ObjectiveTo analyze the relation between the place of residence of patients with colorectal cancer (CRC) and patient compliance or regimen decision-making or outcomes for neoadjuvant therapy (NAT) in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe version of DACCA selected for this analysis was updated on June 29, 2022. The patients were enrolled according to the established screening criteria and then assigned into inside and outside of Sichuan Province groups as well as inside and outside of Chengdu City groups. The differences in the patient compliance or regimen decision-making or outcomes (changes of symptom and imaging, and cancer marker carcinoembryonic antigen) for NAT were analyzed. ResultsA total of 3 574 data that met the screened criteria were enrolled, 3 142 (87.91%) and 432 (12.09%) were inside of Sichuan Province group and outside of Sichuan Province group, respectively; 1 340 (42.65%) and 1 802 (57.35%) were inside of Chengdu City group and outside of Chengdu City group in Sichuan Province, respectively. ① The constituent ratios of the patient compliance for NAT had no statistical differences between the inside and outside of Sichuan Province groups (χ2=0.299, P=0.585) as well as between the inside and outside of Chengdu City groups (χ2=3.109, P=0.078). ② In terms of the impact of the place of residence on the decision-making of NAT: For the patients with targeted therapy or not, there was a statistical difference between the inside and outside of Sichuan Province groups (χ2=5.047, P=0.025), but which had no statistical difference between the inside and outside of Chengdu City groups (χ2=0.091, P=0.762); For the patients with radiotherapy or not, there were no statistical differences in the constituent ratios of patients between the inside and outside of Sichuan Province groups as well as between the inside and outside of Chengdu City groups (χ2=2.215, P=0.137; χ2=2.964, P=0.085); For the neoadjuvant intensity, there was a statistical difference between the inside and outside of Sichuan Province groups (χ2=12.472, P=0.002), but which had no statistical difference between the inside and outside of Chengdu City groups (χ2=2.488, P=0.288). ③ The outcomes for NAT: The changes of carcinoembryonic antigen had no statistical differences between the inside and outside of Sichuan Province groups as well as between the inside and outside of Chengdu City groups (H=1.762, P=0.184; H=3.531, P=0.060); In the symptom changes, there was a statistical difference between the inside and outside of Sichuan Province groups (χ2=3.896, P=0.048), which had no statistical difference between the inside and outside of Chengdu City groups (χ2=0.016, P=0.900); In the image changes, the difference was statistically significant between the inside and outside of Chengdu City groups (χ2=7.975, P=0.005), but which had no statistical difference between the inside and outside of Sichuan Province groups (χ2=0.063, P=0.802). ConclusionsThrough data analysis in DACCA in this study, it is found that there are no statistical differences in compliance and carcinoembryonic antigen changes. However, decision-making of NAT for patients of inside and outside of Sichuan Province has different choices on whether to assist targeted therapy and chemotherapy intensity for NAT; Symptom changes of NAT in patients of inside of Sichuan Province has a better effect than in patients of outside of Sichuan Province; Imaging change of NAT in patients of inside of Chengdu City has a better effect than in patients of outside of Chengdu City.
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 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 association between preoperative staging (cTNM) and neoadjuvant therapy regimen decision-making and efficacy in patients with rectal cancer in the current version of Database from Colorectal Cancer (DACCA). MethodsThe data analysis for this study selected the DACCA version updated on April 20, 2024. The patient information was collected and categorized into three stages (Ⅱ, Ⅲ, and Ⅳ). The differences in neoadjuvant treatment decision-making and therapeutic effects, including gross changes, imaging changes, and tumor regression grade (TRG), were analyzed. ResultsA total of 3 158 eligible cases were collected in this study, with complete preoperative staging and neoadjuvant therapy decision-making data available for 2 370 patients. There were statistically significant differences in the overall comparison among the patients with rectal cancer in terms of the selection of combined targeted therapy, radiotherapy regimens, and the intensity of neoadjuvant chemotherapy by patients at different preoperative stages (χ²=42.239, P<0.001; χ²=41.615, P<0.001; H=1.161, P=0.004). Specifically, the proportion of patients choosing combined targeted therapy and combined radiotherapy gradually increased as the stage advanced. Among patients at different stages, the proportion of those choosing medium-course chemotherapy was the highest, and the proportion of patients choosing long-course chemotherapy was the highest among those with more advanced stages. Regarding the gross changes, imaging changes, and TRG results after neoadjuvant treatment in the patients at different preoperative stages, there were statistically significant differences in the overall comparison among patients with stage Ⅱ, Ⅲ, and Ⅳ rectal cancer (H=7.860, P=0.020; H=9.845, P=0.007; H=6.680, P=0.035). The proportion of partial response was the highest across all response metrics (macroscopic, radiographic, and TRG) in each stage. Notably, stage Ⅱ patients demonstrated the highest rate of complete response. For TRG evaluation, grade 2 (TRG2) was the most common outcome across all stages. ConclusionsData analysis from DACCA reveals that patients with advanced stages are more likely to choose chemotherapy combined with targeted therapy or radiotherapy, and had a higher proportion of intermediate range chemotherapy and the intensity of neoadjuvant chemotherapy is stronger. In terms of neoadjuvant treatment effects, the earlier the staging, the better the gross and imaging changes, and the lower the TRG level.
