| Part 1: Status investigation of clinical incidence, diagnosis and treatment of prostate cancer in Tianjin.Objective To analyze the status and changing trends of clinical incidence, diagnosis and treatment of prostate cancer in Tianjin and explore the differences and shortages in diagnosis and treatment of prostate cancer between Tianjin and advanced foreign country, hoping to improve the diagnosis and treatment level of prostate cancer in Tianjin.Methods Supported by Tianjin Cooperation Group of Prostate Cancer Diagnosis and Treatment, we retrospectively analyzed the clinical data of 965 prostate cancer cases in fourteen hospitals of Tianjin from January 1983 to December 2005. The prostate cancer clinical incidence data of Tianjin Cooperation Group and incidence data of Tianjin were compared. The 965 cases were divided into 3 groups: the first group including 107 patients between 1983 and 1992 (clinical detection of serum PSA for prostate cancer began in 1993 in Tianjin)., the second one including 271 cases from 1993 to 1999 and the third including 587 cases in 2000~2005. The comparison and analysis for these clinical data involved patients age, clinical behavior at diagnostic time, digital rectal examination (DRE), transrectal ultrasound (TRUS), prostate biopsy, computerized tomography (CT), magnetic resonance imaging (MRI), single photon emission computerized tomography (ECT), tumormarkers, clinical stage, tumor grade and therapy methods. At last, clinically related data of the third group and those of PCE and SEER were compared.Results The rude incidence of prostate cancer in 1981 and 2000 in Tianjin were about 1 per 100,000 men and 4 per 100,000 men. The prostate cancer cases of Tianjin Cooperation Group accounted for about 58.9% of new cases in Tianjin. 587 patients of prostate cancer were diagnosed and hospitalized between 2000 and 2005, namely 97.83 + 20.89 cases diagnosed per year. The total cases were 9.14 folds more than those from 1983 to 1992 and 2.50 folds more than those from 1993 to 1999. The 60- and 70- age segments were principal parts (72.9%, 79.0% and 76.8% in 3 groups). With time advancing, the average age of prostate cancer patients had an increasing trend (p=0.000). The main patients were diagnosed when they had clinical signs and symptoms ( 99.1%, 98.9% and 95.9% in 3 groups), few patients were diagnosed through health examination (0.9%, 1.1% and 4.1%). Clinical detection rate of serum PSA were 57.6% in group 2 and 87.1 % in group 3 and that of TRUS were 5.6%, 7.0% and 24.0% in three groups, respectively. The diagnoses rate of prostate cancer combined DRE, PSA with TRUS could improve and achieved to 97.2% in the recent 6 years. The clinical application rate of preoperative prostate system sextent biopsy were 8.5%, 23.4% and 53.1%. Clinical use of CT(17.8%> 20.7% and 28.6%), MRI(4.7%> 4.4% and 23.0%) and ECT (11.2%, 14.4% and 38.2%)for stage purpose increased, but diagnosed rate had an decreasing trend. The proportion of early staged cases were 13.1%> 14.3% and 19.2% and those of late staged were 86.9%> 85.7% and 80.8%, and there was no statistical difference among these 3 groups(p=0.132). As tumor grade as concerned, the tumor grade proportion of well differentiated tumors(17.9%^ 15.6% and 13.8%), poorly differentiated ones(64.1%, 65.6% and 44.8%) and moderated differentiated tumors(17.9%, 18.8% and 41.4%) wasstatistical difference among these 3 groups (p—0.000). The clinical use rate of prostectomy and bilateral orchiectomy were 0.9%, 1.1%, 8.3% and 51.4%, 59.0%, 57.8% respectively. The clinical application proportion of chemistry therapy, radiation therapy, bisphosphonates, radiofrequency thermal ablation (RFTA) and radionuclide therapy were 2.6%, 3.2%, 5.3%, 1.9% and 1.9% Respectively. Comparing the clinical data of 3nd group with those of foreign country, the proportion of patients with no symptom were 2.9%vs68.7%, late stage patients were 80.7%vsl6.9%, poorly or undifferentiated graded tumor were 44.8%vsl9.8%, prostectomy were 8.3%vs37.0%.Conclusion There is increasing trend prostate cancer incidence , hospitalized patients and their average age in Tianjin. The clinical application of serum PSA examination obviously improved the clinical detection rate of prostate cancer. Combining DRE, PSA with TRUS could improve diagnose rate of prostate cancer and decrease false-negative rate. The chief role of MRI in staging and prostate system sextent biopsy in preoperative diagnosis had been established. Prostectomy increased recently(0.9%^ 1.1% and 8.3%) with the increase of early staged cases. Bilateral orchiectomy remained an important role in hormonal therapy of prostate cancer. The proportion of new management aimed to hormonal-refractory prostate cancer and bone-metastasis remained low. compared with abroad, patients of prostate cancer with late stage and poorly differentiated grade had high proportion in all prostate cancer patients in Tianjin, so the most urgent and important thing is to improve the early diagnosis for prostate cancer.Part 2: Construction of clinical data web database of prostate cancer case history in Tianjin.Objective To realize the digitization storage of prostate cancer clinical data, multi-central intercommunion and collaboration, convenience of scientific analysis and scientific evaluation of clinical data, we plan to construct clinical data web database of prostate cancer case history in Tianjin.Methods The database was designed by three-tier client/server architecture with MySQL building up the database server and PHP developing the application program. The database was designed upon several functional modules, i.e. system controlling, data recording, query, data output and system maintenance. The data included almost all clinical significance items in prostate cancer case history and the items were divided to 5 parts, i.e. fundamental information, common information, varied examination, treatment methods and subsequence visit information. The relation between basic case history recording and subsequence visit recording was one-to-many designed. The case history data of prostate cancer came from all member units of Tianjin Cooperation Group of Prostate Cancer Diagnosis and Treatment.Results The clinical data web database of prostate cancer case history have been successfully established. Data communication through Internet proved to be stable and fluent, information storage was convenient and complete, the query function was perfect and credibility, data output was fluent and accurate.Conclusion The database system have stability, security, compatibility and evident specialistic characteristics. The multi-central clinical data digitization storage and data intercommunion and sharing through Internet are primarily realized. The web database supplied strong foundation for improving efficiency and quality ofprostate cancer clinically scientific research. |
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