结直肠癌患者的文化程度与术前肿瘤学特征的关系:基于DACCA的真实世界数据研究

Relationship between educational level 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,四川大学华西医院结直肠患者人群的受教育程度与术前肿瘤学特征的关系。方法本次数据分析选取的DACCA版本为2022年6月29日更新版,其中分析的数据项目包括:受教育程度、癌前病变、癌家族史、肿瘤部位、肿瘤方位、肿瘤病理学性质、肿瘤形态、肿瘤分化程度和术前TNM分期。根据《中华人民共和国教育法》第十七条规定,将本研究患者的受教育程度分为4类,即文盲、初等教育(小学)、中等教育(初中、高中、中专、中职、中技)和高等教育(大学、高职、大专及以上)。结果按照条件筛选DACCA数据库获得5512条有效数据。数据分析结果显示:癌前病变构成比(χ^(2)=27.398,P<0.001)、肿瘤部位构成比(χ^(2)=42.610,P<0.001)和肿瘤方位构成比(χ^(2)=18.967,P=0.025)在不同受教育程度组间比较差异均有统计学意义;患者本人癌家族史中不同肿瘤病史构成比(χ^(2)=9.345,P=0.133)和亲属癌家族史中不同肿瘤病史构成比(χ^(2)=4.310,P=0.635)、肿瘤病理学性质构成比(χ^(2)=27.027,P=0.202)、肿瘤形态构成比(χ^(2)=16.283,P=0.061)、肿瘤不同分化程度构成比(H=3.672,P=0.299)以及术前肿瘤TNM分期构成比(H=0.156,P=0.984)在不同受教育程度组间比较差异均无统计学意义。结论通过DACCA中的数据分析发现,结直肠癌患者的文化程度与肿瘤学特征存在多种关联。患者的文化程度在排查各类癌前病变时有一定的参考价值;随着文化程度的提高,患者肿瘤位于直肠的比例逐渐降低,位于结肠的比例逐渐升高;文化程度可能通过影响术前肿瘤特征进而对治疗方法及预后造成影响。

Objective To analyze the relationship between educational level and oncological characteristics of colorectal patients served by Sichuan University West China Hospital 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 June 29,2022.The data items analyzed included:educational level,precancerous lesions,family history of cancer,tumor location,tumor orientation,tumor pathology,tumor morphology,tumor differentiation and preoperative TNM staging.According to Article 17 of the Education Law of the People's Republic of China,the educational level of the research subjects was divided into four categories:lliteracy group,the primary educated group(elementary school),the secondary educated group(middle school,high school,vocational school and technical school),and the higher educated group(university,higher vocational school,junior college and above).Results The DACCA database was filtered by conditions to obtain 5512 valid data.The data analysis results showed that there were statistically significant differences in the composition ratios of precancerous lesions(χ^(2)=27.398,P<0.001),tumor site(χ^(2)=42.610,P<0.001)and tumor orientation(χ^(2)=18.967,P=0.025)among the different education groups,and there were not statistically significant differences in the composition ratios of family history of cancer in oneself(χ^(2)=9.345,P=0.133)or in the family(χ^(2)=4.310,P=0.635),tumor pathological properties(χ^(2)=27.027,P=0.202),tumor morphology(χ^(2)=16.283,P=0.061),tumor differentiation degree(χ^(2)=3.672,P=0.299)and the TNM staging of tumors before operation(χ^(2)=0.156,P=0.984)among the different education groups.Conclusions Data analysis in DACCA reveal multiple associations between educational level and oncological characteristics of colorectal cancer patients.The education level of patients has a certain reference value in the investigation of various precancerous lesions.With the increase of education level,the proportion of tumors located in the rectum gradually decreases,and the proportion located in the colon gradually increases,and education level may affect treatment and prognosis by influencing preoperative tumor characteristics.