| BackgroundColorectal cancer(CRC)is one of the most common digestive tract malignant tumors.Its symptoms are insidious and difficult to detect in the early stage.More than 50%of patients will eventually develop into metastatic colorectal cancer(mCRC),which threating the survival of colorectal cancer patients and causing a serious economic burden.Although the existing treatment methods have achieved certain curative effects,they are still not ideal.Traditional Chinese medicine is of great significance in the treatment of mCRC.However,due to the characteristics of TCM treatment based on syndrome differentiation,most studies were of low quality,or there were many confounding factors,which cannot provide high-level evidence for the efficacy of TCM in the treatment of mCRC.In addition,the formulation and adjustment of the treatment plan is mostly based on the clinical experience of the doctor and the personal wishes of the patients,and a good diagnosis and treatment plan has not been formed.The optimal treatment strategy is still an urgent clinical problem.ObjectiveBased on the Surveillance,Epidemiology,and End Results Program(SEER)database,the prognostic factors and survival time of mCRC patients were analyzed.To clarify the efficacy of integrated traditional Chinese and Western medicine in the treatment of mCRC,patients with mCRC from the Registration Platform of Oncology Department of Xiyuan Hospital of China Academy of Chinese Medical Sciences were compared with those from SEER database.Summarize the medication rules of TCM in different interventional treatment programs.On the basis of the previous optimal dynamic intervention strategy of traditional Chinese medicine for mCRC,the sample size was increased,and TCM covariates related to prognosis were added to improve the model and provide more accurate guidance for the selection of integrated traditional Chinese and western medicine treatment plans for mCRC patients.Methods1.Analysis of clinical characteristics and prognostic factors of patients with metastatic colorectal cancer—a retrospective study based on the SRRE databaseA total of 13,056 cases were collected from the SEER database of patients with mCRC diagnosed by pathology from 2016 to 2018.Univariate and multivariate Cox regression analysis was used to study the relationship between clinical characteristics and prognosis of mCRC,and to identify prognostic risk factors.Stepwise regression was used to screen the clinical factors that had the greatest impact on prognosis and used to construct a nomogram prognostic model.Finally,the calibration curve was used to evaluate the accuracy of the nomogram prediction model in predicting the 1-and 2-year overall survival of patients with mCRC.2.Efficacy Analysis of Integrative Traditional Chinese and Western Medicine for Advanced Colorectal Cancer Patients-Propensity Score Matching Analysis Based on SEER Database and Real-World ResearchThe clinical case data and survival information of 383 patients with mCRC treated in the outpatient department of Yang Yufei,director of the oncology department of Xiyuan Hospital,China Academy of Chinese Medical Sciences from January 2013 to December 2021 were collected as a cohort of integrated traditional Chinese and Western medicine.The demographic information,clinical and pathological treatment,treatment information and survival information of 31735 patients with mCRC were used as the western medicine cohort.The baseline characteristics and survival analysis of the two groups were compared,and the baseline information of the two groups was matched by propensity score matching(PMS)to eliminate the baseline difference of mCRC between the two queues.Kaplan Meier survival curve was used to analyze the survival difference between the two cohorts of mCRC patients after matching.3.Combing the diagnosis and treatment scheme of integrated traditional Chinese and Western medicine for mCRC--rescription mining based on HIS systemThe information of mCRC patients treated in the outpatient service of Professor Yang Yufei,from January 2019 to January 2022 in the Hospital Information Sy stem(HIS)of Xiyuan Hospital of China Academy of Chinese Medical Sciences was extracted,and 1668 times of 464 mCRC patients were collected and sorted.By constructing a TCM prescription database,the TCM prescriptions of different intervention schemes were mined based on the methods of frequency statistics,association rule analysis and systematic clustering.4.Study on the Optimal Dynamic Intervention Strategy of TCM for mCRC based on Professor Yang Yufei’s clinical experienceFrom the 383 mCRC cases in clinical study 2 who were treated in the outpatient service of Professor Yang Yufei,Department of Oncology,Xiyuan Hospital,China Academy of Chinese Medical Sciences,210 mCRC patients who met the criteria of inclusion and exclusion were screened.The patients were divided into three treatment types according to different TCM intervention treatment strategies,namely pure TCM treatment,auxiliary treatment of western medicine of TCM and equal emphasis on Chinese and western medicine therapy.The TCM and Western medicine factors that affect the actual TCM intervention treatment strategies,such as gender,age,Eastern cooperative oncology group(ECOG)score,onset site,pathological type,metastatic site,genotype,Western medicine treatment stage at the initial outpatient consultation,TCM syndrome differentiation,etc.,were used as decision variables.Using the cost sensitive classification learning for survival(CSCLSurv),the