| Objectives:By collecting clinical case data,this study explored the clinical characteristics of colorectal cancer in the real world and understood its diagnosis and treatment status,so as to provide experience and guidance for better whole-course management and more accurate treatment of colorectal cancer in the future.Methods:Collected 770 patients hospitalized cases from January 1,2017to December 31,2018,the fourth hospital,Hebei medical university and oncology by pathological diagnosis of colon or rectal cancer,according to the site cases will be divided into the right half colon cancer(cecum,ascending colon,transverse colon,colon spleen area,referred to as the right),left colorectal cancer(descending colon and sigmoid colon,rectum,left side).Clinical data were reviewed,and a database was established,then the data were analyzed by SPSS 21.0 statistical software.The rates of different groups were compared byχ~2 test to analyze the clinical characteristics of colorectal cancer of different gender,age and location.At the same time,the precision treatment status of colorectal cancer patients was elaborated.Patients were followed up(telephone follow-up)until December 31,2018,starting from the time of disease diagnosis(pathological diagnosis)and ending from the time of death.Among them,110 patients reached the end point of death.Four clinical or pathological factors that might affect the prognosis of colorectal cancer were selected for analysis.Kaplan-Meie method was used to draw the survival curve,and Log-rank test was performed.P<0.05 was considered statistically significantResults:1.Clinical characteristics of colorectal cancer of different genders:There were no statistically significant differences in the proportion of patients with clinical early stage,the proportion of tumors with medium-high differentiation,the proportion of mucinous adenocarcinoma,the proportion of gene wild-type and the proportion of microsatellite stable type between the male group and the female group(P>0.05).The incidence of liver metastasis in male group was significantly higher than that in female group,and the difference was statistically significant(P<0.01).The incidence of lung metastasis in the female group was significantly higher than that in the male group,with statistically significant differences(P<0.01).2.Clinical characteristics of colorectal cancer of different age groups:The proportion of mucinous adenocarcinoma,the incidence of lung metastasis and the proportion of patients with microsatellite instability in the group aged<50 years old were significantly higher than that in the group aged>50 years old,with statistically significant differences(P<0.05).The incidence of liver metastasis in patients aged<50 years old was significantly lower than that in patients aged 50 years old(P<0.05),and the difference was statistically significant.The proportion of early stage patients,the proportion of patients with medium-high differentiation,and the proportion of patients with wild-type genes in the age group of 50 years old were not statistically significant(P>0.05).3.Clinical characteristics of colorectal cancer of different sites:The proportion of early stage patients in the right colon cancer group and the proportion of patients with microsatellite instability were all higher than that in the left colorectal cancer group,and the difference was statistically significant(P<0.05).The lung metastasis rate in the right colon cancer group was higher than that in the left colorectal cancer group,and the difference was statistically significant(P<0.05).Compared with the left colorectal cancer group,the proportion of patients with liver metastasis,the proportion of tumors with medium-high differentiation,the proportion of mucinous adenocarcinoma and the proportion of wild-type genes in the right colorectal cancer group was almost equal,and the difference was not statistically significant(P>0.05).4.Status of gene and microsatellite detection in colorectal cancer patients:Among the 209 cases of colorectal cancer patients in our department who underwent postoperative,the detection rate of pathological tissue detection with RAS and BRAF gene was 40%,the K-RAS mutation rate,N-RAS mutation rate and BRAF mutation rate were 45%,1%and 1%,respectively.Among the 230 cases who underwent microsatellite detection,and the detection rate was 44%.The microsatellite instability type accounted for 7.2%.Among the 53 cases of colorectal cancer patients who had not undergone surgery,the screening rate of gene was 26.6%.The K-RAS mutation rate,N-RAS mutation rate and BRAF mutation rate were 26.4%,2%and 7.5%,respectively.The screening rate of microsatellite was 16.1%,and the microsatellite instability type accounted for 7.2%.5.Status of adjuvant therapy in colorectal cancer patients:524 patients with colorectal cancer underwent radical or palliative surgery in our department,44 cases(8.4%)refused adjuvant treatment;Among the patients receiving adjuvant treatment,214 cases(40.7%)XELOX program,153cases(29.3%)FOLFOXprogram,26cases(4.9%)SOXprogram,24cases(4.6%)capecitabine program(70%of the patients were stage IIA,and another 30%were stage III or above but could not tolerate double-drug chemotherapy).6.Current status of precision therapy for patients with advanced colorectal cancer:Among the patients with advanced colorectal cancer in our department,96 cases showed postoperative progression,and the median DFS of stage II and III patients was 18 months and 9 months respectively.66cases(68.8%)received chemotherapy alone(30%of the patients received the oxaliplatin-containingregimenpostoperatively,butthefirst-line oxaliplatin-containing regimen was still used after the progress,and its DFS were all over 6 months).30 cases(31.2%)were treated with chemotherapy combined with targeted drugs(bevacizumab only),and the median application time of vascular targeted drugs was 6 months.Among them,24 cases(25%)were treated with first-line chemotherapy combined with vascular targeted drugs.The patients with stage IV in our department who were treated with first-line,109 cases(55.1%)XELOX,57 cases(28.8%)FOLFOX,14cases(7.0%)SOX and 18 cases(9.1%)Capecitabine.The application of single application of chemotherapy is 111 patients(56.1%),87 cases(43.9%)used targeted therapy of combined chemotherapy,including 3 cases of patients with application of targeted drugs for cetuximab(2 cases of left-sided,1 case of right half,genes are all wild type,and for one line of application),84 cases of patients with application of targeted drugs for beacizumab bead sheet resistance,the median treatment time is 7months;The patients who were treated with chemotherapy combined with vascular targeted therapy at first-line was 65(26.6%).7.Changes in treatment patterns for advanced colorectal cancer in2017-2018:There were a total of 49 patients in 2017,36 cases(73.5%)patients receiving treatment,26 cases(72.2%)of the application of simple chemotherapy,targeted drugs chemotherapy combined vessels of 10 cases(27.8%).The application of vascular targeted drugs time is 3 months,including 9 cases of beacizumab(left 6 cases,right 3 cases),cetuximab 1case(left);There were a total of 75 patients in 2018,65(86.7%)patients receiving treatment.Application of combined vascular targeted chemotherapy drugs of 40 cases(61.5%),and application of vascular targeted drugs time is 9months,beacizumab 33 cases(left 22 cases,right 11 cases),cetuximab 2 cases(left 1 case,right 1 case).8.By univariate analysis of the total survival time of colorectal cancer,treatment were related to the total survival time of the patients(P<0.05),while there was no significant correlation between the gene status,microsatellite status,and the application of targeted drugs and the overall survival of the patients(P>0.05).Conclusions:1.Colorectal cancer is more common in male patients,colorectal cancer liver metastasis is more common in male patients、age>50 years old,while lung metastasis is more common in female and age≤50 years old;The proportion of mucinous adenocarcinoma and microsatellite instability was high in age≤50 years old colorectal cancer patients,and the proportion of microsatellite instability was high in right colon cancer patients.2.The proportion of patients receiving gene and microsatellite detection for colorectal cancer is relatively low.K-ras is the most common gene mutation in colorectal cancer.Standard chemotherapy regimens which include Fluorouracil±oxaliplatin were used for adjuvant or advanced first-line treatment of colorectal cancer patients,and most fluorouracil drugs were oral capecitabine.3.With the development of precision therapy,the proportion of patients with advanced colorectal cancer receiving chemotherapy combined with targeted drugs is on the rise in 2017-2018. |
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