SUMSearch and TRIP database are meta search engines for searching clinical evidence. This article introduces major contents and search methods of the SUMSearch and TRIP database, so as to provide quick search resources and technical help for evidence-based practice.
ObjectiveTo understand the impact of preoperative nutritional status on the postoperative complications for patients with low/ultra-low rectal cancer undergoing extreme sphincter-preserving surgery following neoadjuvant therapy. MethodsThe patients with low/ultra-low rectal cancer who underwent extreme sphincter-preserving surgery following neoadjuvant therapy from January 2009 to December 2020 were retrospectively collected using the Database from Colorectal Cancer (DACCA), and then who were assigned into a nutritional risk group (the score was low than 3 by the Nutrition Risk Screening 2002) and non-nutritional risk group (the score was 3 or more by the Nutrition Risk Screening 2002). The postoperative complications and survival were analyzed for the patients with or without nutritional risk. The postoperative complications were defined as early-term (complications occurring within 30 d after surgery), middle-term (complications occurring during 30–180 d after surgery), and long-term (complications occurring at 180 d and more after surgery). The survival indicators included overall survival and disease-specific survival. ResultsA total of 680 patients who met the inclusion criteria for this study were retrieved from the DACCA database. Among them, there were 500 (73.5%) patients without nutritional risk and 180 (26.5%) patients with nutritional risk. The postoperative follow-up time was 0–152 months (with average 48.9 months). Five hundreds and forty-three survived, including 471 (86.7%) patients with free-tumors survival and 72 (13.3%) patients with tumors survival. There were 137 deaths, including 122 (89.1%) patients with cancer related deaths and 15 (10.9%) patients with non-cancer related deaths. There were 48 (7.1%) cases of early-term postoperative complications, 51 (7.5%) cases of middle-term complications, and 17 (2.5%) cases of long-term complications. There were no statistical differences in the incidence of overall complications between the patients with and without nutritional risk (χ2=3.749, P=0.053; χ2=2.205, P=0.138; χ2=310, P=0.578). The specific complications at different stages after surgery (excluding the anastomotic leakage complications in the patients with nutritional risk was higher in patients without nutritional risk, P=0.034) had no statistical differences between the two groups (P>0.05). The survival curves (overall survival and disease-specific survival) using the Kaplan-Meier method had no statistical differences between the patients with and without nutritional risk (χ2=3.316, P=0.069; χ2=3.712, P=0.054). ConclusionsFrom the analysis results of this study, for the rectal cancer patients who underwent extreme sphincter-preserving surgery following neoadjuvant therapy, the patients with preoperative nutritional risk are more prone to anastomotic leakage within 30 d after surgery. Although other postoperative complications and long-term survival outcomes have no statistical differences between patients with and without nutritional risk, preoperative nutritional management for them cannot be ignored.
ObjectiveTo analyze the geographical distribution of patients with colorectal cancer by screening the current Database from Colorectal Cancer (DACCA) version in West China Hospital.MethodsThe selected DACCA database version of this data analysis was updated on September 5, 2019, and the two data of the " date of operation” and " address” were selected as the main research items. The characteristics of each selected data item were analyzed, and then the selected data were used as a joint feature analysis.ResultsAccording to the condition of selection by " address”, 7 096 valid data rows from the whole nation were obtained, 6 551 valid data rows from Sichuan province were obtained, and 2 954 valid data rows from Chengdu city were obtained. The geographic information provided by the DACCA database showed that, with the year changing, the provincial distribution area of patients was mainly the southwest region with middle-east of Sichuan province as center, mainly including the parts of Chongqing, Yunnan, and Guizhou; The distribution area of the municipal level in Sichuan province was mainly the east region with axis of the " Mianyang-Chengdu-Ya’an”, and Chengdu was the core; The regional distribution of patients in the Chengdu was mainly within the third ring load with Wuhou District, the Jinniu District, and the Qingyang District as the core area.ConclusionThegeographical information provided by DACCA database shows the geographical distribution characteristics of patients in the past 20 years, reflecting the basic characteristics and changes of the service area of West China Hospital, and can provide a basis for medical policy makers in screening, diagnosing and treating of colorectal cancer, and key management areas of following-up.
