ObjectiveTo analyze the surgical treatment characteristics for newly diagnosed colorectal cancer (CRC) patients based on hospital registry data in Sichuan Province. MethodsBased on the hospitalization records of CRC inpatients from all secondary and tertiary hospitals in Sichuan Province (2015–2024), the newly diagnosed CRC patients admitted during 2020–2023 were identified and the rates of primary lesion resection, neostomy, and stoma reversal procedures were evaluated. Then stratified analyses by gender, age, tumor location, and organ metastasis at diagnosis were analyzed. The statistical significance was defined as one-sided test with α=0.025. ResultsA total of 118 787 newly diagnosed CRC inpatients in Sichuan Province (2020–2023) were enrolled, the cohort had a mean age of (66.4±12.3) years, with 70 756 (59.6%) males, 64 646 (54.4%) rectal cancer cases, and 16 418 (13.8%) cases exhibiting synchronous organ metastasis at diagnosis. Within one year post-diagnosis, 84 634 (71.2%) patients underwent primary lesion resection and 26 514 (22.3%) received neostomy procedures, both demonstrating significantly increasing annual trends (χ2trend=72.2, P<0.001; χ2trend=70.6, P<0.001) while showing inverse correlations with advancing age (χ2trend=4 096.0, P<0.001; χ2trend=56.3, P<0.001). Stratified analyses revealed significantly lower primary lesion resection rates among females vs. males, rectal cancer vs. colon cancer, and organ metastasis vs. non-organ metastasis patients (all P<0.001), whereas neostomy rates were higher in females and rectal cancer patients but lower in organ metastasis cases (all P<0.001). Among 26 514 neostomy patients, 11 288 (42.6%) underwent stoma reversal after a median (interquartile range) interval of 123 (95, 188) d, with 8 187 reversals (72.5%) within 6 months, 2 700 (23.9%) during 6–12 months, and 401 (3.6%) after 12 months. Reversal rates increased temporally (χ2trend=80.0, P<0.001) but decreased with advancing age (χ2trend=1 072.3, P<0.001). ConclusionIn Sichuan Province, rising trends are observed in the hospitalization burdern of newly diagnosed CRC and rates of primary lesion resection, neostomy, and reversal.
Objective To analyze the basic characteristics of hospitalized patients with colorectal cancer (CRC), to estimate the hospitalization scale, medical resource utilization, and cross-regional hospitalization of CRC inpatients in Sichuan Province, which will provide data support for scientifically formulating colorectal cancer medical resource allocation measures. Methods Based on the hospital discharge records of CRC inpatients collected from secondary hospitals and tertiary hospitals in Sichuan Province between 2015 and 2019, descriptive statistical analysis was performed and the cross-geographical hospitalizations was visualized using a directed network. Results During the study period, the number of CRC inpatients and hospitalizations increased with time. The average age of CRC inpatients in 2019 was 65.1 years, an increase of 1.5 years in the 5-year-period. The proportion of men was relatively high (about 60.1%) and remained stable in the 5-year-period. The median length-of-stay of CRC inpatients per year was 25 days (IQR: 13 days, 45 days), and inpatients in urban areas were 2 days longer than that in rural areas. The median hospitalization cost of CRC inpatients per year was 32 900 yuan (IQR: 11 200 yuan, 59 300 yuan), men were 500 yuan higher than women, and patients in urban areas were 9 900 yuan higher than that in rural areas. From 2016 to 2019, 13.9% hospitalizations (59 512 hospitalizations) were cross-geographical hospitalizations, where Chengdu had the lowest outflow rate (1.0%) and the highest inflow rate (29.3%). Conclusions CRC inpatients showed an aging trend, and the number of hospitalizations and annual hospitalization costs increased year by year. Cross-geographical hospitalizations mainly flow to the provincial medical center and a small part flow to the regional medical centers.
