Real-world Evidence In The Treatment Of Colorectal Cancer And Gastric Cancer

Objective:Relying on professional databases,the registration studies of colorectal cancer and gastric cancer based on hospital were carried out.Continuous data of etiology,diagnosis,treatment and prognosis of patients were collected comprehensively.By mining and analyzing these data,so as to provide scientific support for the establishment of standardized treatment of colorectal cancer and gastric cancer in line with China's clinical reality.Method:By searching literature databases,guideline databases and websites of authoritative academic organizations at home and abroad,we can understand the disputes and differences between different guides in the treatment of colorectal cancer and gastric cancer,and determine the purposes of study correspondingly.Based on the research purpose,special database for storing and analyzing data of patients was established.After the completion of all data entry,according to the different research purposes,subjects that meet the requirements were screened in the database,respectively.Each research purpose forms an independent statistical table.SPSS 23.0 was used for statistical analysis after data collation.Results:? Professional databases of colorectal cancer and gastric cancer were established.Each database contains seven forms:general information,diagnosis data,surgical data,post-operative adjuvant therapy,neoadjuvant therapy,palliative treatment and follow-up records.Up to July 2018,the databases of colorectal cancer and gastric cancer registered 1341 and 967 patients,respectively;?Family history of colorectal cancer is closely related to the incidence of colorectal cancer in patients younger than 50 years old;?In stage II colorectal cancer patients without high risk factors,the median disease-free survival(DFS)was 29.8 months for patients receiving adjuvant chemotherapy and 27.8 months for patients undergoing surgery alone,with no significant difference(P=0.89);?In stage II colorectal cancer patients with high risk factors,postoperative combined chemotherapy or single-drug chemotherapy has no effect on DFS(P>0.05);?In stage III colorectal cancer patients,after at least 4 months of chemotherapy with XELOX or FOLFOX,conversion to capecitabine monotherapy for 2-3 cycles does not affect prognosis(P?0.65);?In colorectal cancer patients with simultaneous liver metastasis,the progression free survival(PFS)was not affected by the sequential order of surgery and chemotherapy(P>0.05);?In colorectal cancer patients with simultaneous liver metastasis,after completion of perioperative treatment,the median PFS of patients in maintenance group was 16.8 months which was significantly longer than that of patients without maintenance therapy for 11 months[HR(95%CI):0.5(0.3-0.9),P=0.04)];?In the first-line treatment of advanced colorectal cancer,the median PFS of patients combined with local therapy was 9.5 months,longer than that of patients without local therapy[(HR(95%Cl):0.4(0.3-0.7),P<0.001)];?In the first-line treatment of advanced colorectal cancer,there was no effect on PFS whether local local therapy was performed before or after first-line chemotherapy(P?0.29);? In advanced colorectal cancer patients whose condition is controlled after first-line chemotherapy and then treated locally,and the patients were divided into two groups according to whether they continued treatment after local therapy or not.The median PFS of the non-continuing treatment group was 7.9 months,and that of the continuing treatment group was 11.7 months.The difference was statistically significant[(HR(95%Cl):3.5(2.1-5.9),P<0.001)];11 In advanced colorectal patients whose condition is controlled after first-line chemotherapy and then treated locally,without further treatment,the duration of progression was 1.9 months.In patients with progression of first-line treatment,and then treated locally,without further treatment,the duration of progression was 1.9 months.There was no significant difference in two groups(P 0.57);12 There was no difference in the effect of five first-line maintenance treatments for advanced colorectal cancer on first-line PFS(P=0.86),including fluorouracil monotherapy,bevacizumab monotherapy,cetuximab monotherapy,bevacizumab plus fluorouracil and cetuximab plus fluorouracil;13 The best curative effect of first-line therapy(P=0.035)and whether combined with local therapy(P=0.046)are the factors influencing the curative effect of first-line maintenance therapy for advanced colorectal cancer;14 In the first-line treatment of advanced colorectal cancer,compared with the two groups whose interval time from maintenance therapy to first-line chemotherapy was less than 4 months and 4-6 months,the first-line PFS of patients whose interval time from maintenance therapy to first-line chemotherapy was more than 6 months was significantly prolonged.(P<0.001);15 After the first-line maintenance therapy for advanced colorectal cancer progressed,reuse the first-line treatment or replace it with the second-line treatment,and there was no difterence in the time of re-progress(P>0.05);16In third-line chemotherapy for advanced colorectal cancer,introducing oxaliplatin or irinotecan after failure of previous treatment regimens containing oxaliplatin and irinotecan,the median PFS was 3.5 months and 3.1 months,respectively.The remission rate and control rate were not ideal;17When regitroxel-based regimens were used in third-line and above-line treatment for advanced colorectal cancer,the median PFS was 3.1 months,and remission rate and disease control rate were 6.4%and 51.3%,respectively.There was no improvement in median PFS in combination with different chemotherapy or targeted drugs,and the incidence of adverse reactions in combination