目的 分析当前版本华西肠癌数据库(Database from Colorectal Cancer,DACCA)中,不同新辅助治疗方案对直肠癌患者预后的影响.方法 根据制定的筛选条件从2022年11月24日更新版DACCA中提取患者信息,分析项目包括:性别、年龄,体质量指数(body mass index,BMI)、婚姻、经济条件、分化程度、新辅助治疗方案和pTNM分期.根据新辅助治疗方案将其分为化疗组、化疗联合放疗组和化疗联合靶向治疗组3组,分析3组患者的总生存(overall survival,OS)期和疾病特异性生存(disease specific survival,DSS)期,应用单因素和多因素Cox比例风险回归模型分析OS和DSS的影响因素.结果 按照筛选条件从DACCA数据库中获得有效数据1 716条,其中化疗组954条(55.6％),化疗联合放疗组332条(19.3％),化疗联合靶向治疗组430条(25.1％).3组不同新辅助治疗方案患者OS和DSS的Kaplan-Merier生存曲线差异均有统计学意义(x2=142.142,P＜0.001;x2=129.528,P＜0.001);3组间的3年和5年OS率和DSS率差异均有统计学意义(P＜0.001);进一步行不同新辅助治疗方案组间两两比较发现:化疗联合靶向治疗组的3年OS略优于化疗组,而5年OS和DSS较化疗组略差,但差异均无统计学意义(P＞0.05);化疗组和化疗联合靶向治疗组的3年和5年OS和DSS均优于化疗联合放疗组,其差异均有统计学意义(P＜0.01).多因素分析结果发现患者的年龄、经济条件、肿瘤分化程度、新辅助方案和pTNM分期是OS和DSS的影响因素.结论 新辅助治疗方案将影响直肠癌患者的长期生存预后.
Effect of neoadjuvant regimens on prognosis in patients with rectal cancer:a real-world study based on DACCA
Objective To analyze the impact of neoadjuvant regimens on prognosis in patients with rectal cancer in the current version of the Database from Colorectal Cancer(DACCA)database.Methods Patient information was extracted from the updated version of DACCA on November 24,2022 according to the established screening criteria,and the following items were analyzed:gender,age,body mass index(BMI),marriage,economic conditions,degree of differentiation,neoadjuvant treatment regimen,and pTNM staging.According to the neoadjuvant treatment regimen,the patients were divided into three groups:chemotherapy group,chemotherapy combined radiotherapy group,and chemotherapy combined targeted therapy group,and the overall survival(OS)and disease-specific survival(DSS)of patients in the three groups were analyzed,and the influencing factors of OS and DSS were analyzed by univariate and multivariate Cox proportional hazard regression models.Results According to the screening criteria,1716 valid data were obtained from the DACCA database,of which 954(55.6％)were in the chemotherapy group,332(19.3％)in the chemotherapy combined radiotherapy group,and 430(25.1％)in the chemotherapy combined targeted therapy group.The differences in the Kaplan-Merier survival curves of patients with different neoadjuvant regimens for OS and DSS in the three groups were statistically significant(x2=142.142,P＜0.001;x2=129.528,P＜0.001).There were significant differences in OS rate and DSS rate between the three groups in 3 years and 5 years(P＜0.001).Further comparison of different neoadjuvant therapy groups showed that the OS of the chemotherapy combined targeted therapy group was slightly better than that of the chemotherapy group in 3 years,however,OS and DSS in 5 years were slightly worse than those the chemotherapy group,but the difference were not statistically significant(P＞0.05).The OS and DSS of the chemotherapy group and the chemotherapy combined targeted therapy group were better than those of the chemotherapy combined radiotherapy group in 3 years and 5 years,and the differences were statistically significant(P＜0.01).The results of multivariate analysis showed that patients'age,economic conditions,degree of tumor differentiation,new auxiliary scheme and pTNM staging were the influencing factors of OS and DSS.Conclusion Neoadjuvant treatment regimen will affect the long-term survival prognosis of rectal cancer patients.
neoadjuvant therapyrectal cancerdatabase from colorectal canceroverall survivaldisease specific survival
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万方数据
