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27-27.62, P=0.024) and RFS (HR; 2.55, 95% CI; 1.01-6.48, P=0.048) than ycN-. In addition, patients with CEA after NAC (post-CEA)≥5ng/ml had a significantly higher risk LR (HR; 5.63, 95% CI; 1.06-29.93, P=0.043). NAC alone had an insufficient survival effect on patients with cT4 disease, ycN+, or an elevated post-CEA level. In contrast, NAC alone is a potential treatment for other patients with LARC. NAC alone had an insufficient survival effect on patients with cT4 disease, ycN+, or an elevated post-CEA level. In contrast, NAC alone is