chemotherapy group was significantly higher;18 When apatinib-based regimens were used in third-line and above-line treatment for advanced colorectal cancer,the median PFS was 3.5 months,and the remission rate and disease control rate were 8.3%and 69.4%,respectively.The median PFS of the combined regimen of apatinib and fluorouracil was 2 months longer than that of apatinib monotherapy(4.3 months vs.2.3 months,P=0.012);19 Compared with the 7th edition,the 8th edition of AJCC/UICC TNM staging system significantly enlarged the survival gap among patients with stage ? A,? B and ? C gastric cancer(P<0.001).The area under the curve and the consistency index of the prediction model based on the 8th edition of the staging system are 0.706 and 0.646 respectively,which are better than the prediction model based on the 7th edition;20 In stage ? and ? gastric cancer,there was no significant difference in survival between patients with the number of lymph node resected is not less than 16 and patients with the number of lymph node resected is less than 16(P>0.05).When the number of lymph node resected was more than 25,the DFS of patients with stage? and ? gastric cancer was significantly improved(P<0.05).When the number of resectable lymph nodes was more than 30,the benefit of DFS in patients with stage ?gastric cancer was not increased(P=0.414),but it could further improve the DFS in patients with stage ? gastric cancer(P=0.003);21 In gastric cancer patients with the number of lymph node resected is less than 16,there was no significant correlation between DFS and different lymph node metastasis rates(P=0.13).However,in gastric cancer patients with the number of lymph node resected is not less than 16,with the increase of lymph node metastasis rate,the median DFS decreased significantly(P<0.001).Further multivariate analysis showed that lymph node metastasis rate was an independent prognostic factor for gastric cancer;22 In adjuvant treatment of gastric cancer,the median DFS of XELOX regimen group was 15.8 months,which was significantly longer than that of SOX regimen group(P=0.002).In multivariate analysis,XELOX regimen group still showed significant survival advantage;23 When apatinib-based regimens were used in the first-line treatment of advanced gastric cancer,the median PFS was 4.5 months.Along all the combined therapies,apatinib combined with Taxus can achieve higher remission rate and disease control rate,and the tolerance of the regimen is slightly poor,but it is still controllable.Conclusion:? For young and middle-aged people with family history of cancer,especially colorectal cancer,screening for colorectal cancer should be carried out regularly earlier;?Patients with stage ? colorectal cancer without high-risk factors do not benefit from adjuvant treatment;? For stage ? colorectal cancer patients with high risk factors,adjuvant chemotherapy is recommended,but oxaliplatin may not increase survival benefits;?In stage ? colorectal cancer patients,after at least 4 months of chemotherapy with XELOX or FOLFOX,conversion to capecitabine monotherapy is feasible;?Both Surgery first and chemotherapy first are alternative treatment strategies for colorectal patients with simultaneous liver metastasis;? PFS can be prolonged by maintenance therapy in colorectal patients with simultaneous liver metastasis after perioperative treatment;? For patients with advanced colorectal cancer,the effect of local treatment alone is limited,and systemic treatment should be the main treatment.After local treatment,systemic treatment or maintenance treatment should be continued to maximize the survival of patients;? Advanced colorectal cancer patients who achieved complete or partial remission from first-line treatment or recieved local treatment after tumor stabilization are more suitable for maintenance therapy;?First-line maintenance therapy for colorectal cancer should not be performed prematurely,but should be started at least six months after standard treatment;? There is no need to use second-line treatment drugs immediately after the first-line maintenance therapy for advanced colorectal cancer has progressed.It is also advisable to follow the first-line regimen and target drugs;11 In third-line chemotherapy for advanced colorectal cancer,introducing oxaliplatin or irinotecan after failure of previous treatment regimens containing oxaliplatin and irinotecan i s not recommended;12 In the treatment of advanced colorectal cancer at or above the third line,more than 50%patients can benefit from the regimen based on retecase,but the combination of retecase and chemotherapy can not increase the survival benefit of patients,but will bring additional side effects;13 The efficacy and safety of apatinib combined with low toxicity chemotherapeutics in the treatment of advanced colorectal cancer at or above the third line are ideal and can be verified in further large-scale clinical studies;14 The 8th edition staging system is superior to the 7th edition staging system in evaluating the prognosis of gastric cancer patients in China and has high clinical applicability;15 For patients with stage ? gastric cancer,the number of lymph node resected is more appropriate in about 25,and the number of lymph node resected should be more than 30 for patients with stage ? gastric cancer;16 Lymph node metastasis rate can help to better guide the treatment and prognosis of gastric cancer;17 XELOX regimen can significantly prolong DFS in patients with gastric cancer after operation,and should be recommended as the first choice;18 First-line application of apatinib-based therapy has shown some efficacy.For patients with advanced gastric cancer who cannot tolerate double or triple-drug chemotherapy,the first-line application of Apatinib plus taxanes may be considered.