Dynamic Trend Analysis Of Characteristics And Genetic Mutations In 68 Patients With Advanced Colorectal Cancer In The Real World

This research is divided into two parts:review and clinical research.First of all,the present situation of the real world research method in the research of TCM tumor is discussed.Secondly,the western medicine treatment of colorectal cancer under the guidance of precision medicine is expounded.In the clinical research section:The first part screened the dominant population according to the screening criteria of the dominant population.By comparing the differences of the dominant and non dominant groups,the dominant population characteristics of the TCM in advanced colorectal cancer were explored.In the second part,a group of patients with the next generation equencing of gene mutation were analyzed and analyzed in order to explore the relationship between the changes of the abundance of ctDNA and the progression of the disease.Research 1:Characteristics of TCM in Advanced Colorectal CancerObjective:By comparing the differences of the dominant and non dominant groups to explore the dominant population characteristics of the TCM in advanced colorectal cancer.Methods:On the basis of real world registration,120 cases of advanced colorectal cancer patients were selected from October 13,2016 to mid March 2018 from the registration and Registration Platform and Hise system in the outpatient and ward of our hospital and Descriptive analysis the baseline data.According to the follow-up and whether genetic testing was performed,68 patients were selected from 120 patients.Using prospective cohort study,combined with the latest data of the surval period of advanced colorectal cancer and the concept of predominant population of TCM,39 National Integrated Chinese and Western cancer experts were consulted by expert consultation method,and on the basis of survival results and genotyping.68 patients were divided into dominant group(26 cases)and non dominant group(42 cases),and the general data,life history,past history,tumor disease characteristics and treatment characteristics of the two groups were compared and analyzed.Results:1 Demographic DataThere was no significant difference in the sex and age between the dominant group and the non dominant group(P>0.05).The two groups had statistically significant difference in KPS(P<0.05),and the KPS more than 80 in the dominant group had a higher proportion(65.38%)and in the multivariate Logistic regression analysis model,KPS is the independent influencing factor of the dominant group of Chinese medicine.2 History of Previous Intestinal Related DiseasesThere was no significant difference between the dominant and non dominant groups in the history of chronic constipation,chronic diarrhea,and intestinal polyps(P>0.05).There were statistical differences in the history of sticky blood and stool(P<0.05),and the dominant group had a history of bloody stool(46.2%).3 History of Tumor DiseaseThere was no statistically significant difference between the two groups(P>0.05)for the tumor location,pathology,metastatic siteand and genotyping of the dominant and non dominant groups.4 Syndrome DifferentiationThere was no significant difference in syndrome differentiation between dominant and non dominant groups(P>0.05),but the proportion of spleen-kidney deficiency(50%)in the dominant crowd was significantly higher than that of non dominant group(35.7%).5 Western Medicine RreatmentThere was no significant difference in palliative chemotherapy and radiotherapy between dominant and non dominant groups(P>0.05),but there were statistical differences between targeting therapy(P<0.05),and in the dominant group,no targeted therapy accounted for a high proportion.6 TCM RreatmentThere was no significant difference between the dominant group and the non dominant group in the period of oral Chinese patent medicine(P>0.05);There were statistical differences in the time of oral Chinese Medicine,Decoction of Four Mild Drugs time(P<0.05).and the mean time,median time was higher than that of non dominant population.In the Logistic multivariate regression analysis model,the IV time of oral Chinese medicine is an independent factor affecting the dominant group of Chinese medicine.7 Main symptoms of TCMThe main symptoms scores were all classified according to the NRS grading method of pain.The interval(0---10 points)represented different degrees of symptoms(0 was asymptomatic,and 10 was the most severe symptom).The study found that as time goes on,the scores of TCM main symptoms of the dominant group fluctuate slowly from top to bottom,and tend to be stable.However,the main symptoms of the non dominant group decreased during a certain period of time,but they had been fluctuating.The number of changes in TCM main symptoms was less than that of the non dominant group,and there was a