Efficacy ang influencing factors of oxaliplatin combined with capecitabine neoadjuvant chemotherapy in the treatment of locally advanced low rectal cancer

doi:10.3877/cma.j.issn.2095-2015.2024.03.004

Abstract

Abstract:

Objective

To observe the efficacy of oxaliplatin combined with capecitabine (XELOX regimen) neoadjuvant chemotherapy in the treatment of locally advanced low rectal cancer, and analyze the influencing factors.

Methods

The short-term curative effect of XELOX neoadjuvant chemotherapy in 113 patients with locally advanced low rectal cancer treated in the People's Hospital of Jieshou City from June, 2019 to June 2023 was evaluated by the new Response Evaluation Criteria in Solid Tumors (RECIST 1.1). The objective remission rate was calculated by the sum of complete remission (CR) and partial remission (PR). The changes of serum tumor markers and immune function of patients with objective remission and non-objective remission before and after neoadjuvant chemotherapy were compared, and the clinical features of the two groups were compared. Multivariate Logistic regression analysis was used to summarize the relevant factors affecting the short-term curative effect of patients.

Results

After two cycles of chemotherapy, there were 10 cases of CR, 45 cases of PR, 49 cases of SD and 9 cases of PD. The objective remission rate was 48.67% (55/113). CEA, CA125 and CA199 in objective remission group were lower than those in non-objective remission group after 2 cycles of chemotherapy (P<0.05). After 2 cycles of chemotherapy, CD3⁺ and CD4⁺ in objective remission group were higher than those in non-objective remission group, and CD8⁺ was lower than that in non-objective remission group (P<0.05). Multivariate Logistic regression model showed that age ≥60 years old and smoking history were independent risk factors affecting the curative effect of XELOX regimen for locally advanced low rectal cancer, while clinical stage N0 and high differentiation were protective factors (P<0.05).

Conclusion

XELOX regimen can effectively reduce the level of tumor markers and improve immune function in patients with locally advanced low rectal cancer, but its curative effect is affected by many factors such as patients' age, smoking history, clinical stage and tumor differentiation degree.

Key words: Oxaliplatin, Capecitabine, Neoadjuvant chemotherapy, Local progressive stage, Low rectal cancer, Influencing factor

Wei Sun, Jingfeng Liu, Chen Chen, Lei Yang. Efficacy ang influencing factors of oxaliplatin combined with capecitabine neoadjuvant chemotherapy in the treatment of locally advanced low rectal cancer[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(03): 208-212.

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References 18

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组别	例数	CEA(ng/mL)		CA125(kU/L)		CA199(kU/L)
组别	例数	化疗前	化疗2周期后	化疗前	化疗2周期后	化疗前	化疗2周期后
客观缓解组	55	19.59±2.83	12.14±2.06^*	33.58±3.91	27.64±2.38^*	38.83±5.95	24.23±2.25^*
非客观缓解组	58	19.55±2.69	16.18±2.24^*	33.45±3.86	30.35±2.54^*	38.76±5.81	27.69±2.58^*
t值		0.077	9.964	0.178	5.845	0.063	7.581
P值		0.939	<0.001	0.859	<0.001	0.950	<0.001

组别	例数	CEA(ng/mL)		CA125(kU/L)		CA199(kU/L)
组别	例数	化疗前	化疗2周期后	化疗前	化疗2周期后	化疗前	化疗2周期后
客观缓解组	55	19.59±2.83	12.14±2.06^*	33.58±3.91	27.64±2.38^*	38.83±5.95	24.23±2.25^*
非客观缓解组	58	19.55±2.69	16.18±2.24^*	33.45±3.86	30.35±2.54^*	38.76±5.81	27.69±2.58^*
t值		0.077	9.964	0.178	5.845	0.063	7.581
P值		0.939	<0.001	0.859	<0.001	0.950	<0.001

组别	例数	CD3+		CD4+		CD8+
组别	例数	化疗前	化疗2周期后	化疗前	化疗2周期后	化疗前	化疗2周期后
客观缓解组	55	51.25±7.13	59.85±10.24^*	29.31±3.25	42.47±5.06^*	27.46±2.58	21.05±1.73^*
非客观缓解组	58	51.46±7.25	55.71±8.89^*	29.52±3.18	38.37±4.19^*	27.11±2.39	23.64±1.95^*
t值		0.155	2.298	0.347	4.701	0.749	7.454
P值		0.877	0.023	0.729	<0.001	0.456	<0.001

组别	例数	CD3+		CD4+		CD8+
组别	例数	化疗前	化疗2周期后	化疗前	化疗2周期后	化疗前	化疗2周期后
客观缓解组	55	51.25±7.13	59.85±10.24^*	29.31±3.25	42.47±5.06^*	27.46±2.58	21.05±1.73^*
非客观缓解组	58	51.46±7.25	55.71±8.89^*	29.52±3.18	38.37±4.19^*	27.11±2.39	23.64±1.95^*
t值		0.155	2.298	0.347	4.701	0.749	7.454
P值		0.877	0.023	0.729	<0.001	0.456	<0.001

组别	例数	年龄		性别		体重指数		肿瘤直径
组别	例数	<60岁	≥60岁	男	女	<24 kg/m²	≥24 kg/m²	<3 cm	≥3 cm
客观缓解组	55	14(25.45)	41(74.55)	35(63.64)	20(36.36)	44(80.00)	11(20.00)	35(63.64)	20(36.36)
非客观缓解组	58	26(44.83)	32(55.17)	34(58.62)	24(41.38)	42(72.41)	16(27.59)	40(68.97)	18(31.03)
χ²值		4.633		0.299		0.893		0.359
P值		0.031		0.585		0.345		0.549
组别	例数	占肠周范围		临床T分期		临床N分期			分化程度
组别	例数	<3/4	≥3/4	T3期	T4期	N0期	N1期	N2期	高分化	中分化	低分化
客观缓解组	55	38(69.09)	17(30.91)	19(34.55)	36(65.45)	6(10.91)	27(49.09)	22(40.00)	9(16.36)	40(72.73)	6(10.91)
非客观缓解组	58	44(75.86)	14(24.14)	22(37.93)	36(62.07)	11(18.97)	37(63.79)	10(17.24)	20(34.48)	36(62.07)	2(3.45)
χ²值		0.65		0.14		7.459			4.858
P值		0.42		0.708		0.024			0.028
组别	例数	病理类型		个人史		既往史
组别	例数	黏液腺癌	非黏液腺癌	吸烟史	饮酒史	高血压	糖尿病	冠心病
客观缓解组	55	6(10.91)	49(89.09)	27(49.09)	16(29.09)	12(21.82)	4(7.27)	7(12.73)
非客观缓解组	58	5(8.62)	53(91.38)	14(24.14)	15(25.86)	11(18.97)	6(10.34)	7(12.07)
χ²值		0.168		7.603	0.148	0.142	0.059	0.011
P值		0.682		0.006	0.701	0.707	0.808	0.915

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