结直肠癌患者的居住地与肿瘤学特征的关系:基于DACCA的真实世界数据研究

Relationship between the residence and oncological characteristics of colorectal cancer patients:A real-world study based on DACCA

目的分析目前版本的华西肠癌数据库(Database from Colorectal Cancer,DACCA)中,四川大学华西医院作为区域性中心所服务的结直肠患者人群的居住地与肿瘤学特征的关系。方法本次数据分析选取的DACCA版本为2022年1月5日更新版,其中分析的数据项目包括:居住地、癌前病变、癌家族史、肿瘤部位、肿瘤形态、肿瘤方位、肿瘤病理学性质、肿瘤分化程度和术前TNM分期。根据数据库中结直肠癌患者居住地的区域分布划分为四川组和非四川组,四川组又分为四川成都组和四川非成都组。结果按照条件筛选DACCA数据库获得7232条有效数据。①不同居住地癌前病变的构成比:四川组与非四川组比较差异有统计学意义(χ^(2)=14.462,P=0.003),四川成都组与四川非成都组比较差异无统计学意义(χ^(2)=7.591,P=0.101)。②不同居住地癌家族史的构成比:在本人癌家族史中,四川组与非四川组以及四川成都组与四川非成都组比较差异均无统计学意义(χ^(2)=1.121,P=0.606;χ^(2)=1.047,P=0.621);在亲属癌家族史中,四川组与非四川组以及四川成都组与四川非成都组的亲属癌家族史中不同肿瘤病史构成比的差异均无统计学意义(χ^(2)=0.813,P=0.692;χ^(2)=2.696,P=0.262)。③不同居住地肿瘤部位构成比:四川组和非四川组比较差异无统计学意义(χ^(2)=0.476,P=0.490),四川成都组和四川非成都组比较差异有统计学意义(χ^(2)=36.216,P<0.001)。④不同居住地肿瘤形态构成比:四川组和非四川组比较差异有统计学意义(χ^(2)=19.560,P<0.001),四川成都组和四川非成都组比较差异无统计学意义(χ^(2)=5.377,P=0.247)。⑤不同居住地肿瘤方位构成比:四川组与非四川组以及四川成都组与四川非成都组之间肿瘤方位的构成比差异均有统计学意义(χ^(2)=17.484,P=0.005;χ^(2)=26.820,P<0.001)。⑥不同居住地肿瘤病理学性质构成比:四川组与非四川组以及四川成都组和四川非成都组CRC患者的病理学性质比较差异均无统计学意义(χ^(2)=8.136,P=0.408;χ^(2)=7.278,P=0.506)。⑦不同居住地肿瘤分化程度构成比:四川组与非四川组以及四川成都组和四川非成都组之间,肿瘤不同分化程度的构成比差异均无统计学意义(H=0.289,P=0.591;H=0.156,P=0.693)。⑧不同居住地术前肿瘤TNM分期构成比:四川组与非四川组之间,CRC患者术前TNM分期的构成比差异有统计学意义(H=8.023,P=0.005);四川成都组与四川非成都组之间,CRC患者术前TNM分期的构成比差异无统计学意义(H=0.218,P=0.640)。结论通过DACCA中的数据分析发现,结直肠癌患者的居住地与肿瘤学特征存在多种关联。不同居住地的结直肠癌患者的癌前病变种类构成存在差异;在癌家族史中结直肠癌的比例更高;从肿瘤发生部位来看,肿瘤位于直肠的占比高于结肠;在各地区肿瘤形态构成中,均为溃疡型最多;结直肠癌患者的肿瘤方位构成不同,累及肠壁1圈者最多;大多数结直肠癌患者发现肿瘤时已是中晚期,非四川省的中晚期患者所占比例更高。

