ObjectiveTo explain surgical and medical comorbidities and preoperative physical status of colorectal cancer in detail as well as their tags and structures of Database from Colorectal Cancer (DACCA) in West China Hospital.MethodThe article was described in words.ResultsThe definition to the surgical comorbidities with its related content module, the medical comorbidity with its related content modules, and the preoperative physical status and characteristics of the DACCA in West China Hospital were given. The data label corresponding to each item in the database and the structured way needed for the big data application stage in detail were explained. And the error correction notes for all classification items were described.ConclusionsThrough the detailed description of the medical and surgical comorbidities and the preoperative physical status of DACCA in West China Hospital, it provides the standard and basis for the clinical application of DACCA in the future, and provides reference for other peers who wish to build a colorectal cancer database.
ObjectiveTo analyze the relation between the marital status of patients with colorectal cancer and surgical treatment options decision-making and outcomes in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe version of DACCA selected for this analysis was updated on August 31, 2022. The patients were enrolled according to the established screening criteria and then assigned to 3 groups: the unmarried, married, and divorced or widowed groups. The differences in the surgical modality decisions, surgical quality, and surgical complications among these 3 groups were analyzed. ResultsA total of 7 634 data that met the screened criteria were enrolled. It was found that the difference in the composition of the willingness to conserve anus among patients with different marital status was statistically significant (χ2=28.635, P<0.001), reflecting that the willingness to conserve anus was “strong” among unmarried and married patients, and the overall willingness to conserve anus was relatively more positive among unmarried patients, while the willingness to conserve anus was “rational” among widowed or divorced patients. No statistical differences were found in the surgical modality decisions (rectal surgery: χ2=0.493, P=0.782; colon surgery: χ2=0.213, P=0.899), including the presence of prophylactic stoma for the patient with radical resection (χ2=5.156, P=0.076）, surgical quality (H=3.452, P=0.178）, presence of surgical in-hospital complications (χ2=1.663, P=0.435), and the presence of short-term surgical complications (χ2=1.695, P=0.428). ConclusionsAnalysis of the data in DACCA reveals that there is difference in willingness to preserve anus among colorectal cancer patients with different marital status. Married and unmarried patients have stronger anal preservation intention, suggesting that clinical care and family support should be strengthened during clinical diagnosis and treatment.
ObjectiveTo analyze the relation between educational level of patients with colorectal cancer (CRC) and decision-making and curative effect of neoadjuvant therapy (NAT) in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe eligible CRC patients were collected from June 29, 2022 updated DACCA according to the screening criteria and were assigned into 4 groups according to their educational level, namely, uneducated, primary educated, secondary educated, and tertiary educated. The differences in NAT decision-making, cancer marker change, symptomatic change, gross change, imaging change, and tumor regression grade (TRG) among the CRC patients with different educational levels were compared. ResultsA total of 2 816 data that met the screening criteria were collected, 138 of whom were uneducated, 777 of whom were primary educated, 1 414 of whom were secondary educated, and 487 of whom were tertiary educated. The analysis results revealed that the difference in the composition ratio of patients choosing NAT regimens by educational level was statistically significant (χ2=30.937, P<0.001), which was reflected that the composition ratio of choosing a simple chemotherapy regimen in the uneducated CRC patients was highest, while which of choosing combined targeted therapy regimen in the tertiary educated CRC patients was highest. In terms of treatment outcomes, the composition ratios of changes in cancer markers (H=4.795, P=0.187), symptoms (H=1.722, P=0.632), gross (H=2.524, P=0.471), imaging (H=2.843, P=0.416), and TRG (H=2.346, P=0.504) had no statistical differences. ConclusionsThrough data analysis in DACCA, it is found that the educational level of patients with CRC can affect the choice of NAT scheme. However, it is not found that the educational level is related to the changes in the curative effect of patients with CRC before and after NAT, and further analysis is needed to determine the reasons for this.
