| Digestive system cancers are the most common malignancy and the lead to the top mortality in China cancer patients. Although some progresses have been made on digestive system oncology, there is still lacking breakthrough progress in this field. To a great extent, oncology is still an experience-based science. Clinical research on digestive system oncology is required for further developing. Factors related to predication and prognosis of digestive cancer need to be further investigated. More effective therapy for digestive cancer need to be developed. As digestive system oncology contains various types with high incidence rate and multifarious clinical data, traditional manual operation system cannot meet demand of processing all the clinical data. A new and convenient method with high efficiency and fast speed is required to set up for saving, arranging and analyzing data, and to assist in clinical decision making. With the development of computer, network and database, the database technology provides an opportunity and possibility to solve this issue mentioned above. In this study, we construct a database system in order to meet the demand of clinical study on digestive system oncology.There are two parts of work in this study, which including: (1) Design and construction of the database system of digestive system oncology; (2) Retrospective analysis of gastric cancer cases by using the database system of digestive system oncology.In the first part of this study, we constructed a database system for digestive system oncology with the technical support of Beijing Rilintech Co., LTD. Using the computer and network of our department, we developed the database system on the software platform of Apache+ Ruby+ PostgreSQL and in B/S distributed computing model. Based on the requirement of clinical study, we established the system demands. After analyzing the procedure of clinical therapy and diagnosis in digestive system oncology, the data entry module including 10 function modules were set up: patient information, hospitalization information, history of present illness, past medical history, physical examination, auxiliary examination, diagnosis, evaluation, treatment and follow up. Afterward, according to the textbooks, authority books and criterions of oncology, the submodules and the key fields are defined. Beijing Rilintech Co., LTD provided computer aided programming support. With development of initial models and consummation, we successfully constructed the database of digestive system cancer, which could perform seven functions: data entry, data view, inquiry, statistics, data export, word dictionary maintenance, user management. Fitting for clinical demands, this database system has a user friendly web-page interface. It can be operated easily by clinical staff without special training. Functions in inquiry and statistics are convenient and quick. Word dictionary with a built-in export function module can be freely defined as required, which facilitate the requirement of clinical study. Meanwhile, as the database system is connected to the local network of our department, clinical staff can share this system with permission simultaneously, which make multi-user visit and the data share into reality. Moreover, the system has a strong expansibility. It can communicate with"Junwen No. 1"HIS system at our hospital by directly adding relevant fuction modules. And it will transfer data with other database sites via internet if permitted at the late stage development phase.In the second part of this study, we analyzed clinical data of 636 patients with gastric cancer retrospectively via the database system. Clinical records of 636 gastric cancer patients who were hospitalized between January 2003 and October 2010 are retrieved and exported, and then PASW/SPSS 18.0 software were used to perform the statistical analysis. The result showed: Total 636 patients were studies in this study: 479 male and 157 female. The medianage was 57 years old (14 to 86); the tumor site was: proximal(41.4%), distal (46.4%) or unknown (12.2%); the histological type was:adenocarcinoma (85.7%), signet ring cell carcinoma (6.9%), or other and unknown (6.4%); the differentiation of adenocarcinoma cell was: well differentiated (31%), moderately differentiated (13.2%), poorly differentiated (37.1%), or unknown (18.7%); and the pTNM stage was: 0 (0.3%), I (3.6%), II (10.1%), III (36.8%), IV (45.6%), or unknown (3.6%). 189 patients with metastatic or unresectable gastric cancer performed HER2 status test, HER2 positive rate was 14.3 %( 27/189). There was no significant difference between HER2 status and tumor location, histology or differentiation of adenocarcinoma. 284 patients underwent radical resection; there is no significant difference in DFS and OS in patients with different operation site, histology type, tumour stage and lymph node numbers. The ratio of identified lymph nodes (more than ten) was higher in hospitals at or above provincial level compared to that in hospitals at regional level (60.4% vs. 39.6%, P=0.009), the DFS was longer (21.67m vs. 14.6m, P=0.005), and the OS was longer (52.90m vs. 33.77m, P=0.04). 20 patients received neo-adjuvant therapy. There is no significant difference in median DFS or median OS between phase III patients with or without neo-adjuvant therapy. 205 patients received adjuvant chemotherapy, the ratio of six and/or more cycles chemotherapy was 42.1% vs. 35.2 %(P=0.318), and the DFS was 22.7m vs. 16.3m (P=0.005) between hospitals at or above provincial level and hospitals at regional level. 387 patients with metastatic or post-surgery relapse gastric cancer patients received palliative chemotherapy; the median OS was 11.07m (95%CI 9.88-12.26m). Among these patients, 198 patients accepted second and/or more line chemotherapy, and the OS was longer (12.53m vs. 7.7m, P<0.001). The result suggested that longer PFS (10.23m, P<0.05) and longer OS (16.87m, P<0.05) were correlated to the regimen containing trastuzumab, compared to other regimens available in first line chemotherapy. The analysis result suggested that there exist big difference in the outcome of gastric cancer therapy due to the varied understanding of standard treatment of gastric cancer in Chinese doctors from different level hospitals.In conclusion, construction of digestive system oncology database system solved the problem in saving and arrangement of abundant clinical cases, in addition, with the assistance of the database system, clinical staff will have more opportunity to investigate the pathogenesis of digestive system cancer and implement more clinical research. |
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