Objective: To evaluate the accuracy of identifying cancer patients by use of medical claims data in a health insurance system in China, and provide the basis for establishing the claims-based cancer surveillance syste...Objective: To evaluate the accuracy of identifying cancer patients by use of medical claims data in a health insurance system in China, and provide the basis for establishing the claims-based cancer surveillance system in China.Methods: We chose Hua County, Henan Province as the study site, and randomly selected 300 and 1,200 qualified inpatient electronic medical records(EMRs) as well as the New Rural Cooperative Medical Scheme(NCMS) claims records for cancer patients in Hua County People’s Hospital(HCPH) and Anyang Cancer Hospital(ACH) in 2017. Diagnostic information for NCMS claims was evaluated on an individual level, and sensitivity and positive predictive value(PPV) were calculated taking the EMRs as the gold standard.Results: The sensitivity of NCMS was 95.2%(93.8%-96.3%) and 92.0%(88.3%-94.8%) in ACH and HCPH,respectively. The PPV of the NCMS was 97.8%(96.7%-98.5%) in ACH and 89.0%(84.9%-92.3%) in HCPH.Overall, the weighted and combined sensitivity and PPV of NCMS in Hua County was 93.1% and 92.1%,respectively. Significantly higher sensitivity and PPV in identifying patients with common cancers than noncommon cancers were detected in HCPH and ACH separately(P<0.01).Conclusions: Identification of cancer patients by use of the NCMS is accurate on individual level, and it is therefore feasible to conduct claims-based cancer surveillance in areas not covered by cancer registries in China.展开更多
Objective:We aimed to prospectively evaluate the association of oral microbiome with malignant esophageal lesions and its predictive potential as a biomarker of risk.Methods:We conducted a case-control study nested wi...Objective:We aimed to prospectively evaluate the association of oral microbiome with malignant esophageal lesions and its predictive potential as a biomarker of risk.Methods:We conducted a case-control study nested within a population-based cohort with up to 8 visits of oral swab collection for each subject over an 11-year period in a high-risk area for esophageal cancer in China.The oral microbiome was evaluated with 16 S ribosomal RNA(rRNA)gene sequencing in 428 pre-diagnostic oral specimens from 84 cases with esophageal lesions of severe squamous dysplasia and above(SDA)and 168 matched healthy controls.DESeq analysis was performed to identify taxa of differential abundance.Differential oral species together with subject characteristics were evaluated for their potential in predicting SDA risk by constructing conditional logistic regression models.Results:A total of 125 taxa including 37 named species showed significantly different abundance between SDA cases and controls(all P<0.05&false discovery rate-adjusted Q<0.10).A multivariate logistic model including 11 SDA lesion-related species and family history of esophageal cancer provided an area under the receiver operating characteristic curve(AUC)of 0.89(95%CI,0.84-0.93).Cross-validation and sensitivity analysis,excluding cases diagnosed within 1 year of collection of the baseline specimen and their matched controls,or restriction to screenendoscopic-detected or clinically diagnosed case-control triads,or using only bacterial data measured at the baseline,yielded AUCs>0.84.Conclusions:The oral microbiome may play an etiological and predictive role in esophageal cancer,and it holds promise as a non-invasive early warning biomarker for risk stratification for esophageal cancer screening programs.展开更多
Objective： There have been few population-based studies evaluating health related quality of life（HRQOL） in rural populations in China, and this study aimed to assess the current status of and risk factors for HRQO...Objective： There have been few population-based studies evaluating health related quality of life（HRQOL） in rural populations in China, and this study aimed to assess the current status of and risk factors for HRQOL in a general rural population in high risk region of esophageal cancer in China.Methods： From November 2015 to September 2016, 12,085 permanent residents aged 45–69 years from 257 villages in the Endoscopic Screening for Esophageal Cancer in China（ESECC） trial（Clinical Trials.gov：NCT01688908） randomly selected from Hua County, Henan Province, China were interviewed. The EQ-5 D-3 L,a generic measure of HRQOL, and a questionnaire were used to assess their HRQOL and potential risk factors.Results： Among