| Objective: This study is based on a national multi-center survey of the current status of colorectal cancer patients,analyzing and exploring the diagnosis and treatment status of stage Ⅲ/Ⅳ colorectal cancer patients in China,their understanding of colorectal cancer related knowledge,medical behavior,economic burden,and self-reported treatment effectiveness;Based on an international public database,analyze the clinical characteristics,treatment strategies,and prognostic factors of stage Ⅲ/Ⅳ colorectal cancer patients,establish a survival prediction model,and verify the model’s discrimination,calibration,and clinical effectiveness;Based on the database of Xinjiang Cancer Center,analyze the clinical characteristics,treatment strategies,and prognostic factors of stage Ⅲ/Ⅳ colorectal cancer patients,and establish a survival prediction model that conforms to the population characteristics of Xinjiang.The aim of this study is to provide a clinical strategy basis for the early detection,diagnosis,improvement of prognosis,and development of personalized and precise treatment plans for colorectal cancer to maximize patient survival benefits.Method: Two cities were randomly selected from 7 administrative regions across the country,with each city selecting a tertiary cancer hospital or tertiary comprehensive as the research center.Convenient samples were used to select Ⅲ/Ⅳ colorectal cancer patients who met the inclusion criteria for questionnaire surveys.The self filled structured questionnaire used in the study mainly used the EORTC QLQ-C30/FACT scale to localize the FACT-C scale(fourth edition),and added relevant information such as demographic sociology,treatment status,health economics,medical behavior,medical insurance,etc.on this basis.A retrospective study was conducted on stage Ⅲ/Ⅳ colorectal cancer patients from the SEER database and the Xinjiang Cancer Center database from January 2010 to December 2019.Prognostic factors were analyzed.First,LASSO regression was used to compress the variables,and then COX uni-variate and multivariate regression models were used to analyze independent risk factors affecting the prognosis and survival of stage Ⅲ/Ⅳ colorectal cancer patients,Establish a clinical prediction model for survival prognosis of stage Ⅲ/Ⅳ colorectal cancer patients using column charts;Conduct internal validation using SEER database and Xinjiang Cancer Center data separately;Simultaneously comparing the demographic,clinicopathological characteristics,and treatment strategies of stage Ⅲ/Ⅳ colorectal cancer patients between the SEER database and the Xinjiang Cancer Center database,and using the Xinjiang Cancer Center database to externally validate the column chart clinical prediction model established based on the SEER database.Result: 1)As the research object,a total of 4533 patients with stage Ⅲ/Ⅳ colorectal cancer were included in 19 hospitals in 7 regions of China,including 2694 males(59.4%),1839 females(40.6%),2063 colon cancer patients(45.51%),and 2470 rectal cancer patients(54.49%);2)Insufficient understanding of risk factors and screening knowledge.65.1% of patients had no knowledge of high-risk factors for colorectal cancer before diagnosis,while 84.9% of patients did not know early screening knowledge.Cognitive level was positively correlated with education level;3)5.82% of patients seek medical attention when abnormalities are found during physical examination,and 76.83% of patients are diagnosed as stage Ⅲ or Ⅳ when diagnosed;37.86% of patients have concurrent metastasis,with 14.01% of them having liver metastasis;4)Treatment methods: Surgery combined with chemotherapy accounted for32.43%,surgery combined with chemotherapy combined with targeted therapy accounted for 13.13%,and surgery alone accounted for 9.75%;5)Biomarker testing: Clinicians recommend that 67.7% of patients with advanced colorectal cancer undergo biomarker testing,while only 46.2% of patients undergo at least one molecular test(RAS,BRAF,or MSI).The RAS gene mutation rate is 37.0%,the BRAF gene mutation rate is 9.9%,and tumors in MSI-H and MSI-L account for 8.1% and 4%,respectively.The type of hospital visited,age at diagnosis,education level,family annual income,doctor recommendation,tumor location The history of radiotherapy,chemotherapy,and metastasis are the influencing factors for receiving gene testing;6)The proportion of stage Ⅲ/Ⅳ colorectal cancer patients choosing to go to prefecture level hospitals for diagnosis and treatment is relatively high.Factors such as age,gender,education level,occupation,patient’s annual family income,medical insurance,whether to transfer at the first diagnosis,and HRQOL before the first treatment are significantly correlated with the level of choosing medical institutions;More than one-third(36.5%)of patients have previously sought medical treatment in another location,and 31.9% of patients have encountered difficulties;7)The participation of patients in treatment decision-making is not high,with 36% of patients being made solely by family members or doctors.Relevant factors include gender,age at diagnosis,education level,average annual income of the family,and type of hospital visited;8)Patients have a