结直肠癌患者职业与新辅助方案决策和疗效的关系:基于DACCA的真实世界数据研究

Association between occupational type of patients with colorectal cancer and decision making or curative effect of neoadjuvant therapy:a real-world study based on DACCA

目的分析在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职业类型与新辅助方案决策和疗效的关系。方法根据制定的筛选条件,从2022年6月29日更新版DACCA中收集符合条件的结直肠癌患者,其中分析的数据项目包括:性别、年龄、BMI、血型、婚姻、职业、新辅助方案、症状变化、影像变化、病理学肿瘤消退分级(tumor regression grade,TRG),按劳动类型将职业分为脑力劳动组、体力劳动组、无业及居民组,比较不同职业类型患者新辅助治疗后的临床症状、病理特征等,探究结直肠癌患者职业类型对新辅助治疗的决策与疗效的影响。结果共筛选出符合条件的数据2415条,其中体力劳动组1160条(48.0%),最多,其次为无业及居民组877条(36.3%),最后为脑力劳动组378条(15.7%)。≤60岁和>60岁患者中,不同职业类型与使用靶向药物有关(P=0.004、P=0.019),未使用靶向药物的患者占比均更高[75.6%(958/1267)比82.5%(947/1148)]。>60岁的患者中,不同职业类型与新辅助治疗后的症状变化和影像变化有关,二者变化为部分缓解者均最多[71.5%(161/225)比66.7%(148/222);P=0.001、P=0.017]。结论通过DACCA数据分析发现,结直肠癌患者的职业类型与新辅助方案的选择有关;>60岁患者中,不同职业类型与结直肠癌患者新辅助治疗前后疗效变化有关,需要进一步分析其原因。

Objective To analyze the relationship between occupational type of patients with colorectal cancer(CRC)and decision-making and curative effect of neoadjuvant therapy in the current version of the Database from Colorectal Cancer(DACCA).Methods The eligible CRC patients were collected from June 29,2022 updated DACCA according to the screening criteria,in which the data items analyzed included:gender,age,BMI,blood type,marriage,occupation,neoadjuvant therapy,symptomatic changes,imaging changes,and tumor regression grade(TRG),and the occupations were classified into the mental labour group,physical labour group,and the unemployed and resident groups according to the type of labour,then compared the decision-making and curative effect of neoadjuvant therapy among the 3 groups.Results A total of 2415 eligible data were screened,of which 1160(48.0%)were the most in the manual labour group,followed by 877(36.3%)in the unemployed and resident group,and finally 378(15.7%)in the mental labour group.The proportion of those who did not use targeted drugs was higher in both patients≤60 years old and>60 years old[75.6%(958/1267)vs.82.5%(947/1148)],with both differences being statistically significant(P=0.004 and P=0.019),and among patients>60 years old,the different occupational types were associated with symptomatic changes and imaging changes after neoadjuvant therapy,with the highest number of both changes to partial remission[71.5%(161/225)vs.66.7%(148/222)],both differences being statistically significant(P=0.001 and P=0.017).Conclusion The analysis results of DACCA data reveal that the occupational type of CRC patients was associated with the choice of neoadjuvant therapy,and that different occupational types were associated with changes in curative effect before and after neoadjuvant therapy in CRC patients>60 years old,which needs to be further analysis for the reasons.