all the participants, 30.62% of the participants reported problems in at least one EQ-5 D dimension. Pain/discomfort（25.52%） was the most frequently reported problem followed by anxiety/depression（7.97%）, mobility（5.82%）, usual activities（2.61%） and self-care（1%）. These rural residents had a mean EQ-5 D index score of 0.948, and lower EQ-5 D index scores were associated with older age, female gender, lower levels of household annual per capita income, living alone, using shallow wells as main source of drinking water, exposure to family members smoking, testiness, unhealthy dietary habits, overweight or obesity, upper gastrointestinal cancer related symptoms and chronic diseases.Conclusions： Rural residents in China have a relatively low quality of life. Health promotion programs in this population should focus on the elderly, especially elderly women and the elderly living alone. Improving basic living circumstances and primary medical care services should be priorities. Results of this study will also serve as the basis for the cost-utility evaluation in our ESECC screening trial.展开更多
Extreme hot weather is occurring more frequently due to global warming,posing a significant threat to species survival.Birds in particular are more likely to overheat in hot weather because they have a higher body tem...Extreme hot weather is occurring more frequently due to global warming,posing a significant threat to species survival.Birds in particular are more likely to overheat in hot weather because they have a higher body temperature.This study used a heat stress model to investigate the antioxidant defense mechanisms and changes in fatty acid catabolism in Red-billed Leiothrix(Leiothrix lutea)to gain an understanding of how birds adapt to high temperatures.The birds were divided into five groups:a control group(30℃for 0 days),1 D group(40℃for 1 day),3 D group(40℃for 3 days),14 D group(40℃for 14 days)and recovery group(40℃for 14 days,then 30℃for 14 days).Our results indicated that when Red-billed Leiothrix are subjected to heat stress,malondialdehyde(MDA)content in the liver significantly increased,as did the enzyme activities of catalase(CAT),glutathione-SH-peroxidase(GSH-PX)and total antioxidant capacity(T-AOC)in the liver.Furthermore,there was a significant increase in heat shock protein 70(HSP70)expression in the liver,while avian uncoupling protein(avUCP)expression in muscle was significantly reduced.Additionally,there was a significant reduction in fatty acid catabolism enzyme activity such as 3-hydroxyacyl-CoAdehydrogenase(HOAD)activity in the heart,and carnitine palmitoyl transferase 1(CPT-1)and citrate synthase(CS)activity in the heart and liver.Furthermore,fatty acid translocase(FAT/CD36)in the heart,heart-type fatty acid binding protein(H-FABP)and fatty acid binding protein(FABP-pm)in the liver and heart were also significantly decreased.These changes reverted after treatment,but not to the same level as the control group.Our results indicated that when Red-billed Leiothrix are exposed to heat stress their internal antioxidant defense system is activated to counteract the damage caused by high temperatures.However,even with high antioxidant levels,prolonged high temperature exposure still caused some degree of oxidative damage possibly requiring a longer recovery time.Additionally,Red-billed Leiothrix may be able to resist heat stress by reducing fatty acid transport and catabolism.展开更多
Esophageal squamous cell carcinoma （ESCC） has a high mortality rate. To determine the molecular basis of ESCC development, this study sought to identify characteristic genome-wide alterations in ESCC, including exon...Esophageal squamous cell carcinoma （ESCC） has a high mortality rate. To determine the molecular basis of ESCC development, this study sought to identify characteristic genome-wide alterations in ESCC, including exonic mutations and structural alterations. The clinical implications of these genetic alterations were also analyzed. Exome sequencing and verification were performed for nine pairs of ESCC and the matched blood samples, followed by validation with additional sam- ples using Sanger sequencing. Whole-genomc SNP arrays were employed to detect copy number alteration （CNA） and loss of heterozygosity （LOH） in 55 cases, including the nine ESCC samples subjected to exome sequencing. A total of 108 non-synonymous somatic mutations （NSSMs） in 102 genes were verified in nine patients. The chromatin modification process was found to be enriched in our gene ontology （GO） analysis. Tumor