ObjectiveTo analyze the current version of the West China Database from Colorectal Cancer (DACCA) and explore how the occupational background of colorectal cancer patients affects the complexity of surgical difficulty and postoperative complications. MethodsWhen using the updated version of DACCA data on May 28, 2023 for analysis, the data items concerned covered occupation, operative duration, anatomical difficulty, pelvic stenosis, abdominal obesity, adhesion in surgical area, abnormal mesenteric status, tissue or organ hypertrophy, intestinal quality in surgical area, postoperative complications in hospital, short-term postoperative complications and long-term postoperative complications. According to the “Occupational Classification Code of the People’s Republic of China”, the occupations of patients were divided into professional and technical personnel, staff, service personal, production personnel, manufacturing personnel and retirees according to different occupations. The operative difficulty and postoperative complications of 6 groups were analyzed. ResultsAccording to the screening conditions, 5 734 valid data rows were obtained from DACCA. The results of occupation analysis showed that there were significant difference in operative duration (H=11.609, P=0.041), anatomical difficulty (H=29.166, P<0.001), pelvic stenosis (H=16.412, P=0.006), abdominal obesity (H=44.622, P<0.001), adhesion in surgical area (H=23.695, P<0.001), abnormal mesenteric status (χ2=39.252, P=0.035), tissue or organ hypertrophy (χ2=58.284, P<0.001) and intestinal quality in surgical area (H=21.041, P=0.001) between different groups. There were no significant differences in the occurrence of complications in hospital, near and short-term and long-term after operation among different occupations (P>0.05). Further subgroup analysis showed that only the difference of fever (χ2=10.969, P=0.041) and intestinal obstruction (χ2=12.025, P=0.021) were statistically significant among different occupations. ConclusionThe occupation of patients may affect the difficulty of colon cancer surgery, and the occurrence of postoperative complications is nothing to do with the occupation of patients, but the occurrence of postoperative fever and postoperative intestinal obstruction is related to occupations, and the possible causes need to be further explored.
ObjectiveTo analyze the risk factors for early mortality in patients with stage Ⅳ colorectal cancer, and further construct and validate Nomogram prediction model for early mortality in stage Ⅳ colorectal cancer. MethodsA retrospective analysis was conducted on the clinical and pathological data of stage Ⅳ colorectal cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database in the United States from 2018 to 2020. The study data was randomly divided into a training cohort and a validation cohort at a ratio of 8∶2. Multivariate logistic regression analysis was performed in the training cohort to screen for risk factors for early mortality in stage Ⅳ colorectal cancer patients, and Nomogram prediction model was further constructed. Receiver operating characteristic curve (ROC), calibration curve, and clinical decision curve analysis (DCA) were plotted. ResultsAge (50–70 group, OR=1.984, P=0.007; >70 group, OR=1.997, P=0.008), unmarried (OR=1.342, P=0.025), primary tumor differentiation of G3+G4 (OR=1.817, P<0.001), T4 stage (OR=1.434, P=0.009), N2 stage (OR=1.621, P<0.001), M1c stage (OR=1.439, P=0.036), no chemotherapy (OR=21.820, P<0.001), bone metastasis (OR=2.000, P=0.042), brain metastasis (OR=6.715, P=0.001) and liver metastasis (OR=1.886, P<0.001) were risk factors for all-cause early death in stage Ⅳ colorectal cancer patients. Age（50–70 group, OR=2.025, P=0.008; >70 group, OR=1.925, P=0.017), primary tumor differentiation grade of G3+G4 (OR=1.818, P<0.001), T4 stage (OR=1.424, P=0.013), N2 stage (OR=1.637, P<0.001), M1c stage (OR=1.541, P=0.016), no chemotherapy (OR=21.832, P<0.001), brain metastasis (OR=6.089, P=0.001), liver metastasis (OR=2.100, P<0.001) were factors for cancer-specific early death of stages Ⅳ colorectal cancer patients. Based on these variables, we constructed two Nomogram prediction models for all-cause early death and cancer-specific early death in stage Ⅳ colorectal cancer patients. The area under curve (AUC) value of the all-cause early death prediction model in the training queue was 0.874 [95% CI (0.855, 0.893)], and the AUC value of the cancer specific early death prediction model was 0.874 [95%CI (0.855, 0.894)]; the AUC value of the all-cause early death prediction model in the validation queue was 0.868 [95%CI (0.829, 0.907)], and the AUC value of the cancer specific early death prediction model was 0.867 [95%CI (0.827, 0.907)], indicating that the model had good predictive ability. The calibration curve showed that the predictive models had good consistency with the actual results for predicting early mortality in stage Ⅳ colorectal cancer, and the DCA curve showed that the models could provide patients with higher clinical benefits. ConclusionThe predictive models established in this study have good predictive performance for early mortality in stage Ⅳ colorectal cancer patients, which is helpful for clinical physicians to identify high-risk patients in the early stage and develop personalized treatment plans in clinical practice.