two-stage treatment strategy was used as the research object to improve the TCM dynamic intervention treatment strategy model for mCRC.Results1.Analysis of clinical characteristics and prognostic factors of patients with metastatic colorectal cancer—a retrospective study based on the SRRE databaseAge,race,marital status,disease site,degree of differentiation,pathological type,liver metastasis,lung metastasis,bone metastasis,distant lymph node metastasis,metastasis to other sites,primary tumor resection,metastasis resection,chemotherapy,and elevated carcinoembryonic antigen(CEA)are independent prognostic factors for mCRC.Based on the above factors,a nomogram model was constructed,the receiver operating characteristic curve was analyzed,and the prognostic model predicted that the area under curve in 1 and 2 years was above 0.7,and the model had good diagnostic value.2.Efficacy Analysis of Integrative Traditional Chinese and Western Medicine for Advanced Colorectal Cancer Patients——Propensity Score Matching Analysis Based on SEER Database and Real-World ResearchThe results of pre PSM statistical analysis showed that there were significant differences in gender,marital status,diagnosis time,primary location,pathological type,bone metastasis,liver metastasis,lung metastasis,chemotherapy,radiotherapy and surgery between the two cohorts(P<0.05).The proportion of male patients,married patients,left colon patients,patients with bone metastasis,patients with lung metastasis and patients undergoing primary focus resection in the cohort of integrated traditional Chinese and Western medicine was higher;while the proportion of patients with liver metastasis,chemotherapy and radiotherapy was lower.There was significant difference in survival time between the two groups.A total of 925 patients were included after PMS,including 689 cases in the Western medicine cohort and 236 cases in the integrated Chinese and Western medicine cohort.There was no significant difference in gender,age,diagnosis time,marital status,primary location,pathological type,liver metastasis,lung metastasis,bone metastasis,distant lymph node metastasis,other site metastasis,resection of primary site,radiotherapy and chemotherapy between the two groups(P>0.05).The matching results were satisfactory.369 patients died in the western medicine cohort,and the median survival time was 19 months.A total of 178 patients in the integrated traditional Chinese and Western medicine cohort died,and the median survival time was 34 months,which was significantly better than that in the western medicine cohort.3.Combing the diagnosis and treatment scheme of integrated traditional Chinese and Western medicine for mCRC--rescription mining based on HIS systemAfter sorting out,a total of 9 types of mCRC treatment plans have been summarized,including pure TCM,TCM combined with local therapy,TCM combined with single-drug chemotherapy,TCM combined with single-drug chemotherapy+targeted drugs,TCM combined oral targeted drugs,TCM combined oral targeted drugs+oral chemotherapy drugs,TCM with double/triple chemotherapy,TCM combined with double/triple+bevacizumab/cetuximab,and TCM combined with immunotherapy.TCM always takes"strengthening the spleen,nourishing the kidney and detoxification" as the basic method.According to the strength of "detoxification" in Western medicine,the doses of anti-tumor drugs and anti-tumor Chinese patent medicines in TCM are also adjusted accordingly.At the same time,according to the characteristics of toxic and side effects treated by western medicine,Chinese medicine also has corresponding additions and subtractions.4.Study on the Optimal Dynamic Intervention Strategy of TCM for mCRC based on Professor Yang Yufei’s clinical experienceA total of 210 cases were included in the study,and 147 cases entered the second stage of TCM Intervention treatment,including 107 dead cases and 103 surviving cases;63 cases did not enter the second stage of TCM intervention.Taking the survival time of TCM Intervention treatment as the evaluation index,the TCM optimal dynamic intervention treatment strategy for mCRC established based on CSCLSurv algorithm can dynamically select different TCM Intervention treatment strategies for mCRC according to different decision variables such as gender,age,ECOG score,primary site,pathological type,metastasis site,genotyping,number of Western medicine treatment lines at initial diagnosis,TCM syndrome differentiation and so on.Conclusionthis paper clarified the efficacy of integrative medicine in the treatment of mCRC and provided a basis for further research on the treatment of integrative medicine by comparing the clinical characteristics and survival time of mCRC patients between the SEER database and the oncology registration platform of Xiyuan Hospital,Chinese Academy of Chinese Medical Sciences.The 9 kinds of treatment plans of integrated traditional Chinese and Western medicine for mCRC provided new ideas for the treatment of mCRC,and the optimal dynamic intervention strategy of traditional Chinese medicine for metastatic colorectal cancer based on this provides guidance for the selection of treatment plans for patients with mCRC.In the future,the model can be further improved,optimized and popularized through the integrated traditional Chinese and western medicine tumor diagnosis and treatment platform,in order to provide a path of integrated traditional Chinese and western medicine treatment with Chinese characteristics for patients with metastatic colorectal cancer. |