genomes with TP53 mutations were signifi- cantly more unstable than those without TP53 mutations. In terms of the landscape of genomic alterations, deletion of 9p21.3 covering CDKN2A/2B （30.9%）, amplification of 1 1q13.3 covering CCND1 （30.9%）, and TP53 point mutation （50.9%） occurred in two-thirds of the cases. These results suggest that the deregulation of the G1 phase during the cell cycle is a key event in ESCC. Furthermore, six minimal common regions were found to be significantly altered in ESCC samples and three of them, 9p21.3, 7p 11.2, and 3p 12.1, were associated with lymph node metastasis. With the high correlation of TP53 mutation and genomic instability in ESCC, the amplification of CCND1, the deletion of CDKN2A/2B, and the somatic mutation of TP53 appear to play pivotal roles via G1 deregulation and therefore helps to classify this cancer into different genomic subtypes. These findings provide clinical significance that could be useful in future molecular diagnoses and therapeutic targeting.展开更多
Individual executive function improvement through physical and cognitive training is a research hotspot in physical education and cognitive science.However,few studies have evaluated whether combined physical and cogn...Individual executive function improvement through physical and cognitive training is a research hotspot in physical education and cognitive science.However,few studies have evaluated whether combined physical and cognitive training(CPCT)has greater benefits for executive function performance and cerebral oxygenation in adolescent athletes than cognitive training alone.This study randomly assigned 33 adolescent shooting athletes to a CPCT(n=17)or computerized cognitive training(CCT,n=16)group and compared their executive function after six weeks of training.All subjects were assessed using the 2-back,task-switching,and Stroop tests before and after training.The prefrontal cortex oxygenated hemoglobin(Oxy-Hb)activation level was monitored while executing the three tasks using functional near-infrared spectroscopy.Our results showed that the CPCT and CCT groups similarly improved their updating function as indicated by the 2-back task accuracy.The CPCT group significantly improved the switching function in the task-switching test accuracy,while the CCT group did not.However,both groups did not improve in behavioral performance as indicated by the inhibition function in the Stroop task.Cerebral oxygenation,indicated by the oxy-Hb activation level in the frontal pole area of the prefrontal lobe,significantly improved in the CPCT group during the three cognitive tasks,whereas the CCT group showed no change.These findings indicated that CPCT endowed greater advantages in task-switching in the behavioral performance of the executive function than CCT.Moreover,CPCT was superior to CCT in increasing task-efficient cerebral oxygenation during the activation of the prefrontal cortex in adolescent shooting athletes.展开更多
Extensive efforts have been put into reducing the heavy burden of esophageal squamous cell carcinoma(ESCC)in China.However,the joint impact of prevention and treatment on the long-term overall survival(OS)of ESCC pati...Extensive efforts have been put into reducing the heavy burden of esophageal squamous cell carcinoma(ESCC)in China.However,the joint impact of prevention and treatment on the long-term overall survival(OS)of ESCC patients remains largely unknown.We consecutively recruited 13,255 ESCC patients from two Chinese centers:the Northern center,located in a high-risk area with abundant screening programs;and the Southern center,situated in a non-high-risk area with improved clinical practices.Inter-center comparison,longitudinal intra-center comparison,and a simulation analysis were conducted to investi-gate the influence of tumor downstaging and high-quality clinical treatment on OS.During a follow-up period of 12.52 years,the Northern center exhibited higher median survival than the Southern center(6.22 vs.3.15 years;H_(Radjusted)=0.73,95%CI:0.69-0.77).Mediation analysis demonstrated that its OS advantage was largely(77.7%)attributed to earlier TNM stage(stage 0-II:51.3%vs.24.6%).In temporal analyses,patient survival in the Southern center gradually improved(median survival during 2015-2018 vs.2009-2014:3.58 vs.2.93 years;H_(Radjusted)=0.86,95%CI:0.79-0.94),coinciding with the progress of treatment-related indices(completeness of TNM staging in discharge diagnosis[from 53.7%to 99.6%],adoption of minimally invasive esophagectomy[from 0.0%to 51.1%]and right thoracic esophagectomy[from 12.4%to 86.4%],etc.).Simulation analysis further demonstrated that integrating both downstaging and high-quality treatment would lead to the best survival.Tumor downstaging and high-quality clinical treatment have a joint impact on ESCC patient survival.Establishing a comprehensive strategy that inte-grates cancer prevention with optimal clinical treatment is crucial for alleviating the ESCC burden.展开更多