ObjectiveTo analyze the characteristics of colorectal cancer surgery in the current version of Database from Colorectal Cancer (DACCA).MethodsThe DACCA version selected for this data analysis was the updated version on July 16th, 2020. The data items included operative duration, anatomy (anatomical difficulty), pelvis (pelvic stenosis), obesity (abdominal obesity), adhesion (adhesion in surgical area), mesentery (abnormal mesenteric status), hypertrophy (tissue hypertrophy or organ hypertrophy), intestinal quality, death (risk of death), injury (risk of tissue injury), recurrence (tumor recurrence), metastasis (tumor metastasis), anastomotic leakage (risk of anastomotic leakage), difficulty of operation, prognosis, quality of operation. The selected data items were statistically analyzed.ResultsThetotal number of medical records (data rows) that met the criteria was 6 116. Spearman correlation text showed a negative correlation between operative duration and years (rs=–0.433, P<0.001). In anatomy, pelvis, obesity, adhesion, mesentery, and hypertrophy, the most cases were “normal or basically normal”, and the percentages were 32.55%, 44.52%, 48.68%, 55.79%, 53.36%, and 57.72%, respectively. In quality of intestinal, the highest proportion was “bad” (43.25%). In risk of death, risk of tissue injury, and tumor recurrence, the most cases were “very small”, and the percentages were 69.00%, 94.41%, and 68.21%, respectively. In tumor metastasis, risk of anastomotic leakage, difficulty of operation, prognosis, and quality of operation, the highest proportion were “small” (48.58%), “average” (49.25%), “average” (32.96%), “uncertain” (45.65%), and “very good” (39.85%).ConclusionsIn the DACCA, the intestinal quality is characteristic of difficulty in operation, and in the evaluation of operation quality, the judgment of anastomotic leakage deserves much more attention. However, the relationship between the difficulty of operation and postoperative effects, and the relationship between the quality of operation and the prognosis still need to be further studied.
ObjectiveTo analyze the risks and complications after operation of colorectal cancer in the current version of Database from Colorectal Cancer (DACCA).MethodsThe DACCA version selected for this data analysis was the updated version on July 28th, 2020. The data items included surgery reaction, body temperature, flatus, pain and mental status; preoperative complication, postoperative complication, short-term and long-term complication. The selected data items were statistically analyzed.ResultsThe total number of medical records (data rows) that met the criteria was 6 422, including 4 185 (65.2%) valid data on surgery reaction, 3 833 (59.7%) valid data on body temperature, 3 835 (59.7%) valid data on flatus, 3 597 (56.0%) valid data on pain, 3 551 (55.3%) valid data on mental status, 6 422 (100%) valid data on preoperative complications, postoperative complications, short-term complications and long-term complications. In the surgical response, 1 517 (36.2%) lines of data showed “normal” structure were the most. Among the days with elevated body temperature, the number of 0-day data lines with the structure of “body temperature >37.5 ℃” was the highest, with 1 980 (51.7%). In postoperative flatus, there were 1 675 (43.7%) data lines with the structure showing “3 days”. The largest number of rows (2 755, 76.6%) showed a structure that was “not obvious” in the pain scale. The mental status showed the highest number of “better” rows (2 976, 83.8%). There were 50 preoperative complications (0.8%). And 595 postoperative complications (9.3%), including anastomotic leakage (80, 13.4%), inflammatory ileus (62, 10.4%), pulmonary infection (57, 9.6%), and anastomotic bleeding (56, 9.4%), etc. There were 6 169 (96.1%) without short-term complication in structural form. There were 6 283 (97.8%) without long-term complications.ConclusionsThe changes in complications shown in the real world data from DACCA suggest that the focus of postoperative risks must be changed with the over the follow-up time. As for the complication evaluation system, it is necessary to establish a complete evaluation system combining the corresponding types and risks, to carry out valuable complication researches.
