| BackgroundIn recently several decades there have witnessed a tremendous advancement in the management of hepatocellular carcinoma (HCC). However, still a great deal of problems must be studied in this area. Further clinical research should be done in order to find out the risk factor affecting the therapeutic effect and to select appropriate therapeutic methods in the treatment of HCC. It has practical importance to do the work to guide the clinical decision making. Owing to the work of treating the patients who suffer from HCC scattered in different department in hospital except few specialized clinical centers in China, there exist a series of problems such as difficulty of data collection and analysis, short of reproducibility and accuratissime when research work is done. Such disadvantages limit large scale clinical researches and brings us to choose treat mode with subjective and one-sidedness. So the question is often contemplated by the aesculapians who have to finish the heavy clinical work: could we have a convenient and high-performance method to acquire the data so that the data, which is needed and useful information, can be analyzed, aggregated and retrieved to guide clinical decision. Thanks to the development of computer and network and database technique, the opportunity and possibility have been provided for solving the problem. In stead of the application software on advanced database, which can be used by the expert on database, Microsoft Access can be mastered easily by the physician dealing with clinical work. It can not only store datapermanently, retrieve and inquire useful information quickly, but make the tabulations and plots as well. What's more, data interchange can be completed between Access and Excel. Therefore, statistical analysis and curative evaluation can be executed easily, prognosis tendency predicted, clinical plan provided for doctors. The database integrating the function of information management and data analysis would be beneficial to our clinical researches.In the meantime, we have founded that both of survivin and vascular endothelial growth factors (VEGF) are two hot oncogenes in tumors' studies in recent years. Survivin containing a baculovirus of apoptosis repeat (BIR) is a recently discovered protein belonging to the inhibitor of apoptosis (LAP) gene family.Survivin is expressed in embryonic tissues as well as in the majority of human cancers, but is not expressed in most normal adult tissues and terminally differentiate tissues. The cancer-specific expression of surviving, coupled with its important in inhibiting cell death and in regulating cell division, makes it a useful diagnostic maker of cancer and a potential target for cancer treatment. Series of studies has proved that VEGF is upregulated in a variety of human cancers, and its high-expression in tumors is associated with a more aggressive phenotype and poor prognosis. Both of them in HCC are not unclear. The investigation about their expression and correlations between them in HCC would be beneficial to predicting the patients' prognosis and then the targeted therapy on HCC would be broken through in the future.For the reason above-mentioned, this study was designed to construct the Specialized Microsoft Access Database of HCC (SMADHCC) in hospital and evaluate the therapeutic effect and analyze the prognostic factors in order to find the reasonable modality of HCC therapy. The expression of Survivin and VEGF in HCC and the relationship between them would also be studied by means of IT.ObjectiveThe aims of this study are: 1. to construct SMADHCC and get the messages of patients suffering from HCC in hospital, 2. to investigate the curative effect of HCC for finding reasonable treatment modality by means of retrospective analysis and large-sample research, 3. to detect the expression of Survivin and VEGF and therelationship between them in course of the origin and the development on HCC. Methods1. Accorging to the diagnosing and staging national standards for HCC and pathological diagnosis, a total of 940 medical records of HCC in Zhujiang hospital from Jan 1993 to Dec 2003 were used to create a SMADHCC with personal computer containing Microsoft Access and Excel and SPSS 10.0. The patients suffering from metastatic hepatic carcinoma were not brought into the study.2. The follow-ups were performed by phone or follow-up sheet, ended by the end of 2004. According to the different treatment modalities, nine hundred and forty patients suffering from HCC were divided into four groups: group A was treated by combined therapy with operation (n=181), group B by removal operation only (n=44), group C by combined therapy with no-operation (n=369), group D (excluding group B) by no-combined therapy (n=346). Data extracting from the SMADHCC having been constructed were analyzed in SPSS 10.0 and different treatment modes were estimated retrospectively to find out the risk factors and protected factors for establishing reasonable clinical strategies.3. The expression of Survivin and VEGF in 48 HCC, 48 Para-tumorous liver tissues and 10 normal liver tissues were detected by the means of IT, the data and the correlation between Surviving and VEGF were analyzed.4. Statistical comparisons of numeration data for significance were made by Chi-square test or Fisher' exact test and measurement data by independent sample Mest, correlation test by Spearman, cumulative survival rates were analyzed by life table, and cumulative survival curves by Kaplan-Meier, clinical characteristics and prognostic factors by Cox's proportional hazard regression model, and Log-Rank method were performed. The statistical difference, in all analyses, was accepted when the P-value was lower than 0.05, and all statistical analyses were performed by using SPSS 10.0.Results1. The SMADHCC consisting of 940 medical records on HCC in hospital was established successfully within 4 months, and the statistical analysis of data in it hadbeen finished. The database system, which possesses powerful capacity for the management information of HCC, works in good condition.2. There were no statistically differences of clinical data before treatment in group A and B, group C and D (P>0.05). The overall 1-, 3-, 5- year survival rates in all patients were 55.74% > 38.SS*^ 23.19% respectively, and the median survival time was 28.8 months. The 1-, 3-, 5- year survival rates in group A, B, C, D were 87.26%, 77.33%, 51.97%; 83.33%, 70.51%, 29.97%; 67.13% ? 39.26% , 20.89%; 23.26%,8.66%, 6.74%, respectively. The median survival time in different group was 75.2 months, 58.9 months, 33.7 months, 11.9 months, respectively. There was significant difference between every two groups by Log-Rank analyses (P<0.05).The univariate analysis revealed that frequency in hospital, complications, hepatic cirrhosis type and staging, AST level, serum bilirubin level, serum albumin level, ascitic fluid, hepatic encephalopathy, nutritional status, AFP level, Child-Pugh grades, vein tumor thrombus, type of tumor, tumor number, tumor location, extra-hepatic metastases and treatment modalities significantly affected the survival rate (P<0.05). However, gender, age, serum ALT level, and HBsAg were not found to exert an influence of the survival rate(P>0.05) .Cox regression multivariate analysis showed that frequency in hospital, nutritional status, treatment modalities, Child-Pugh class, vein tumor thrombus, extra-hepatic metastases significantly affected the survival rate(/><0.05) . The former three were protection factors while the latter three were risk ones.3. Expression of Survivin in 30 of the 48 HCC tumor samples was positive (62.5%), but 48 para-tumorous liver tissues and 10 normal liver tissues had no expression; positive rates of VEGF expression in 48 HCC, 48 Para-tumorous tissues and 10 normal liver tissues were 68.8%, 35.4%, 20.0%, respectively. Both of Survivin and VEGF were negative correlations with the HCC cell differentiation degree (rs=-0.434, -0.380, respectively, P<0.05). There were significant positive correlations relationship between expression of Survivin and VEGF in HCC (rs=0.662, P<0.05), the association between them is close (Gamma=0.818, P=0.000).Conclusions1. It is of great practicality to construct a database of HCC using Microsoft Access and of convenience to retrieval information and recycle data. The database is beneficial to not only information management of medical records but also clinical treatment & diagnosis and clinical research on HCC.2. Combined therapy with operation represents the optimal therapeutic efficacy. Though removal operation may result in well curative effect, high recurrence rate after operation without other adjunctive therapy reduces the survival time. Compared with no-combined therapy group, combined therapy without operation on no-chance procedure patients can also reach better efficacy.It is beneficial to prolongation of survival time to increase the frequency in hospital, to improve patients' nutritional status, to adopt appropriate treatment modality. However, bad Child-Pugh class, vein tumor thrombus and extra-hepatic metastases reduce the survival time.4. The expression level of Survivin and VEGF keeps an important role in the course of origin and development of HCC. Both of them interact and influence each other, keep synergistic effect. Detecting the expression of Survivin and VEGF in HCC conduce to understanding the progression of disease and prognosis of HCC. |
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