基金supported by the National Natural Science Foundation of China (No. 30930102, 81473033)the National Key R&D Program of China (No. 2016YFC0901404)+2 种基金the Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (No. XXZ0204)the Science Foundation of Peking University Cancer Hospital (No. 2017-4)the Open Project funded by the Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing (No. 2017-10)
文摘Objective: To evaluate the accuracy of identifying cancer patients by use of medical claims data in a health insurance system in China, and provide the basis for establishing the claims-based cancer surveillance system in China.Methods: We chose Hua County, Henan Province as the study site, and randomly selected 300 and 1,200 qualified inpatient electronic medical records(EMRs) as well as the New Rural Cooperative Medical Scheme(NCMS) claims records for cancer patients in Hua County People’s Hospital(HCPH) and Anyang Cancer Hospital(ACH) in 2017. Diagnostic information for NCMS claims was evaluated on an individual level, and sensitivity and positive predictive value(PPV) were calculated taking the EMRs as the gold standard.Results: The sensitivity of NCMS was 95.2%(93.8%-96.3%) and 92.0%(88.3%-94.8%) in ACH and HCPH,respectively. The PPV of the NCMS was 97.8%(96.7%-98.5%) in ACH and 89.0%(84.9%-92.3%) in HCPH.Overall, the weighted and combined sensitivity and PPV of NCMS in Hua County was 93.1% and 92.1%,respectively. Significantly higher sensitivity and PPV in identifying patients with common cancers than noncommon cancers were detected in HCPH and ACH separately(P<0.01).Conclusions: Identification of cancer patients by use of the NCMS is accurate on individual level, and it is therefore feasible to conduct claims-based cancer surveillance in areas not covered by cancer registries in China.
基金the National Natural Science Foundation of China(No.30930102,82073626,81502855,81773501)the National Key R&D program of China(No.2016YFC0901404)+4 种基金the National Special Programme of Scientific and Technological Resources Investigation(No.2019FY101102)the Digestive Medical Coordinated Development Center of Beijing Hospitals Authority(No.XXZ0204)the Beijing Natural Science Foundation(No.7182033)the Beijing Municipal Administration of Hospital’s Youth Programme(No.QML20171101)the Science Foundation of Peking University Cancer Hospital(No.2020-7)。
文摘Objective:We aimed to prospectively evaluate the association of oral microbiome with malignant esophageal lesions and its predictive potential as a biomarker of risk.Methods:We conducted a case-control study nested within a population-based cohort with up to 8 visits of oral swab collection for each subject over an 11-year period in a high-risk area for esophageal cancer in China.The oral microbiome was evaluated with 16 S ribosomal RNA(rRNA)gene sequencing in 428 pre-diagnostic oral specimens from 84 cases with esophageal lesions of severe squamous dysplasia and above(SDA)and 168 matched healthy controls.DESeq analysis was performed to identify taxa of differential abundance.Differential oral species together with subject characteristics were evaluated for their potential in predicting SDA risk by constructing conditional logistic regression models.Results:A total of 125 taxa including 37 named species showed significantly different abundance between SDA cases and controls(all P<0.05&false discovery rate-adjusted Q<0.10).A multivariate logistic model including 11 SDA lesion-related species and family history of esophageal cancer provided an area under the receiver operating characteristic curve(AUC)of 0.89(95%CI,0.84-0.93).Cross-validation and sensitivity analysis,excluding cases diagnosed within 1 year of collection of the baseline specimen and their matched controls,or restriction to screenendoscopic-detected or clinically diagnosed case-control triads,or using only bacterial data measured at the baseline,yielded AUCs>0.84.Conclusions:The oral microbiome may play an etiological and predictive role in esophageal cancer,and it holds promise as a non-invasive early warning biomarker for risk stratification for esophageal cancer screening programs.