ObjectiveTo analyze the details and efficacy of neoadjuvant therapy of colorectal cancer in the current version of Database from Colorectal Cancer (DACCA).MethodsThe DACCA version selected for this data analysis was the updated version on July 28th, 2020. The data items included “planned strategy of neoadjuvant therapy” “compliance of neoadjuvant therapy”, and “cycles of neoadjuvant therapy”. Item of “planned strategy of neoadjuvant therapy” included “accuracy of neoadjuvant therapy” and “once included in researches”. Item of “the intensity of neoadjuvant therapy” included “chemotherapy” “cycles of neoadjuvant therapy” “targeted drugs”, and “neoadjuvant radiotherapy”. Item of “effect of neoadjuvant therapy” included CEA value of “pre-neoadjuvant therapy” and “post-neoadjuvant therapy”“variation of tumor markers” “variation of symptom” “variation of gross” “variation of radiography”, and tumor regression grade (TRG). The selected data items were statistically analyzed.ResultsThe total number of medical records (data rows) that met the criteria was 7 513, including 2 539 (33.8%) valid data on the “accuracy of neoadjuvant therapy”, 498 (6.6%) valid data on “once included in researches”, 637 (8.5%) valid data on the “compliance of neoadjuvant therapy”, 2 077 (27.6%) valid data on “neoadjuvant chemotherapy”, 614 (8.2%) valid data on “cycles of neoadjuvant therapy”, 455 (6.1%) valid data on “targeted drugs”, 135 (1.8%) valid data on “neoadjuvant radiotherapy”, 5 022 (66.8%) valid data on “pre-neoadjuvant therapy CEA value”, 818 (10.9%) valid data on “post-neoadjuvant therapy CEA value ”, 614 (8.2%) valid data on “variation of tumor marker”, 464 (6.2%) valid data on “variation of symptom”, 478 (6.4%) valid data on “variation of gross”, 492 (6.5%) valid data on “variation of radiography”, and 459 (6.1%) valid data on TRG. During the correlation analysis, it appeared that “variation of tumor marker” and “variation of gross” (χ2=6.26, P=0.02), “variation of symptom” and “variation of gross”, “radiography” and TRG (χ2=53.71, P<0.01; χ2=38.41, P<0.01; χ2=8.68, P<0.01), “variation of gross” and “variation of radiography”, and TRG (χ2=44.41, P<0.01; χ2=100.37, P<0.01), “variation of radiography” and TRG (χ2=31.52, P<0.01) were related with each other.ConclusionsThe protocol choosing of neoadjuvant therapy has a room for further research and DACCA can provide data support for those who is willing to perform neoadjuvant therapy. The efficacy indicators of neoadjuvant therapy have association with each other, the better understand of it will provide more valuable information for the establishment of therapeutic prediction model.
ObjectiveBased on the current version of Database from Colorectal Cancer (DACCA), we aimed to analyze the comorbidities and preoperative physical status of colorectal cancer patients.MethodsThe DACCA version selected for this data analysis was updated on May 9, 2019. The data items included: surgical comorbidities and classified by systems, surgical history, pelvic disease history, medical comorbidities, and some important subdivision types, infectious disease status, allergic history, nutrition risk screening 2002 (NRS2002) score, amount of weight loss after illness, anemia, low protein status, preoperative ascites status, preoperative pleural effusion status, immune system disease and immunocompromised status, and preoperative nutritional support. Characteristic analysis was performed on each selected data item.ResultsA total of 6 166 admitted data were filtered from the DACCA database. Among them, surgical comorbidities, surgical history, medical comorbidities, and allergy history had 6 166 admitted data, and weight loss had admitted 4 703. There were 2 923 (47.4%) with surgical comorbidities. According to the system, the most common one was digestive system (2 005, 68.6%), and the least one was skin tissue system (24, 0.8%). There were 4 361 (70.7%) patients without surgical history and 1 805 (29.3%) patients had surgical history. There were 2 397 (38.9%) patients without medical comorbidities and 3 769 (61.1%) had medical comorbidities, of which pneumonia/pulmonary infection/chronic bronchopneumonia/lung indeterminate nodules were the most common(2 330, 37.8%), the least was cerebral infarction (unspecified type, 63, 1.0%). There were 5 813 (94.3%) without allergy history and 353 (5.7%) had allergy history. According to the NRS2002 nutrition screening criteria, the scores ranged from 1 to 7 points, with an average of 1.22 points, which could be classified as non-nutrition risk (5 279, 85.6%, included 1 point of 4 310, 2 points of 969), nutritional risk (887, 14.4%, included 3 points of 415, 4 points of 358, 5 points of 100, 6 points of 12, and 7 points of 2), the result of linear regression analysis of NRS2002 scores with the trend of the year showed that: ?=0.000 2x–6.275 8, R2=0.716 2, P<0.001. A total of 2 840 (60.4%) had no weight loss while 1 863 (39.6%) had, and weight loss with the trend of year were analyzed by linear regression analysis: ?=0.000 2x–3.956, R2=0.685 7, P<0.001. The number of cases of other physical status and the proportion of valid data were anemia (1 194, 33.1%), preoperative ascites (1829, 51.7%), preoperative pleural effusion (171, 5.7%), hypoproteinemia (1 206, 33.6%), immune system disease and immunocompromised status (495, 56.6%), and nutritional support (824, 25.0%).ConclusionsThrough the analysis of the DACCA database, nearly 1/2 of colorectal cancer surgery patients have surgical comorbidities before surgery, more than 1/2 of the patients have medical comorbidities, and the types of diseases are various. Preoperative nutritional status in patients with colorectal cancer also shows certain characteristics, suggesting the state of preoperative risk. These data will provide a detailed big data basis for future preoperative risk assessment of colorectal cancer.