ObjectiveTo analyze the impact of preoperative hypoproteinemia on postoperative complications in patients with rectal cancer based on the current version of the Database from Colorectal Cancer (DACCA). MethodsThe patient information was extracted from the updated version of DACCA in April 2024 according to predefined inclusion criteria. The preoperative hypoproteinemia and incidence of complications were analyzed. The univariate and multivariate logistic regression analyses were performed to identify risk factors for complications in three postoperative periods (in-hospital, short-term, and long-term). The test level was α=0.05. ResultsA total of 1 440 patients with rectal cancer were included, 322 (22.4%) with preoperative hypoproteinemia and 1 118 (77.6%) without. Compared to the patients without preoperative hypoproteinemia, those with preoperative hypoproteinemia were older (P<0.001), had a lower body mass index (P<0.001), smaller tumor margins (P=0.032), and a higher proportion of patients with pTNM stage Ⅳ (P<0.001). There were no statistically significant differences in the overall incidence of complications during the three postoperative periods (in-hospital, short-term, and long-term) between the patients with and without preoperative hypoproteinemia (χ2=0.399, P=0.280; χ2=0.298, P=0.585; χ2=1.416, P=0.234). Except for urinary retention, there were no significant differences in the incidence of specific complications between the two groups (P>0.05). The univariate and multivariate logistic regression analyses did not identify preoperative hypoproteinemia as a risk factor for postoperative complications (P>0.05). ConclusionsThe results of this study suggest that the incidence of preoperative hypoproteinemia is higher in patients with rectal cancer. Patients with preoperative hypoproteinemia tend to be older, have a lower body mass index, and a higher proportion of pTNM stage Ⅳ. However, it was not found that preoperative hypoproteinemia is a risk factor for postoperative complications.
Objective To analyze the impact of preoperative pulmonary dysfunction on postoperative complications in patients with rectal cancer. MethodsPatient information was extracted from the updated version of West China Database from Colorectal Cancer in April 2024. The incidences of preoperative pulmonary dysfunction and postoperative complications were analyzed. Multivariate logistic regression analyses were employed to explore the risk factors for complications occurring in postoperative phases (in-hospital, short-term). ResultsA total of 1 726 patients with rectal cancer were included. Among them, 684 (39.6%) had preoperative pulmonary dysfunction, while 1 042 (60.4%) did not. Compared to patients without preoperative pulmonary dysfunction, those with pulmonary dysfunction were older [(65.04±10.19) years vs. (57.09±11.83) years, P<0.001], had higher proportion of males [62.9% (430/684) vs. 55.7% (580/1 042), P=0.003], smaller tumor distance from the anal verge [5.0 (1.7, 8.0) vs. 5.0 (2.0, 10.0) cm, P=0.004], higher rates of diabetes [29.8% (204/684) vs. 22.0% (229/1 042), P<0.001] and hypertension [49.0% (335/684) vs. 39.0% (406/1 042), P<0.001]. There were no statistically significant differences in the overall incidence of complications between the two groups during the in-hospital [7.5% (51/684) vs. 7.7% (81/1 042), P=0.798], short-term [6.3% (43/684) vs. 5.5% (57/1 042), P=0.472] and long-term [0.3% (2/684) vs. 0.4% (4/1 042), P=0.552]. However, spectrum analysis showed that the pulmonary dysfunction group had a lower incidence of in-hospital non-digestive system complications [37.3% (19/51) vs. 65.4% (53/81), P=0.019] and a higher incidence of short-term other digestive system complications [20.9% (9/43) vs. 7.0% (4/57), P=0.028]. After controlling for demographic, comorbidity, and tumor-related factors, multivariate logistic regression analysis revealed that preoperative pulmonary dysfunction was not a risk factor of in-hospital complications [OR=0.832, 95%CI (0.559, 1.237), P=0.363] and short-term complications [OR=1.106, 95%CI (0.708, 1.728), P=0.658].ConclusionsPatients with rectal cancer have a relatively high incidence of preoperative pulmonary dysfunction, but it shows no statistically significant association with in-hospital or short-term postoperative complications. Instead, its impact is reflected in changes to the spectrum of complications.
ObjectiveTo analyze the association between preoperative staging (cTNM) and neoadjuvant therapy regimen decision-making and efficacy in patients with rectal cancer in the current version of Database from Colorectal Cancer (DACCA). MethodsThe data analysis for this study selected the DACCA version updated on April 20, 2024. The patient information was collected and categorized into three stages (Ⅱ, Ⅲ, and Ⅳ). The differences in neoadjuvant treatment decision-making and therapeutic effects, including gross changes, imaging changes, and tumor regression grade (TRG), were analyzed. ResultsA total of 3 158 eligible cases were collected in this study, with complete preoperative staging and neoadjuvant therapy decision-making data available for 2 370 patients. There were statistically significant differences in the overall comparison among the patients with rectal cancer in terms of the selection of combined targeted therapy, radiotherapy regimens, and the intensity of neoadjuvant chemotherapy by patients at different preoperative stages (χ2=42.239, P<0.001; χ2=41.615, P<0.001; H=1.161, P=0.004). Specifically, the proportion of patients choosing combined targeted therapy and combined radiotherapy gradually increased as the stage advanced. Among patients at different stages, the proportion of those choosing medium-course chemotherapy was the highest, and the proportion of patients choosing long-course chemotherapy was the highest among those with more advanced stages. Regarding the gross changes, imaging changes, and TRG results after neoadjuvant treatment in the patients at different preoperative stages, there were statistically significant differences in the overall comparison among patients with stage Ⅱ, Ⅲ, and Ⅳ rectal cancer (H=7.860, P=0.020; H=9.845, P=0.007; H=6.680, P=0.035). The proportion of partial response was the highest across all response metrics (macroscopic, radiographic, and TRG) in each stage. Notably, stage Ⅱ patients demonstrated the highest rate of complete response. For TRG evaluation, grade 2 (TRG2) was the most common outcome across all stages. ConclusionsData analysis from DACCA reveals that patients with advanced stages are more likely to choose chemotherapy combined with targeted therapy or radiotherapy, and had a higher proportion of intermediate range chemotherapy and the intensity of neoadjuvant chemotherapy is stronger. In terms of neoadjuvant treatment effects, the earlier the staging, the better the gross and imaging changes, and the lower the TRG level.