Objective To analyze the relationship between the residence and oncological characteristics of colorectal patients served by Sichuan University West China Hospital as a regional center in the current version of the Database from Colorectal Cancer(DACCA).Methods The DACCA version selected for this data analysis was the updated version on January 5,2022.The data items analyzed included:residence,precancerous lesions,family history of cancer,tumor location,tumor morphology,tumor orientation,tumor pathology,tumor differentiation and preoperative TNM staging.According to the regional distribution of colorectal cancer patients'residence in the database,they were divided into Sichuan group and non-Sichuan group,and the Sichuan group was further divided into Sichuan-Chengdu group and Sichuan-non-Chengdu group.Results The DACCA database was filtered by conditions to obtain 7232 valid data.①The composition ratio of precancerous lesions in different places of residence:The difference between the Sichuan group and the non-Sichuan group was statistically significant(χ^(2)=14.462,P=0.003),and the difference between the Sichuan-Chengdu group and the Sichuan-non-Chengdu group was not statistically significant(χ^(2)=7.591,P=0.101).②Composition ratio of family history of cancer in different places of residence:In the family history of cancer in oneself,the difference between Sichuan group and non-Sichuan group as well as between Sichuan-Chengdu group and Sichuannon-Chengdu group were not statistically significant(χ^(2)=1.121,P=0.606;χ^(2)=1.047,P=0.621).In the family history of cancer in relatives,the differences in the composition ratio of different tumor histories between the Sichuan group and the non-Sichuan group,and between the Sichuan-Chengdu group and the Sichuan-non-Chengdu group were not statistically significant(χ^(2)=0.813,P=0.692;χ^(2)=2.696,P=0.262).③Tumor site composition ratios in different places of residence:The difference between Sichuan group and non-Sichuan group was not statistically significant(χ^(2)=0.476,P=0.490),and the difference between Sichuan-Chengdu group and Sichuan-non-Chengdu group was statistically significant(χ^(2)=36.216,P<0.001).④Tumor morphology composition ratio in different places of residence:The difference between Sichuan group and non-Sichuan group was statistically significant(χ^(2)=19.560,P<0.001),and the difference between Sichuan-Chengdu group and Sichuan-non-Chengdu group was not statistically significant(χ^(2)=5.377,P=0.247).⑤Composition ratio of tumor orientation in different places of residence:The differences in composition ratio of tumor orientation between Sichuan group and non-Sichuan group and between Sichuan-Chengdu group and Sichuan-non-Chengdu group were statistically significant(χ^(2)=17.484,P=0.005;χ^(2)=26.820,P<0.001).⑥Composition ratio of tumor pathological properties under different residence:The differences in the comparison of pathological properties between Sichuan group and nonSichuan group as well as between Sichuan-Chengdu group and Sichuan-non-Chengdu group of CRC patients were not statistically significant(χ^(2)=8.136,P=0.408;χ^(2)=7.278,P=0.506).⑦Composition ratio of tumor differentiation degree under different residence groupings:the differences in the composition ratio of tumors with different degrees of differentiation were not statistically significant between Sichuan group and non-Sichuan group,and between Sichuan-Chengdu group and Sichuan-non-Chengdu group(H=0.289,P=0.591;H=0.156,P=0.693).⑧The composition ratio of TNM staging of tumors before operation in different places of residence:between the Sichuan group and the non-Sichuan group,the difference in the composition ratio of preoperative TNM staging of CRC patients was statistically significant(H=8.023,P=0.005);between the Sichuan-Chengdu group and the Sichuan-non-Chengdu group,the difference in the composition ratio of preoperative TNM staging of CRC patients was not statistically significant(H=0.218,P=0.640).Conclusions Data analysis in DACCA reveal multiple associations between the place of residence and oncological characteristics of CRC patients.There are differences in the composition of the types of precancerous lesions among CRC patients in different places of residence.The proportion of CRC is higher in the family history of cancer.In terms of the site of tumor occurrence,the proportion of tumors located in the rectum is higher than that in the colon.In the composition of tumor morphology in all regions,the ulcerative type is the most frequent.The composition of tumor orientation is different in patients with CRC,and those who has involved a circle of the intestinal wall are the most frequent.Most CRC patients are already in middle or late stage when the tumor is discovered,and the proportion of middle or late stage patients in nonSichuan provinces was even higher.