Clinical Characteristics And Prognostic Factors Of 499 Patients With Colorectal Cancer

Objective:To summarize the clinical characteristics of 499 patients with colorectal cancer treated in the First Affiliated Hospital of Dali University from January 1,2015to August 30,2020,and to study the prognostic factors of patients with colorectal cancer in our hospital,so as to further understand the diagnosis and treatment of patients with colorectal cancer in our hospital,so as to provide reference for the prevention of colorectal cancer and treatment to provide reference,so as to better guide the clinical work of our hospital.Methods:the clinical data of 499 patients with colorectal cancer treated in the First Affiliated Hospital of Dali University from January 1,2015 to August 30,2020 were retrospectively analyzed,including the general situation（gender,age,occupation,education level,nationality,region,smoking,drinking,etc.）,clinical characteristics（first symptom,tumor location,clinical stage,ECOG score）and surgical treatment methods of operation,the number of metastatic sites,whether combined chemotherapy,chemotherapy regimen,efficacy evaluation,survival and so on.The progression free survival（PFS）and overall survival（OS）were followed up.SPSS25.0 statistical software was used for data management and analysis in this study.Descriptive analysis and survival analysis were conducted for each factor,including chi square test,univariate Kaplan Meier analysis and multivariate COX regression analysis.result:1.A total of 499 patients were included in this study,including 65 in 2015,68in 2016,99 in 2017,92 in 2018,118 in 2019 and 57 from January to August 2020.There were 279 males and 220 females.The ratio of male to female was 1.27:1.The minimum age of onset was 18 years old,the maximum age of onset was 84 years old,and the average age was 59.76±11.40 years old.The majority of nationalities are Han and Bai,accounting for 51.9%and 33.1%respectively.Most of the patients came from cities and counties within the jurisdiction of Dali Bai Autonomous Prefecture,a total of 413 cases（82.77%）.2.In this study,213 cases of colon,286 cases of rectum（57.31%）,including 95 cases of left colon（19.04%）,118 cases of right colon（23.65%）;the clinical manifestations of patients were hematochezia,abdominal pain,difficult to defecate,accounting for 43.28%,37.87%,5.81%respectively;135 patients had metastasis,including 79 cases of single organ metastasis,56 cases of multiple organ metastasis,single organ metastasis could be transferred to the liver（48.87%）,lung（15.19%）,lymph node（24.04%）,etc.3.In the degree of pathological differentiation,ulcerative type was the most common,221 cases,followed by uplift type and polyp type;tumor differentiation was the most moderately differentiated,321 cases（64.33%）;in this study,431 cases described the depth of invasion,including T₁12 cases（2.78%）,T₂38 cases（8.82%）,T₃241 cases（55.91%）,T₄140 cases（32.49%）,42 cases（9.74%）in stage I,186 cases （43.16%）in stage II,167 cases（38.75%）in stage III and 36 cases（8.35%）in stage IV.4.In this study,456 cases（91.38%）were operated and 43 cases（8.62%）were non operated,among which 296 cases（59.32%）were operated by laparoscopy and154 cases（30.86%）were operated by laparotomy.Among the surgical patients,425cases（85.17%）underwent radical resection and 31 cases（6.21%）underwent palliative operation;135 cases had metastasis,including 38 cases of liver metastasis;52 cases（10.42%）used targeted drugs,including 40 cases（8.02%）used bevacizumab and 9 cases（1.80%）used cetuximab.5.The factor analysis of relevant research data showed that there was no significant difference in gender,nationality,occupation,tumor location,neoadjuvant chemotherapy,surgery or not,adjuvant chemotherapy and year（P>0.05,no statistical significance）;in the choice of targeted treatment,the number of people receiving targeted treatment increased year by year,the difference was statistically significant（P<0.05）.6.499 patients were followed up to 478 cases,388 cases survived,90 cases died,21 cases lost,the follow-up rate was 95.19%.The overall median PFS was 20.5months and the median OS was 27.2 months.Diabetes mellitus,appendectomy,tumor differentiation,primary tumor（T stage）,regional lymph node（N stage）,distant metastasis（M stage）,TNM stage,operation,operation mode,neoadjuvant therapy,combined targeted therapy had statistical significance on the prognosis of colorectal cancer patients（P<0.05）.By OS multivariate Cox regression analysis,diabetes, appendectomy,regional lymph node（N stage）,distant metastasis（M stage）,neoadjuvant therapy,surgery,adjuvant chemotherapy were closely related to the prognosis of colorectal patients;by PFS multivariate COX regression analysis,diabetes,appendectomy,regional lymph node（N stage）,distant metastasis（M stage）were obtained neoadjuvant therapy is closely related to the prognosis of colorectal patients.Conclusion:1.From 2015 to 2020,the number of cases of colorectal cancer in our hospital increased year by year,and the incidence rate of male was higher than that of female,and all ages could be found.Most of the ethnic groups were Han（51.9%）and Bai（33.1%）.82.77%of the patients came from cities and counties within the jurisdiction of Dali Bai Autonomous Prefecture.2.Rectum is the most common primary site of tumor,abdominal pain, bloody stool and difficult defecation are the first symptoms of most patients,and liver metastasis is the most common metastatic site.3.Operation is the main means of treatment,surgical treatment can significantly improve the prognosis of patients.4.The survival and prognosis of colorectal cancer patients are related to diabetes,appendectomy,tumor differentiation,primary tumor（T stage）,regional lymph node（N stage）,distant metastasis（M stage）,TNM stage,operation,operation mode,neoadjuvant therapy and combined targeted therapy.PFS multivariate analysis:diabetes,appendectomy,regional lymph node（N stage）,distant metastasis（M stage）and neoadjuvant therapy were closely related to the prognosis of colorectal cancer patients,and they were all independent risk factors affecting the prognosis of colorectal cancer.5.Multivariate analysis of OS:diabetes mellitus,appendectomy,regional lymph node（N stage）,distant metastasis（M stage）and neoadjuvant therapy were risk factors affecting the prognosis of colorectal cancer,while surgery and adjuvant chemotherapy were protective factors affecting the prognosis of colorectal cancer.