ObjectiveTo evaluate the efficacy of multicycle neoadjuvant chemotherapy combined with apatinib in the treatment of advanced rectal cancer through the Database from Colorectal Cancer (DACCA).MethodsA total of 173 patients with advanced rectal cancer who underwent surgery after 2–4 cycles of neoadjuvant chemotherapy combined with apatinib were selected from the DACCA (Version January 20, 2019). The patients were grouped by treated cycle and clinical TNM (cTNM) stage, and the overall variation of clinical and pathological indicators before and after treatment were compared.ResultsAmong 173 cases, 63 cases (36.42%), 45 cases (26.01%), and 65 cases (37.57%) were respectively in the 2, 3, and 4-cycle group; 54 cases (31.21%), 91 cases (52.60%), and 28 cases (16.18%) in stage Ⅱ, Ⅲ, and Ⅳ-group. Clinical response degree: complete pathologic response (cPR) was observed in 23 cases (13.29%), and the rate of conversion resection was 100% (173/173). Clinical response grade: complete response (CR) in 58 cases (33.53%), partial response (PR) in 93 cases (53.76%), stable disease (SD) in 21 cases (12.14%), progressive disease (PD) in 1 cases (0.58%). Tumor regression grade: TRG0 in 21 cases (12.57%), TRG1 in 22 cases (13.17%), TRG2 in 84 cases (50.30%), TRG3 in 40 cases (23.95%). There was a statistical difference in CEA before and after the treatment (P<0.001). All cases underwent radical resection, and the successful rate of transformed resection was 100%. There was significant difference on the clinical response grade among the cases of different treatment cycle (H=18.513, P<0.001), and the longer treatment cycle was correlated with better clinical response (G=–0.474, P<0.001). In addition, there was significant difference on the cPR rate among the cases of different cTNM stage (χ2=6.450, P=0.040).ConclusionsMulticycle neoadjuvant chemotherapy combined with apatinib in treating patients with advanced rectal cancer is efficient. More treatment cycles lead to better efficacy. The lower cTNM stage maybe means more chance of achieving cPR and a satisfactory rate of conversion resection.