Benefit Factors Of Neoadjuvant Therapy For Locally Advanced Rectal Cancer

Objective: To study the benefit factors of neoadjuvant therapy for locally advanced rectal cancer and establish a predictive model to provide evidence for individualized treatment of locally advanced rectal cancer.In addition,we evaluated the accuracy of MRI in evaluating the efficacy of preoperative neoadjuvant therapy for locally advanced rectal cancer.Method: The clinical,imaging and pathological data of patients with locally advanced middle and low rectal cancer admitted to the intestinal surgery department of Tongling People's Hospital from August 2013 to August 2018 were retrospectively analyzed.Benefit factors of neoadjuvant therapy for locally advanced rectal cancer:According to the pathological grade of tumor regression after operation,the patients were divided into beneficiary group and non-beneficiary group.Possible beneficiary factors included gender,age,BMI,basic disease,hemoglobin,serum tumor indicators(CEA,CA19-9),rectal MRI,T stage(enteroscopy),peripheral lymph node.Node status,tumor location,tumor size,endoscopic classification of tumors,degree of differentiation of tumors,histopathological types.Using single factor analysis,the relevant factors were screened out from the results,and then incorporated into the Logistic regression model for multi-factor analysis.Finally,the area method under ROC line is used to verify the validity.Finally,the benefit factors of neoadjuvant therapy for middle and low advanced rectal cancer were screened and the related prediction models were established.The ratio method was used to calculate the percentage of cases whose stages were consistent with the pathological stages after operation,so as to estimate the accuracy of the efficacy of neoadjuvant therapy for middle and advanced rectal cancer.Results: 1)Sixty-nine patients were enrolled,including 46 males(66.7%)and 23females(33.3%);the youngest was 34 years old,the oldest was 77 years old,and themedian was 61 years old;40 patients underwent Dixon operation(29 cases underwent prophylactic end ileostomy)and 29 patients underwent Miles operation.2)Postoperative pathological benefit(TRG3-4)was found in 44 cases(63.8%)and insignificant benefit(TRG0-2)in 25 cases(36.2%).Further univariate analysis confirmed that gender,BMI value,serum CA199 and tumor microscopic typing were significantly correlated with complete remission(p < 0.05).Multivariate analysis showed that BMI was an important prognostic factor for the gross types of tumors(P< 0.05).3)Comparing the results of MRI and pathology after neoadjuvant therapy,28cases(40.6%)were consistent with the pathological T stage after neoadjuvant therapy,34 cases(49.3%)were consistent with the pathological N stage after operation,and 15cases(21.7%)were completely consistent with the pathological stage after operation.This is the case.Conclusion:1)The patients with stage II and ? middle and low rectal cancer of neoadjuvant therapy,the easier of the patients with proliferative colorectal and lower BMI cancer are to get complete pathological remission(pCR).2)MRI can preliminarily judge the efficacy by comparing the changes of tumor size before and after neoadjuvant therapy,while the accuracy of TNM staging alone is not high.