基金supported by the Charity Project of National Ministry of Health (No. 201202014)the Natural Science Foundation of China (No. 81473033)+2 种基金the National Key R&D Program of China (No. 2016YFC0901404)the Science Foundation of Peking University Cancer Hospital (No. 2017-4)the Open Project funded by Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing (No. 2017-10)
文摘Objective： There have been few population-based studies evaluating health related quality of life（HRQOL） in rural populations in China, and this study aimed to assess the current status of and risk factors for HRQOL in a general rural population in high risk region of esophageal cancer in China.Methods： From November 2015 to September 2016, 12,085 permanent residents aged 45–69 years from 257 villages in the Endoscopic Screening for Esophageal Cancer in China（ESECC） trial（Clinical Trials.gov：NCT01688908） randomly selected from Hua County, Henan Province, China were interviewed. The EQ-5 D-3 L,a generic measure of HRQOL, and a questionnaire were used to assess their HRQOL and potential risk factors.Results： Among all the participants, 30.62% of the participants reported problems in at least one EQ-5 D dimension. Pain/discomfort（25.52%） was the most frequently reported problem followed by anxiety/depression（7.97%）, mobility（5.82%）, usual activities（2.61%） and self-care（1%）. These rural residents had a mean EQ-5 D index score of 0.948, and lower EQ-5 D index scores were associated with older age, female gender, lower levels of household annual per capita income, living alone, using shallow wells as main source of drinking water, exposure to family members smoking, testiness, unhealthy dietary habits, overweight or obesity, upper gastrointestinal cancer related symptoms and chronic diseases.Conclusions： Rural residents in China have a relatively low quality of life. Health promotion programs in this population should focus on the elderly, especially elderly women and the elderly living alone. Improving basic living circumstances and primary medical care services should be priorities. Results of this study will also serve as the basis for the cost-utility evaluation in our ESECC screening trial.
基金This study was financially supported by grants from the National Natural Science Foundation of China(No.31971420,32171497).
文摘Extreme hot weather is occurring more frequently due to global warming,posing a significant threat to species survival.Birds in particular are more likely to overheat in hot weather because they have a higher body temperature.This study used a heat stress model to investigate the antioxidant defense mechanisms and changes in fatty acid catabolism in Red-billed Leiothrix(Leiothrix lutea)to gain an understanding of how birds adapt to high temperatures.The birds were divided into five groups:a control group(30℃for 0 days),1 D group(40℃for 1 day),3 D group(40℃for 3 days),14 D group(40℃for 14 days)and recovery group(40℃for 14 days,then 30℃for 14 days).Our results indicated that when Red-billed Leiothrix are subjected to heat stress,malondialdehyde(MDA)content in the liver significantly increased,as did the enzyme activities of catalase(CAT),glutathione-SH-peroxidase(GSH-PX)and total antioxidant capacity(T-AOC)in the liver.Furthermore,there was a significant increase in heat shock protein 70(HSP70)expression in the liver,while avian uncoupling protein(avUCP)expression in muscle was significantly reduced.Additionally,there was a significant reduction in fatty acid catabolism enzyme activity such as 3-hydroxyacyl-CoAdehydrogenase(HOAD)activity in the heart,and carnitine palmitoyl transferase 1(CPT-1)and citrate synthase(CS)activity in the heart and liver.Furthermore,fatty acid translocase(FAT/CD36)in the heart,heart-type fatty acid binding protein(H-FABP)and fatty acid binding protein(FABP-pm)in the liver and heart were also significantly decreased.These changes reverted after treatment,but not to the same level as the control group.Our results indicated that when Red-billed Leiothrix are exposed to heat stress their internal antioxidant defense system is activated to counteract the damage caused by high temperatures.However,even with high antioxidant levels,prolonged high temperature exposure still caused some degree of oxidative damage possibly requiring a longer recovery time.Additionally,Red-billed Leiothrix may be able to resist heat stress by reducing fatty acid transport and catabolism.