Objective To explore the impact of preventive stoma on the occurrence and development trajectory of low anterior resection syndrome (LARS) following rectal cancer surgery. MethodsA retrospective cohort study design was employed to collect clinical data from 540 patients who underwent rectal cancer resection at West China Hospital, Sichuan University between April 2018 and June 2022. Patients were categorized into stoma group (n=275) and non-stoma group (n=265) based on the presence or absence of preventive stoma. Generalized estimating equation was used to analyze the impact of stoma-related factors (presence of stoma, stoma type, and interval to stoma closure) on the occurrence of LARS at 1, 3, 6, 9, and 12 months postoperatively. Latent class growth modeling was employed to identify LARS development trajectories, and multi-class logistic regression was used to assess the influence of stoma-related factors on LARS trajectory categories. ResultsThe incidence of LARS showed an overall downward trend within 12 months postoperatively, the incidence rates at 1, 3, 6, 9, and 12 months after operation were 46.3% (250/540), 36.5% (197/540), 27.8% (150/540), 23.0% (124/540) and 16.9% (91/540), respectively. Generalized estimating equation analysis revealed that preventive stoma (OR=1.410, P=0.283), stoma type (OR=1.375, P=0.099), and interval to stoma closure (OR=0.999, P=0.502) were not independent predictors of LARS occurrence. Conversely, at various postoperative time points, educational level (junior college vs. bachelor’s degree or higher: OR=1.834, P=0.039), TNM (stage 2 vs. stage 4: OR=0.533, P=0.016; stage 3 vs. stage 4: OR=0.556, P=0.015), tumor length (OR=1.316, P=0.015), tumor width (OR=0.707, P=0.009), and surgical procedure (ultra-low anterior resection vs. coloanal anastomosis/colon anal anastomosis: OR=2.076, P=0.017) were closely associated with the occurrence of LARS. Latent class growth modeling identified three LARS trajectory categories: low symptom burden–rapid improvement group (286 cases, 53.0%), high symptom burden–slow improvement group (163 cases, 30.2%), and high symptom burden–persistent impairment group (91 cases, 16.8%). Multi-class logistic regression analysis revealed that the presence or absence of preventive stoma was not a predictive factor for LARS trajectory category (high symptom burden–slow improvement group: OR=0.739, P=0.407; high symptom burden–persistent impairment group: OR=0.693, P=0.400). However, patients undergoing ultra-low anterior resection were more likely to be assigned to the high symptom burden-slow improvement group (OR=2.677, P=0.026).ConclusionsPreventive stoma is not an independent risk factor for the occurrence or trajectory of LARS. The occurrence of LARS is associated with the tumor’s biological characteristics, surgical approach, and postoperative time, moreover, the surgical approach is a key factor influencing the progression of LARS.
Against the backdrop of medical digital transformation, West China Hospital of Sichuan University has conducted a 30-year exploration and practice of colorectal cancer data engineering. This study focuses on the integration of special disease digitization and value-based healthcare, achieving standardized management and in-depth mining of colorectal cancer diagnosis and treatment data through constructing a full-life cycle data governance system, multi-center data platform, and intelligent application scenarios (such as clinical decision support systems). The practical results show that this data engineering has formed a specialized disease database containing more than 9 500 cases of structured data, and promoted the collaborative development of the entire chain of “production–study–research–business–government”, providing a learnable digital paradigm for improving diagnostic and treatment accuracy and optimizing medical resource allocation. The study indicates that special disease digitization is a key path to achieving value-based healthcare, and its experience in data standardization and medical-engineering cross-innovation is of reference significance for other disease fields.