significant difference between the two groups(P<0.05).Conclusion:There were statistical differences between the dominant group and non dominant group in KPS,whether there was a history of sticky blood and stool,whether to target treatmentt,as well as oral Chinese medicine,Decoction of Four Mild Drugs and.the number of main changes.The dominant population of TCM may have the following characteristics:KPS>80,a high proportion of the history of sticky blood and stool,no target treatment,long time oral Chinese medicine,less main symptoms and better stability of the body,and the KPS and the time of oral Chinese medicine is the independent influence of the dominant population of TCM factor.Research 2:The correlation and dynamic trend of ctDNA mutation in advanced colorectal cancer under the Next generation sequencing technologyObjective:Objective to describe the mutation characteristics of the next generation sequencing gene,and to discuss the relationship between the cases of 2 and above ctDNA dynamic monitoring and the progression of advanced colorectal cancer.Methods:(1)A descriptive statistical method was used to analyze the genetic mutation of 61 patients with advanced colorectal cancer,which were detected by next generation of gene,and the correlation analysis between the general data,the site of the tumor,the pathological data,the location of the metastasis,the syndrome differentiation and so on,and to explore the characteristics of the gene distribution.(2)In 24 cases with 2 and more ctDNA dynamic monitoring,the relationship between the variation of ctDNA mutation and the progression of the disease was explored by observing the mutation abundances of the gene ctDNA and the evaluation of the curative effect,the tumor markers and the dynamic changes of the main disease.The next generation of gene detection is responsible for panoramic driving gene exon DNA sequencing by Nanjing Shihe gene biology Co.,Ltd.Results:In this study,a total of 61 patients were enrolled in the study.There were 41 cases of simultaneous tissue and plasma paired examination and the pairing rate.is 98.8%.1 There were 36 males and 25 females in 61 cases,among which there was a statistically significant difference between ERBB2 mutation and sex(P<0.05),and the mutation rate was higher in women.The mutations of KRAS,STK11 and THADA genes were statistically different in different age groups(P<0.05)and were higher in 40 years of age.Whether PTCH1 mutation and smoking had statistical differences(P<0.05)and only PTCH1 mutations were found in smokers;There was a significant difference between BRAF mutation and tumor location(P<0.05)and BRAF mutation had a high proportion in right colon cancer;KRAS、TP53、APC、PIK3CA、TGFBR2、FBXW7 mutation and liver metastasis were statistically different(P<0.05),and the proportion of patients with KRAS,TP53 and APC mutations in the liver metastases was higher,while PIK3CA,TGFBR2 and FBXW7 have a higher proportion of patients with liver metastases.There was a significant difference between the mutation of TGFBR2 gene and lymph node metastasis(P<0.05),and occupied a high proportion in lymph node metastasis.2 In the 24 patients who underwent dynamic ctDNA testing for 2 times or more,the variation of ctDNA abundance was highly consistent with the overall trend of overall disease change,and the concordance rate was 79.2%.The total gene ctDNA abundances were highly concordance with the RECIST evaluation criteria,with a consistent rate of 83.33%.The variation of ctDNA abundance and the trend of swollen marks had a high consistency,the consistency rate was 76%,and the coincidence rate of the ctDNA abundance and the main trend was 47.7%.In depth observation of the genes of the ctDNA abundances and the contrary tendency of the disease,it was found that it could be found earlier than the traditional tumor markers and imaging examinations.Conclusion:The ctDNA detection and traditional tissue detection in the observation group had a higher matching rate.Whether the mutation of ERBB2 might be related to sex and had a high mutation rate in women;The mutation of KRAS,STK11 and THADA gene may be related to age,and it has a high mutation rate in people below 40 years old.PTCH1 mutation is associated with smoking and has a high mutation rate in smokers.BRAF mutation may be associated with left and right colorectal cancer and has a high mutation rate in right colon cancer;The mutation of KRAS,TP53,APC,PIK3CA,TGFBR2 and FBXW7 is related to liver metastasis,and the mutation rates of KRAS,TP53 and APC in liver metastases were higher,while PIK3CA,TGFBR2,and FBXW7 were higher in patients without liver metastases.The mutation of TGFBR2 gene may be related to lymph node metastasis.The variation of ctDNA abundance is highly consistent with the change of disease and it may have the effect of predicting the change of the disease in advance.