Objective To analyze the primary status of database in multi-disciplinary team （MDT） of colorectal cancer, and to explore the tendency in construction of database in the future. Methods Described the current status of different database respectively, and analyzed the data statistically, involving the patients’ general information, essential information of duration of hospital stay, therapy and MDT from the database of patients. Results The development of different database was uncoordinated. Among the total, the database of patients was advanced, the database of reference and the database of specialists were also developing in certain. Conclusion The primary reason, which results in the lag of construction of database currently, is the long span of database and the cost of much time in data acquisition. The direction of development of database involves consummation of database gradually, refreshment of it promptly, and expanding the research of informatics related clinical medicine.
ObjectiveTo analyze the relation between the age of patients with colorectal cancer and neoadjuvant therapy (NAT) regimen 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 January 5, 2022. The patients were enrolled according to the established screening criteria and then assigned to 3 age groups: ≤45, 45–65, and ≥65 years old groups. The differences in the NAT regimen decision-making and changes of symptom, imaging, and cancer markers in these 3 age groups were analyzed. ResultsA total of 4 882 data that met the screened criteria were enrolled. The results of statistical analysis showed that the difference in the constituent ratio of patients chosen NAT strategies among 3 age groups was not statistically significant (χ2=8.885, P=0.180). There was a statistical difference in the constituent ratio of patients chosen combined target drug among 3 age groups (χ2=8.530, P=0.014), it was found that the proportion of the patients with ≤45 years old adopting combined target drug regimen was higher. Although the changes of symptom (H=12.299, P=0.056), image (H=1.775, P=0.412), and cancer markers (H=11.351, P=0.183) had no statistical differences of the 3 age groups after NAT, it was found that the proportions of patients with ≥65 years old with progresses of symptom and imaging changes and elevated cancer markers after NAT were higher, and the proportions of patients with ≤45 years old with complete and partial remissions of symptom and imaging changes and with normal cancer markers after NAT were higher. ConclusionsThrough analysis of DACCA data, it is found that in the selection of NAT strategy for colorectal cancer, the lower age group, the higher proportion of patients adopting combined target drug regimen. Although it is not found that age is related to changes of symptoms, imaging, and cancer markers after NAT, it still shows a trend of better outcomes in younger patients.
