| Background and purpose::Rectal cancer is a common malignant tumor in China and abroad.In recent years,the incidence of rectal cancer patients in China has been increasing year by year,and most patients have reached the locally advanced stage when they was diagnosed.Neoadjuvant chemoradiotherapy combined with TME surgery has become the optimal treatment scheme for locally advanced rectal cancer.Neoadjuvant chemoradiotherapy improves the surgical resection rate and pCR rate,reduces the local recurrence rate and distant metastasis rate,and improves the long-term prognosis of locally advanced rectal cancer patients.By analyzing the clinical data of locally advanced rectal cancer patients,this study further discussed the influencing factors of long-term neoadjuvant chemoradiotherapy on postoperative pathological decline,disease-free survival for 3 years and total survival for 3 years,so as to provide more basis for individualized treatment of clinical rectal cancer patients.Materials and Methods:We did a retrospective review involived of 64 patients with locally advanced rectal cancer who completed neoadjuvant chemoradiotherapy from July 2014 to July 2018.The total radiation dose was 46-50 Gy,2 Gy/f,lf/day,5 times a week.All patients received oral capecitabine ehemotherapy at the same time of radiotherapy(825 mg/m2,2/day,5 days a week).After the end of radiotherapy,the patients suitable for surgery were selected to receive surgical treatment 6-12 weeks after neoadjuvant therapy.The postoperative pathological sections were staged according to the AJCC staging criteria of the eighth edition,and the degree of tumor regression was evaluated according to the Dworak grading.Radiotherapy adverse reactions were evaluated according to the grading criteria of RTOG acute radiation injury and the grading scheme of RTOG/EORTC late radiation injury.Statistical data were processed with SPSS software.Results:(1)The median follow-up time was 37.5 months,and the postoperative pCR rate was 14.1%,3-year DFS rate was 75%,and 3-year OS rate was 89.1%.(2)Univariate analysis showed that postoperative pathological staging,ypT,ypN,and the time from radiotherapy to surgery had significant effects on tumor TRG(P<0.05),and Logistic regression analysis indicated that postoperative ypT staging was an independent factor affecting tumor TRG.The earlier ypT staging was,the higher TRG was,and the greater degree of tumor regression was(p=0.002,OR=0.035).(3)K-M analysis showed that the grading of ypN and TRG was significantly correlated with 3-year OS(P<0.05).Postoperative lymph node negative patients had higher 3-year OS and higher TRG,indicating that the higher the degree of tumour descent,the higher the 3-year OS.Multivariate COX model analysis showed that ypN and TRG had no independent effect on 3-year OS.(4)The grading of ypN and TRG and the 3-year interval between radiotherapy and surgery had significant influence on DFS(P<0.05).Multivariate COX model was used to analyze the factors affecting 3-year DFS,and the results showed that ypN,radiotherapy and operation interval time were independent factors affecting DFS.(5)Platinum-containing chemotherapy in neoadjuvant therapy increased acute and late side effects of radiotherapy,but had no significant effect on prognosis.Conclusions:(1)Postoperative pathological T,N stage and the interval from the end of radiotherapy to the operation are important factors affecting the degree of tumor regression of locally advanced rectal cancer.(2)The higher the TRG,the higher the overall survival rate and the 3-year disease-free survival rate,and the better the prognosis of patients.TRG can be used as an indicator to predict the prognosis of locally advanced rectal cancer.(3)ypN and the time between the end of radiotherapy and surgery were independent factors affecting the local progressive rectal cancer 3-year DFS;The interval was greater than or equal to 8 weeks,the 3-year DFS was higher.(4)The preoperative chemotherapy regimen containing platinum increased the adverse reactions of acute and late radiotherapy,but did not significantly benefit the overall survival. |
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