The analysis of big data in medical field cannot be isolated from the high quality clinical database, and the construction of first aid database in our country is still in the early stage of exploration. This paper introduces the idea and key technology of the construction of multi-parameter first aid database. By combining emergency business flow with information flow, an emergency data integration model was designed with reference to the architecture of the Medical Information Mart for Intensive Care III (MIMIC-III), created by Computational Physiology Laboratory of Massachusetts Institute of Technology (MIT), and a high-quality first-aid database was built. The database currently covers 22 941 medical records for 19 814 different patients from May 2015 to October 2017, including relatively complete information on physiology, biochemistry, treatment, examination, nursing, etc. And based on the database, the first First-Aid Big Data Datathon event, which 13 teams from all over the country participated in, was launched. The First-Aid database provides a reference for the construction and application of clinical database in China. And it could provide powerful data support for scientific research, clinical decision making and the improvement of medical quality, which will further promote secondary analysis of clinical data in our country.
ObjectiveTo analyze the tumor characteristics of colorectal cancer in the current version of Database from Colorectal Cancer (DACCA).MethodsThe DACCA version was the updated version on April 16, 2020. The data items including: procedure of anastomosis, shape of anastomosis, enhanced suture for anastomosis, stuffing, drainage, coverage of major omentum, anti-adhesion material, reconstruction of pelvic peritoneum, contaminate, and drug implants were analyzed for the characteristics of each selected data item.ResultsA total of 6 338 analyzable data rows were obtained by screening the DACCA database. Among the 6 338 pieces of data, the most common one was the double staple technique (58.1%), end-to-end anastomosis (69.4%), one-total-circle of enhancement (33.2%), and without stuffing (54.1%) in the items of procedure of anastomosis, shape of anastomosis, enhanced suture for anastomosis, stuffing, respectively; the ratio with drainage was higher (79.2%) in the term of drainage, the drainage time was (3.74±2.89) d and median drainage time was 3.00 d; the ratio with covering part of major omentum, without anti-adhesion material, with unilateral partial closure, without contaminate, and without drug implants were more higher, which was 41.1%, 79.8%, 58.7%, 73.9%, and 53.9% in the items of coverage of major omentum, anti-adhesion material, reconstruction of pelvic peritoneum, contaminate, and drug implants, respectively.ConclusionIt might better explain the outcome of surgery associated with intraoperative operation by studying the features of surgery of DACCA and guide the operation in the future for better outcomes.
ObjectiveTo compare the clinical therapeutic efficacy of radiofrequency ablation (RFA) and external beam radiation (XRT) in the treatment of early hepatocellular carcinoma (HCC). MethodsThe early HCC patients were collected in the SEER (Surveillance, Epidemiology, and End Results) database, from 2010 to 2015, according to the established inclusion and exclusion criteria. The patients were assigned into an XRT group and a RFA group according to according treatment plans. The propensity score matching (PSM) was performed at a ratio of 1∶4 based on age, gender, race, alpha-fetoprotein (AFP), cirrhosis, and tumor diameter. The overall survival of the patients of the two groups was compared, and the risk factors affecting the long-term prognosis for the early HCC patients were analyzed. ResultsA total of 2 861 early HCC patients were collected, including 2 513 in the RFA group and 348 in the XRT group. After PSM, a total of 1 582 patients were enrolled, including 343 in the XRT group and 1 239 in the RFA group. After PSM, the proportion of tumor with larger diameter (>5 cm) in the XRT group was still higher than that in the RFA group (P<0.001), but there were no statistically significant differences in the other clinical pathological characteristics between them (P>0.05). The Kaplan-Meier survival curves of the RFA group was better than that of the XRT group (HR=1.65, P<0.001); The stratified analysis based on the tumor diameter revealed that the survival curves of the RFA group were superior to those of the XRT group in the HCC patients with tumor diameters <3 cm, 3–5 cm, and >5 cm (<3 cm: HR=1.79, P<0.001; 3–5 cm: HR=1.50, P<0.001; >5 cm: HR=1.67, P=0.003). The results of the multivariate Cox regression model analysis showed that the older age (≥65 years), higher AFP level (≥400 μg/L), larger tumor diameter (≥3 cm), and later AJCC stage (stage Ⅱ) were the risk factors for overall survival in the early HCC patients (HR>1, P<0.05), while the XRT treatment was a risk factor for shortening overall survival in the HCC patients [HR(95%CI)=1.62(1.41, 1.86), P<0.001]. ConclusionThe data analysis results from the SEER database suggest that the long-term overall survival of RFA treatment is superior to XRT treatment for patients with AJCC stage Ⅰ or Ⅱ.
