Analysis Of Clinical Predictors Of Efficacy And Prognosis Of Neoadjuvant Chemoradiotherapy For Locally Advanced Rectal Cancer

Objective: To explore the clinical predictors for the efficacy and prognosis of Neoadjuvant chemoradiotherapy(nCRT)in patients with locally advanced rectal cancer(LARC).To provide basis for individualized treatment of rectal cancer.Methods: Clinical data of 335 LARC patients who received nCRT and underwent radical surgery in Liaoning Tumor Hospital were retrospectively analyzed.Clinical factors including gender,age,pre-nCRT tumor invasion of intestinal diameter,CT stage,CN stage,TRG grade,pre-nCRT CEA and CA199 levels were recorded.Statistical analysis was conducted to analyze the correlation between clinical factors and nCRT efficacy and prognosis in LARC patients.Results:1.The efficacy and prognosis of nCRT are different among patients with different LACR.Among the 335 patients with LACR,176(52.6%)had TRG grade 0/1,and 159(47.4%)had TRG grade 2/3.Among 176 patients(52.5%)with TRG grade 0/1,115 patients(34.3%)were male;138 cases(41.2%)were under 65 years old;Before nCRT,91 patients(27.2%)had > 1/2 of tumor circumference.Before nCRT,161 cases(48.1%)had cT staging of T3,and 155 cases(46.3%)had cN staging of N0.CEA before nCRT ≤20ng/ml 161 cases(48.1%);Before treatment,165 cases(49.3%)had CA199≤ 37 U /ml.2.To analyze the clinical factors affecting the efficacy of nCRT in LARC patients.Univariate analysis showed that pre-nCRT tumor invasion of intestinal diameter(P < 0.01),cT stage(P=0.021),cN stage(P < 0.01),pre-nCRT CEA(P=0.045)and CA199 level(P=0.027)were correlated with the efficacy of nCRT in patients with LACR.Logistic multivariate analysis showed that intestinal circumference of tumor invasion before nCRT(P=0.01,OR=2.350),cT stage(P=0.043,OR=2.101)and cN stage(P < 0.01,OR=5.836)were independent clinical factors affecting nCRT efficacy in LARC patients.3.To analyze the clinical factors affecting the prognosis of LARC patients after nCRT.Univariate Fine-Gray test showed that cT stage(P < 0.01),cN stage(P < 0.01),TRG grade(P < 0.01),pre-nCRT CEA(P < 0.01)and CA199 level(P < 0.01)were correlated with the prognosis of LARC patients receiving nCRT.There was no statistical significance in the cumulative incidence of competitive risk events among all influencing factors(P > 0.05).The competitive risk model showed that TRG grade(P<0.01 HR=3.236),cT stage(P=0.030,HR=1.852),cN stage(P=0.027,HR=2.008),CEA level before nCRT(P<0.01,HR=7.038),and CA199 level before nCRT(P<0.01,HR=3.849)had significant effects on independent factors of prognosis in patients with LARC.Conclusion:1.Intravenous intestinal diameter,cT stage and cN stage of tumor before nCRT were independent clinical factors affecting the efficacy of nCRT in LARC patients.The larger the diameter of intestinal tract invaded by tumor before nCRT,the higher the cT stage and cN stage,and the worse the nCRT efficacy in LARC patients.2.TRG grade,cT stage,cN stage,pre-nCRT CEA level and CA199 level were independent factors affecting the prognosis of LARC patients.In LARC patients receiving nCRT,the higher the TRG grade,the higher the cT stage and the higher the cN stage,the higher the pre-nCRT CEA and CA199 levels,the worse the prognosis may be.