Objective To investigate the efficacy of neoadjuvant chemotherapy in patients with stage T3 and T4 rectal cancer and its related influencing factors, and to provide reference for the Locally advanced rectal cancer to choose optimal treatment schemes.Methods Ninetyone patients with locally advanced rectal cancer receiving neoadjuvant chemotherapy from a hospital were selected, and after receiving XELOX chemotherapy, the patients were divided into three groups: complete remission , partial remission and stable disease , according to Response Evaluation Criteria in Solid Tumors.The general characteristics of patients and relevant clinical indicators before and after chemotherapy were collected  to observe the changes of the indicators related to the cancer, and univariate and multivariate analysis were used to analyze the related factors affecting the efficacy of neoadjuvant chemotherapy. Results Of the 91 patients, 18 (19.78%) had complete remission, and 40 (43.96%) with partial remission, 33(36.36%) with stable disease. Multivariate analysis showed that lymph node metastasis before treatment was an independent factor affecting the efficacy of neoadjuvant chemotherapy after adjusting gender (OR=1.731,95%CI: 1.152～2.601).Conclusion Patients with locally advanced rectal cancer can benefit from neoadjuvant therapy, to maximize the efficacy of neoadjuvant chemotherapy, the condition of patients including gender, tumor diameter, and the situation of lymph node metastasis should be considered before chemotherapy.