Analysis of clinical factors influencing the effect of neoadjuvant chemoradiotherapy for locally advanced rectal cancer / 中国综合临床

ABSTRACT

Objective:To investigate the clinical factors influencing the efficacy and prognosis of neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC).Methods:The clinical data of 335 patients with LARC who underwent radical operation after nCRT in Liaoning Cancer Hospital were retrospectively analyzed.Through univariate and multivariate analysis, we found out the clinical factors that may affect the efficacy and prognosis of nCRT in patients with LARC.Results:Multivariate logistic regression analysis showed that the independent clinical factors influencing the curative effect of nCRT in LARC patients were tumor invasion circumference( OR=2.350, 95% CI 1.438-3.842, P=0.01), cT stage( OR=2.101, 95% CI 1.024-4.314, P=0.043) and cN stage( OR=5.836, 95% CI 3.305-10.306, P<0.01). Competitive risk model analysis showed that the independent factors affecting the prognosis of LARC patients were tumor regression grading (TRG) ( HR=3.236, 95% CI 1.714-6.110, P<0.01), cT stage ( HR=1.852, 95% CI 1.061-3.230, P=0.030), cN stage ( HR=2.008, 95% CI 1.083-0.372, P=0.027), and carcinoembryonic antigen (CEA) level before nCRT ( HR=7.038, P<0.01), 95% CI 3.894-12.720, P<0.01) and serum carbohydrate antigen 199 (CA199) ( HR=3.849, 95% CI 2.016-7.350, P<0.01). Conclusion:The larger the circumference of tumor invasion before nCRT, cT stage and the cN stage were independent clinical factors influencing the nCRT efficacy of LARC patients.The larger the degree of tumor invasion to the rectum, the higher cT stage and the higher the cN stage before nCRT, the worse the efficacy of nCRT in LARC patients may be. TRG grade, cT stage, cN stage, CEA and CA199 level before nCRT were independent factors affecting the prognosis of LARC patients who received nCRT. The higher the TRG grade, of LARC patients receiving nCRT, the higher cT and cN stage, and the higher the CEA and CA199 level before nCRT, the worse the prognosis of LARC patients may be.