To describe the construction and application of clinical evidence database of traditional Chinese medicine (TCM-CED) so as to provide evidence for TCM research. The construction process primarily includes: expert team building, TCM-CED function module design, evidence collection and quality control. The applications of TCM-CED primarily include the following aspects: automatic generation of systematic review/meta-analysis in TCM, automatic generation of evidence reports on dominant diseases of TCM, automatic generation of evidence index of Chinese patent medicine, optimizing the selection of outcomes in TCM research, tracking methodological and reporting quality of TCM research, and promoting international dissemination of TCM evidence. With the rapid development of information technology and artificial intelligence, TCM-CED will be combined with artificial intelligence to achieve the construction of all-dimensional TCM evidence chain and the automation of the whole process.
Objective To analyze the expression of H2A histone family, member X (H2AFX) gene in lung adenocarcinoma and its influence on prognosis. Methods We analyzed the expression level of H2AFX gene in the tumor tissues (497 cases) and normal adjacent tissues (54 cases) of lung adenocarcinoma patients via The Cancer Genome Atlas. The patients were divided into high expression group and low expression group according to the expression level of H2AFX gene in lung adenocarcinoma samples. The relationship between H2AFX and clinicopathological features of patients was analyzed through logistic regression. Kaplan-Meier survival curve and log-rank test were used to study the correlation between H2AFX expression and the prognosis of lung adenocarcinoma patients. Univariate and multiple Cox regression analyses were performed to determine the prognostic significance of H2AFX expression in lung adenocarcinoma patients. The research also covered H2AFX-related pathways of genes in the development of lung adenocarcinoma with gene set enrichment analysis (GSEA). Results The H2AFX expression was higher in lung adenocarcinoma tissues than that in normal adjacent tissues (P<0.001). Besides, it was significantly correlated with age (P<0.001), T staging (P=0.007), and N staging (P=0.010), but had little to do with M staging or gender (P>0.05). Kaplan-Meier survival curve and log-rank test showed that the survival rate of patients with high H2AFX expression was vastly lower than that of patients with low H2AFX expression (P<0.001). Multiple Cox regression analysis demonstrated that H2AFX could be an independent prognostic factor for lung adenocarcinoma [hazard ratio=1.41, 95% confidence interval (1.11, 1.78), P=0.004]. The results of GSEA displayed that H2AFX was involved in cell cycle, homologous recombination, DNA replication, base excision and repair, spliceosome, mismatch repair, p53 signaling pathway, nucleotide excision and repair, RNA degradation, RNA polymerase, and other pathways. Conclusions The expression of H2AFX gene is high in lung adenocarcinoma, and closely connected to the prognosis, occurrence, and evolution of lung adenocarcinoma. This gene can be one of the new molecular markers and therapeutic targets for lung adenocarcinoma.
