Abstract: Objective: To explore the value of preoperative CD68⁺ tumor-associated macrophages (TAMs) levels and its combination detection with carcinoembryonic antigen (CEA) in evaluating the risk of recurrence in patients undergoing radical resection of rectal cancer. Methods: A total of 150 patients with rectal cancer undergoing radical surgery were selected,the expression level of CD68⁺ TAMs in cancer tissue was detected using flow cytometry,and serum CEA levels were measured using chemiluminescence immunoassay.All patients were followed up for at least 1 year,who experienced recurrence were included in the recurrence group,and who did not experience recurrence were included in the non-recurrence group.The proportion of CD68⁺TAMs in tumor tissue and adjacent cancer tissue,as well as in tumor tissue of the recurrence group and non-recurrence group were compared.The receiver operating characteristic (ROC) curve was used to analyze the combined evaluation of CD68⁺ TAMs proportion level and CEA level to evaluate the Jordan index of postoperative recurrence risk in rectal cancer patients undergoing radical surgery. Results: The proportion of CD68⁺ TAMs in tumor tissue of 150 patients was (21.58±3.98)%,while the proportion of CD68⁺ TAMs in normal tissue adjacent to cancer was (8.32±1.06)%,and the difference of which between the two groups was statistically significant (P<0.01).The proportion of CD68⁺ TAMs in tumor tissue of patients in the recurrence group was (16.25±2.06)%,while the proportion of CD68⁺ TAMs in tumor tissue of patients in the non-recurrence group was (26.85±3.51)%,and the difference of which between the two groups was statistically significant (P<0.01).Univariate analysis indicated that there were significant differences in CA199,CEA,proportion of CD68⁺ TAMs in tumor tissue,and pathological classification between the recurrence group and non-recurrence group (P<0.05 to P<0.01).Multivariate regression analysis showed that serum CEA and pathological classification were risk factors for postoperative recurrence in rectal cancer patients (P<0.01 and P<0.05),while the proportion of CD68⁺ TAMs in tumor tissue was a protective factor for postoperative recurrence in rectal cancer patients (P<0.05).ROC curve analysis showed that the Jordan index of the combined detection of CD68⁺ TAMs ratio and CEA level was higher than that of individual detection. Conclusions: The proportion of CD68⁺ TAMs is significantly increased in rectal cancer tissues compared to normal tissues.The proportion of CD68⁺TAMs in postoperative rectal cancer tissues is correlated with postoperative recurrence.Combining this indicator with postoperative serum CEA for ROC curve analysis has certain value in predicting the risk of recurrence in patients.For patients with postoperative cancer tissue CD68⁺ TAMs ratio and serum CEA levels exceeding the diagnostic threshold,they should be alert to recurrence and may consider an intensified chemotherapy regimen after surgery.