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 relation between preoperative staging and surgical decision-making in rectal cancer patients from the West China Colorectal Cancer Database (DACCA) and to identify key factors influencing the selection of surgical approach. MethodsBased on the updated DACCA dataset as of April 24, 2024, the patients with rectal cancer were included. Chi-square tests and logistic regression analyses were performed to evaluate the correlation between preoperative staging [(y)cTNM stage] and the selection of sphincter-preserving surgery or intersphincteric resection (ISR). Additional factors, including age, body mass index (BMI), tumor location, and nutritional score, were assessed for their impact on surgical choices. ResultsA total of 2 733 rectal cancer patients were included. Preoperative (y)cTNM staging distribution was as follows: 23 (0.8%) at stage 0, 388 (14.2%) at stage Ⅰ, 760 (27.8%) at stage Ⅱ, 873 (31.9%) at stage Ⅲ, and 689 (25.2%) at stage Ⅳ. The preoperative stage Ⅱ–Ⅳ were the independent risk factors for both the choices of sphincter-preserving surgery and ISR [stage Ⅱ: sphincter-preserving surgery: OR(95%CI)=13.634 (4.952, 37.540), P<0.001; ISR: OR (95%CI)=3.097 (2.108, 4.551), P<0.001. stage Ⅲ: sphincter-preserving surgery: OR (95%CI)=14.677 (5.339, 40.345), P<0.001; ISR: OR (95%CI)=2.985 (2.042, 4.363), P<0.001. stage Ⅳ: OR (95%CI)=25.653 (9.320, 70.610), P<0.001; ISR: OR (95%CI)=4.445 (3.015, 6.555), P<0.001]. The low/ultra-low tumor location was an independent risk factor for choice of sphincter-preserving surgery [OR (95%CI)=2.038 (1.489, 2.791), P<0.001], but which was an independent protective factor for the choice of ISR [OR (95%CI)=0.013 (0.009, 0.019), P<0.001]. ConclusionsResults of this study are consistent with clinical practice, indicating that preoperative staging is the core basis for surgical decision-making in rectal cancer. With the progression of staging, patients are more inclined to choose non-sphincter-preserving and non-ISR procedures. Although low/ultralow tumors pose great challenges for anal preservation, the proportion of ISR selection remains relatively high. The anatomical location of the tumor and nutritional status also significantly affect surgical selection, necessitating comprehensive preoperative evaluation.
Based on previous evidence-based researches and teaching experience, our team conducted literature and book review, and summarized 4 requirements, 1) effect measure calculation and conversion, 2) registration of evidence-based research, 3) evidence-based research database and 4) quality evaluation tools and reporting guidelines. We developed an online platform of evidence-based medicine research helper using the front-end and back-end technology, which can be accessed using www.ebm-helper.cn. Currently, the online tool has included 46 scenarios for effect measure calculation and conversion, introduction of 7 evidence-based research registration platforms, 26 commonly used databases for evidence-based research and 29 quality evaluation tools and reporting guidelines. This online tool can help researchers to solve specific problems encountered in different stages of evidence-based medicine research. Promoting the application of this platform in evidence-based medicine will help researchers to use the tool scientifically and improve research efficiency.
ObjectiveTo analyze differences in postoperative pathological stage characteristics of colorectal cancer (CRC) patients with different marital status in Database from Colorectal Cancer (DACCA). MethodsAccording to the established screening conditions, the patients were collected from the updated version of DACCA on January 23, 2023, and then assigned into three categories according to marital status: married, unmarried, widowed or divorced patients. The differences in postoperative pathological staging, peripheral nerve involvement, pathological tumor regression grade (TRG), cancer nodules, and high-risk factors among the CRC patients with different marital statuses were analyzed. ResultsA total of 6 947 data matching the screening criteria were collected, including 113 unmarried patients (1.6%), 6 315 married patients (90.9%), and 519 divorced or widowed patients (7.5%). The analysis results showed that the pathological TNM staging (Ⅰ–Ⅳ staging: H=19.030, P<0.001;Ⅰ+Ⅱ and Ⅲ+Ⅳ staging: χ2=19.124, P<0.001), pathological T staging (H=7.147, P=0.028), and high-risk factors grading (H=10.246, P=0.006) had statistical differences. The trend presented that the proportions of the patients with earlier pathological TNM staging and T staging (Ⅰor T1 staging) in the married patients were the highest among the 3 marital statuses patients, and the proportions of the later staging (Ⅳ or T4 staging) were the lowest in the married patients. The same trend was found in the high-risk factors grading. However, there were no statistical differences in other pathological features such as peripheral nerve involvement, pathological TRG, and cancer nodules among the CRC patients with 3 marital statuses (P>0.05). ConclusionsThrough data analysis in DACCA, it is found that CRC patients with different marital statuses exhibit certain differences in postoperative pathological stage characteristics, especially in terms of pathological TNM staging, pathological T staging, and high-risk factor grading. However, this conclusion needs to be objectively regarded. From a statistical perspective, the samples size of patients with 3 marital statuses in this study is different. In the future, further analysis can be conducted by balancing the samples size on this basis. From a clinical perspective, there may be more influencing factors, so objective analysis should be conducted after eliminating interference factors one by one.