ObjectiveTo analyze the distribution, prognostic differences, and characteristics of patients with colorectal cancer (CRC) from 2007 to 2022 based on the current version of the Database from Colorectal Cancer (DACCA), so as to provide a basis for clinical decision-making. MethodsThe eligible CRC patients based on the established screening criteria from the updated DACCA were collected. The distribution and survival status of CRC patients in different residence places were analyzed. The residence places included 21 cities (prefectures) within Sichuan Province. ResultsA total of 5 416 cases that met the screening criteria from 2007 to 2022 were collected. Among these, CRC patients were predominantly concentrated in Chengdu (44.77%), Meishan (5.78%), and Nanchong (4.56%) cities. A heatmap depicting the superimposed trend of CRC patients origins revealed the distribution of patients was basically divided into eastern and western regions along the axis of “Mianyang–Chengdu–Yaan cities”. The majority of patients (5 359 cases, 98.95%) was distributed in the eastern region, while a few in the western region (57 cases, 1.05%). The patients in the eastern region were more high clustered (especially Chengdu city), while those in the western region was sporadically dispersed, and the patients in the western region increased slowly without aggregation. The 1, 3, and 5-year cumulative overall survival rates of the CRC patients in the DACCA were 96.2%, 89.7%, and 85.1%, respectively. The multivariate Cox proportional hazards regression model showed that the male, age ≥35-year old, adenocarcinoma (mucinous adenocarcinoma as a reference), poorly differentiated degree, pTNM stages Ⅲ and Ⅳ, obstruction, and perforation were the risk factors for median overall survival shortening in the CRC patients (all P<0.05). The survival curve of patients with CRC drawn by Kaplan-Meier method showed that the overall survival of CRC patients in different cities (prefectures) had no statistical differences as compared with the integral CRC patients (P>0.05), except for Neijiang city (was worse than that of the integral CRC patients, P<0.05). ConclusionsBased on data analysis for the DACCA from 2007 to 2022, the majority of CRC patients clusters in the eastern region. Chengdu city exhibits a high clustering, while the western region shows a sporadic distribution without aggregation phenomena. It is found that the cumulative overall survival of CRC patients in Neijiang city is worse than that of the integral CRC patients, while which in the other cities (prefectures) was relatively close to that of the integral CRC patients in Sichuan Province.
ObjectiveTo analyze the impact of the residence of patients with colorectal cancer (CRC) on surgical characteristics in the current version Database from Colorectal Cancer (DACCA). MethodsAccording to the established screening conditions, the patients with CRC were collected from the updated version of DACCA on January 23, 2023. The analysis indicators enrolled in this study included: the grouping indicator was residence, the surgical characteristic indicators included the surgical timing, surgical nature, expanded resection, intersphincteric resection (ISR) type, patient’s willingness of preserving the anus, and whether preserving the anus. The patients were categorized into three groups based on the residence: inside Chengdu City, outside Chengdu City within Sichuan Province, and outside Sichuan Province. The surgical characteristic indicators of patients with CRC from different residences were comparatively analyzed. ResultsA total of 6 832 analyzable data rows were enrolled. The results of statistical analysis revealed the following findings: there were no statistical differences in the surgery timing and surgery nature among the patients with colon cancer or rectal cancer from the different residences (Surgery timing: H=1.665, P=0.435; H=4.153, P=0.125. Surgery nature: χ2=1.586, P=0.453; χ2=0.990, P=0.610); For the patients with rectal cancer from the different residences, the distributions of the ISR type (H=0.514, P=0.773), patients’ willingness of preserving the anus (χ2=1.437, P=0.487), and whether preserving the anus (χ2=5.513, P=0.064) had no statistical differences. In addition, although there was no statistical difference in the distribution of expanded resection or not among the patients with rectal cancer in different residences (χ2=2.363, P=0.307), it was found that there was statistical difference in the distribution of enlarged resection or not among the patients with colon cancer in different residences (χ2=17.324, P＜0.001). ConclusionsFrom the data analysis in DACCA, there are not statistical differences in surgical characteristic indicators such as surgical timing, surgical nature, ISR type, patients’ willingness of preserving the anus, and whether preserving the anus among patients with colon or rectal cancer from different residences. However, the proportion of underwent expanded surgery in the colon cancer patients who from outside Sichuan Province as compared with inside Sichuan Province is relatively higher, this suggests that surgical difficulty is more difficult for the patients from outside Sichuan Province.
Objective To establish the Chinese Evidence-Based Medicine/Cochrane Centre Database of Clinical Trials and Diagnostic Tests to provide reliable scientific data for clinical practice, teaching, research and systematic reviewers and submit the results of randomised controlled trials (RCTs) and controlled clinical trials (CCTs) to The Cochrane Collaboration. Methods Data were collected by handsearching and electronic searching based on the criterion of the Collaboration and clinical epidemiology. Results Up to December 2003, there were 16 652 RCTs /CCTs and 3 786 DT included in the database. A total of 4 966 RCTs and CCTs were submitted to the Collaboration. Nineteen specialized databases were set up. Conclusions The first phase of the Chinese Evidence-Based Medicine/Cochrane Centre Database of Clinical Trials and Diagnostic Tests has been completed. The database has provided advice for contributiors both at home and abroad.