ObjectiveTo investigate whether neoadjuvant chemotherapy alone may affect recent anal function in patients with rectal cancer.MethodsThe structured data from the December 3, 2018 version of Database from Colorectal Cancer (DACCA) of West China Hospital were extracted . The follow-up investigation was performed within 2 weeks from December 3, 2018 to December 16, 2018 by the telephone. The postoperative anal function of patients with rectal cancer was evaluated by the lower anterior resection symptom (LARS) score questionnaire.ResultsA total of 209 patients with rectal cancer treated by the total mesolectal excision in the Department of Gastrointestinal Surgery of West China Hospital were included. One hundred and thirty-six patients of them were only treated with TME, while the other 73 patients were treated by the TME and neoadjuvant chemotherapy. As for the baseline data of the 2 groups, there was no difference in the age, body mass index, gender, surgical procedure, differentiation degree or anastomotic position (P>0.050), while the pathological staging (P=0.022) and postoperative recovery time (P<0.001) had the significant differences between these 2 groups. The postoperative 1-year LARS score was not associated with the gender, age, body mass index, pathological stage, physical comorbidity, neoadjuvant chemotherapy or time of postoperative recovery (P>0.050), but which was associated with the heart disease (P=0.019) or position of anastomosis (P=0.005). Moreover, the multivariate analysis showed that the higher anastomosis position was a protective factor for the LARS after 1 year (OR=0.706, P=0.003).ConclusionsThere is no significant difference in postoperative anal function between patients with rectal cancer treated with neoadjuvant chemotherapy or not . It suggests that neoadjuvant chemotherapy has no more additional adverse effects on postoperative anal function in patients either.
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.
Objective To analyze the impact of age on surgical reaction and postoperative complications of patients with colorectal cancer served by West China Hospital of Sichuan University as a regional center in the Database from Colorectal Cancer (DACCA). Methods The data of DACCA was updated on January 5, 2022. All data items included age, surgical trauma reaction, elevated body temperature time, exhaust time, pain, mental status, and postoperative hospital complications. According to the age segmentation method in China, the patients can be divided into 3 groups: ≤35 years old (including infant, toddler, child, teenager and youth, set as the younger group), 36–59 years old (set as the middle-aged group), and ≥60 years old (set as the elderly group). Results After scanning, 5 224 data rows were analyzed. There was no significant difference in surgical trauma reaction (H=0.352, P=0.838), elevated body temperature time (H=3.999, P=0.135), exhaust time (H=1.940, P=0.379), mental status (H=2.075, P=0.354), incidence of postoperative complications (χ2=2.078, P=0.354), incidence of anastomotic bleeding (χ2=1.737, P=0.420), incidence of anastomotic leakage (χ2=0.573, P=0.751), and incidence of pulmonary infection (P=0.410) among different age groups, but the younger group had more severe pain (H=12.985, P=0.002) and higher incidence of inflammatory obstruction (χ2=7.789, P=0.020). Conclusions Age has little effect on trauma reaction related parameters and overall incidence of complications in colorectal cancer patients. However, younger patients with colorectal cancer showed increased pain levels and increased incidence of inflammatory obstruction after surgery. These clinical manifestations can provide clinicians with evidence for intervention, but more prospective intervention trials are needed.
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.
Objective To analyze the influence of the age of colorectal cancer patients served by West China Hospital as a regional center on hospitalization process in the current version of Database from Colorectal Cancer (DACCA). Methods The DACCA version was updated on January 5, 2022. All data items analyzed included age, date of admission, date of operation, date of discharge, pre-operation time, post-operation time, total hospital stay and management process. Data were assigned to three groups according to age with ≤45, 46–64 and ≥65 years old. Results After scanning, 8 013 data rows were obtained, from 2005 to 2022. The patients’ ages ranged from 14 to 104 years old, and were (58.01±13.52) years old in average. The results showed that the relationship between age and post-operative time was not statistically related (P>0.05). However, the pre-operative time (P=0.001) and total hospital stay time (P=0.005) were positively correlated with the age of colorectal cancer patients. The pre-operation time was longer in the older-aged group (P=0.021). Youth group had longer total hospital stay than other groups (P=0.028). Additionally, there was significant difference in the management process of colorectal cancer patients of different age groups (χ2=32.824, P＜0.05), but in terms of each process management classification, patients in different age groups had the same choice tendency as the overall choice, with “routine” management accounting for the largest proportion. “ERAS (enhanced recovery after surgery)” management was in the second place. Conclusions This study showed that the age group of patients with colorectal cancer has a certain influence on the length of hospital stay. Older patients have longer pre-operation time, but the effect of age on the total length of hospital stay still remains to be discussed. The composition of clinical management process varies among different age groups, and the elderly patients received the highest proportion of “ERAS” management process.
Objective To analyze the relation between the marital status 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). Methods The 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 to 5 groups: the unmarried, married, divorced, remarried and widowed groups. The differences in the NAT regimen decision-making and changes of symptom, imaging, and cancer markers in these 5 groups were analyzed. Results A total of 3 053 data that met the screened criteria were enrolled. The results of statistical analysis reflected that the difference in the constituent ratio of patients chosen NAT strategies among 5 groups was obviously statistically significant (χ2=27.944, P=0.004), showing that remarried patients were inclined to adopt combined target drug. No statistical differences were found in changes of symptom (H=5.717, P=0.221), image (H=8.551, P=0.073), and cancer markers (H=11.351, P=0.183) of the 5 groups after NAT. Conclusion Through analysis of DACCA data, it is found that in the selection of NAT strategy for colorectal cancer, more married and remarried patients tended to choose chemotherapy combined target drug regimen.
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 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.
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.