438 patients with(LARC)were admitted to the our hospital from January 1st 2010 to December 31 st 2011.Including 215 cases ofⅡstage and 223 case of Ⅲ stage.167 cases were only wih TME,60 cases underwent adjuvant chemoradiocherapy,and 211 cases underwent adjuvant chemotherapy.And the effects of preoperative CEA/CA19-9 levels,postoperative pathological stages,different therapy method on LRF,PFS and OS were analyzed.Results:1.Analysis the relative factors influencing the Survival of the whole populationUnivariate analysis showed that preoperative CEA,preoperative CA19-9,circumferential margin,vascular embolus,nerve invasion,lymph node metastasis and TNM stage were related to the prognosis of the patients.The results of multivariate analysis showed that the number of lymph node metastasis was an independent risk factor for LRF;the neuroinvolvement,the number of lymph node metastasis and the treatment mode after operation were independent influencing factors of PFS;The number of lymph node metastasis,TNM stage and postoperative treatment pattern were independent factors of OS.2.Survival Analysis of different treatment modes in the whole populationThe PFS of the postoperative chemoradiotherapy group was significantly lower than the other two groups,although there was no significant difference in PFS and OS between the two groups,but the data showed that the postoperative chemoradiotherapy group was lower than the other two groups,and the status of lymph node metastasis was further analyzed.It was found that the N stage of the radiotherapy group was later than the other two groups.3.Subgroup stratification analysis1)When the CEA or CA19-9 were negative before operation,the LRF and PFS in the radiochemical group were lower than those in the other two groups in 5 years(P<0.05).The difference between the three groups was not statistically significant(P > 0.05).2)No matter stage Ⅱ or stage Ⅲ no statistical significance was found in the 5-year LRF and and PFS and OS between the three treatment groups.(P > 0.05).Conclusion1.Adjuvant chemoradiotherapy have not reduce local recurrence and improve survival,which may be related to the late N stage of patients in this group,which should be further analyzed and verified.2.The value of adjuvant chemoradiotherapy in patients with low expression of CEA/CA19-9 is debatable.3.The results show that the higher risk was with later stage.The number of lymph node metastasis and the way of treatment were independent influenc factors of PFS and OS. |
