1.Combining Blood Indicators Before Neoadjuvant Chemoradiotherapy To Predict Treatment Response And Prognosis Of Patients With Locally Advanced Rectal Cancer 2.Clinicopathological Characteristics And Prognostic Analysis Of Patients With Pathological Comp

Objective:Currently,neoadjuvant concurrent chemoradiotherapy(NCRT)is the first choice for locally advanced rectal cancer(LARC).However,there is a lack of effective method to predict the treatment effect of neoadjuvant therapy and the patients’ prognosis.So,this study aimed to assess the value of pretreatment blood indicators in predicting patients’ response to NCRT and the value of the combing blood indicators in the prognosis of patients with LARC.Material and Methods:Between 2013 to 2016,We retrospectively analyzed the blood indicators before neoadjuvant therapy in 427 consecutive patients with LARC at our hospital,including CEA,CA19-9,systemic inflammatory indexes(PLR,NLR,LMR,C-reactive protein,etc.)and systemic immune inflammatory indexes(SII),D-D dimer,and prognostic nutritional index(PNI).According to the tumor regression grading(TRG),patients were divided into two groups with a good response to tumor treatment(TRG1-2)and a poor response(TRG 3-5).The differences in blood indicators between the two groups were compared to identify those indicators that significantly influenced the treatment response to neoadjuvant therapy.Based on the patient’s disease-free survival(DFS),the optimal cut-off values of the blood indexes were obtained by X-tile.Univariate and multivariate survival analyses affecting prognosis were performed to identify independent influencing factors for patients’ DFS.Results:The serum CEA,NLR,PLR,and SII values of the patients in the poor response group(TRG 3-5)were higher than those in the good response group(TRG 1-2).The differences were considered statistically significant(P<0.05).Further multivariate logistic regression analysis showed that higher CEA(cut-off 3.00,OR=1.012,95%CI=1.001-1.023,P=0.033)and NLR(cut-off 1.92,OR=1.107,95%CI=1.002-1.222,P=0.045)before treatment were associated with poor neoadjuvant treatment response in patients.The results of univariate survival analysis showed that the PLR,PNI,PLR-PNI scores were associated with patients’ DFS;The results of multivariate Cox proportional hazards regression model analysis showed that PLR-PNI score(HR=3.610,95%CI 1.777-7.336,P<0.001)was an independent influencing factor for patients’ DFS.Combining and contrasting pathological TNM stage,PLR-PNI score could significantly discriminate DFS differences between patients with PCR and stage Ⅱ as well as between patients with stage Ⅰand Ⅱ disease(all P<0.001).Conclusion:Higher CEA and NLR in patients with rectal cancer before neoadjuvant therapy were associated with poor patient response to neoadjuvant therapy.The PLR-PNI score was an independent influencing factor for patients’ DFS,and a higher score was associated with a relatively shorter DFS time.The PLR-PNI score could better discriminate the DFS time of patients with PCR stage to stage Ⅱ,especially for stage Ⅱ patients.Objective:To investigate the clinicopathological characteristics and prognosis of rectal cancer patients with pathological complete response and near complete response after neoadjuvant therapy.Materials and Methods:The clinicopathological data of 441 patients who underwent neoadjuvant chemoradiotherapy plus radical surgery of rectal cancer in the our hospital from January 2004 to December 2016 were retrospectively collected.The clinicopathological characteristics and prognostic factor of 142 patients with pathological complete response and near complete response were analyzed.Results:The 3-year DFS rate and OS rate of 142 patients were 90.8%and 96.5%,respectively,and the 5-year DFS rate and OS rate were 88.0%and 94.4%,respectively.A total of 17 patients(12%)had postoperative recurrence and metastasis events,mainly pulmonary metastasis,mostly within two years after surgery.Univariate analysis showed that the maximum diameter of scar or lesion,the status of lymph node metastasis and the distance between the lower edge of tumor and anal edge were associated with disease-free survival time;the status of lymph node metastasis and the maximum diameter of scar or lesion were associated with overall survival time.Multivariate Cox proportional hazards regression analysis showed that patients with scar or lesion diameter>3 cm(HR=4.406,95%CI:1.619-12.006),positive lymph node metastasis status(HR=4.102,95%CI:1.461-11.513)and tumor lower margin to anal margin distance(4 cm(HR=18.171,95%CI:2.357-140.073)had shorter disease-free survival time;The patients with scar or lesion diameter>3 cm(HR=8.573,95%CI:1.630-45.099)and lymph node metastasis status(HR=4.721,95%CI:1.068-20.860)had shorter overall survival time.Conclusion:After neoadjuvant treatment,the rectal cancer patients with complete pathological response(pCR)and near pCR had good prognosis,generally.However,it is still necessary to pay attention on the occurrence of metastasis in a small number of patients.The distance between the lower edge of the tumor and the anal edge,the status of lymph node metastasis,and the maximum diameter of scars/residual lesions were the important factors affecting the prognosis.