heavy burden of self paid medical expenses,with nearly 80% of patients taking measures to alleviate economic pressure,including reducing household expenses(66.2%),reducing household purchases of large items(57.3%),and borrowing from relatives and friends(25.5%);9)3824 patients in the treatment stage submitted self efficacy evaluation reports.For the first treatment,76.46% of patients believed that the treatment effect was good,14.81% of patients believed that the condition remained stable,and 8.73% of patients believed that the treatment effect was poor.The total HRQOL score of stage Ⅲ/Ⅳ colorectal cancer patients is 128.2±24.70,which is lower than the general population.There is a correlation between gender,education level,occupation,region,number of hospitals visited,and treatment methods and HRQOL score;10)In the SEER database,33776 patients with stage Ⅲ/Ⅳ colorectal cancer were included in the queue,including 23644 in the modeling group and 10132 in the validation group.Patient age,primary tumor site,tumor differentiation,T-stage,preoperative CEA level,degree of neural invasion,lymph node metastasis rate,and radiation history were independent factors that affect the prognosis of stage Ⅲ/Ⅳ colorectal cancer.A survival prediction model was established by incorporating a column chart.The AUC values of the internal validation ROC curve were 0.727 and 0.7305 in the modeling and validation groups,respectively;The calibration curve is relatively close to the ideal 45°,and the DCA curve is plotted,showing good clinical effectiveness.Using the stage Ⅲ/Ⅳ colorectal cancer data from the Xinjiang Cancer Center database as external validation,the AUC value is0.612,and the calibration curve is not completely close to the ideal 45° reference line.The DCA curve is relatively close to the XY axis;11)There are certain differences in demographic and pathological characteristics between the SEER database and the Xinjiang Cancer Center database for stage Ⅲ/Ⅳ colorectal cancer patients.The proportion of patients over 60 years old,the proportion of preoperative CEA abnormalities,and the proportion of patients with lymph node metastasis greater than 0.6 are all higher in the SEER database(59.03%,65.26%,66.27%)than in the Xinjiang Cancer Center database(48.96%,54.02%,46.26%).The proportion of stage Ⅳ patients,preoperative nerve infiltration,liver,lung The proportion of patients with bone metastasis was higher in the Xinjiang Cancer Center database(49.77%,28.69%,35.25%,22.65%,15.94%)than in the SEER database(22.39%,20.99%,15.36%,3.77%,0.54%).Comparing the treatment strategies of the two databases,the SEER database showed a higher surgical rate(96.87%)compared to the Xinjiang Cancer Center patients(86.29%),and a higher resection rate for metastatic lesions The rates of chemotherapy and radiation therapy were higher among patients in the Xinjiang Cancer Center database(23.01%,91.37%,44.81%)than those in the SEER database(9.94%,74.51%,20.99%);12)The Xinjiang Cancer Center database ultimately included 3325 patients with stage Ⅲ/Ⅳ colorectal cancer in the queue,identifying 8 independent prognostic risk factors,including primary tumor site,pathological stage,degree of differentiation,longest tumor diameter,surgery,liver metastasis,brain metastasis,and spleen metastasis.Incorporating the column chart to predict survival,the internal validation AUC values were 0.784 and 0.792 in the modeling and validation groups,respectively.The calibration curve for overall survival was relatively close to the ideal 45°reference line.Conclusion: 1)patients with stage Ⅲ/Ⅳcolorectal cancer have poor understanding of risk factors and early screening knowledge before diagnosis,and the early diagnosis rate is relatively low;Its biomarker detection rate and targeted drug treatment rate are both low;Most patients choose to seek medical treatment at prefecture level hospitals,with about one-third of patients seeking cross regional medical care and 31.9% experiencing difficulties in seeking medical treatment in other places;The dominance of patients in treatment decision-making is not high,with the vast majority making decisions together with their families or by their families/doctors;Patients have high self paid medical expenses and a heavy economic burden;In terms of self-reported treatment effectiveness,the HRQOL score is significantly lower than that of the general population;2)The survival prognosis model established based on the SEER database can effectively predict the survival rate of stage Ⅲ/Ⅳ colorectal cancer patients in the United States,but its predictive ability is weak when extended to external validation of patients at the Xinjiang Cancer Center;3)The prognostic model established based on the Xinjiang Cancer Center database can effectively predict the survival rate of stageⅢ/Ⅳ colorectal cancer in Xinjiang.Through internal validation,its discrimination,consistency,and clinical effectiveness are all high;4)There are certain differences in demographic characteristics,pathological characteristics,and treatment strategies between SEER database and stage Ⅲ/Ⅳ colorectal cancer patients at Xinjiang Cancer Center. |
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