基金supported by the National Basic Research Program of China from the National Ministry of Science and Technology(973 Program)to YK(Grant No.2011CB504300)and to HC(Grant No.2012CB910800)the National Natural Science Foundation of China(Grant No.30930102)to YK+3 种基金the National High-tech R&D Program of China(863 ProgramGrant No.2012AA022502)Key Research Program of the Chinese Academy of Sciences of China(Grant No.KJZD-EW-L06-2)to CZthe Open Fund of MOE Key Laboratory of Carcinogenesis and Translational Research(Grant No.2014KAIFANG-4)to JB
文摘Esophageal squamous cell carcinoma （ESCC） has a high mortality rate. To determine the molecular basis of ESCC development, this study sought to identify characteristic genome-wide alterations in ESCC, including exonic mutations and structural alterations. The clinical implications of these genetic alterations were also analyzed. Exome sequencing and verification were performed for nine pairs of ESCC and the matched blood samples, followed by validation with additional sam- ples using Sanger sequencing. Whole-genomc SNP arrays were employed to detect copy number alteration （CNA） and loss of heterozygosity （LOH） in 55 cases, including the nine ESCC samples subjected to exome sequencing. A total of 108 non-synonymous somatic mutations （NSSMs） in 102 genes were verified in nine patients. The chromatin modification process was found to be enriched in our gene ontology （GO） analysis. Tumor genomes with TP53 mutations were signifi- cantly more unstable than those without TP53 mutations. In terms of the landscape of genomic alterations, deletion of 9p21.3 covering CDKN2A/2B （30.9%）, amplification of 1 1q13.3 covering CCND1 （30.9%）, and TP53 point mutation （50.9%） occurred in two-thirds of the cases. These results suggest that the deregulation of the G1 phase during the cell cycle is a key event in ESCC. Furthermore, six minimal common regions were found to be significantly altered in ESCC samples and three of them, 9p21.3, 7p 11.2, and 3p 12.1, were associated with lymph node metastasis. With the high correlation of TP53 mutation and genomic instability in ESCC, the amplification of CCND1, the deletion of CDKN2A/2B, and the somatic mutation of TP53 appear to play pivotal roles via G1 deregulation and therefore helps to classify this cancer into different genomic subtypes. These findings provide clinical significance that could be useful in future molecular diagnoses and therapeutic targeting.
文摘Individual executive function improvement through physical and cognitive training is a research hotspot in physical education and cognitive science.However,few studies have evaluated whether combined physical and cognitive training(CPCT)has greater benefits for executive function performance and cerebral oxygenation in adolescent athletes than cognitive training alone.This study randomly assigned 33 adolescent shooting athletes to a CPCT(n=17)or computerized cognitive training(CCT,n=16)group and compared their executive function after six weeks of training.All subjects were assessed using the 2-back,task-switching,and Stroop tests before and after training.The prefrontal cortex oxygenated hemoglobin(Oxy-Hb)activation level was monitored while executing the three tasks using functional near-infrared spectroscopy.Our results showed that the CPCT and CCT groups similarly improved their updating function as indicated by the 2-back task accuracy.The CPCT group significantly improved the switching function in the task-switching test accuracy,while the CCT group did not.However,both groups did not improve in behavioral performance as indicated by the inhibition function in the Stroop task.Cerebral oxygenation,indicated by the oxy-Hb activation level in the frontal pole area of the prefrontal lobe,significantly improved in the CPCT group during the three cognitive tasks,whereas the CCT group showed no change.These findings indicated that CPCT endowed greater advantages in task-switching in the behavioral performance of the executive function than CCT.Moreover,CPCT was superior to CCT in increasing task-efficient cerebral oxygenation during the activation of the prefrontal cortex in adolescent shooting athletes.
基金supported by the National Key R&D Program of China(2021YFC2500405)the Natural Science Foundation of Beijing Municipality(7182033).
文摘Extensive efforts have been put into reducing the heavy burden of esophageal squamous cell carcinoma(ESCC)in China.However,the joint impact of prevention and treatment on the long-term overall survival(OS)of ESCC patients remains largely unknown.We consecutively recruited 13,255 ESCC patients from two Chinese centers:the Northern center,located in a high-risk area with abundant screening programs;and the Southern center,situated in a non-high-risk area with improved clinical practices.Inter-center comparison,longitudinal intra-center comparison,and a simulation analysis were conducted to investi-gate the influence of tumor downstaging and high-quality clinical treatment on OS.During a follow-up period of 12.52 years,the Northern center exhibited higher median survival than the Southern center(6.22 vs.3.15 years;H_(Radjusted)=0.73,95%CI:0.69-0.77).Mediation analysis demonstrated that its OS advantage was largely(77.7%)attributed to earlier TNM stage(stage 0-II:51.3%vs.24.6%).In temporal analyses,patient survival in the Southern center gradually improved(median survival during 2015-2018 vs.2009-2014:3.58 vs.2.93 years;H_(Radjusted)=0.86,95%CI:0.79-0.94),coinciding with the progress of treatment-related indices(completeness of TNM staging in discharge diagnosis[from 53.7%to 99.6%],adoption of minimally invasive esophagectomy[from 0.0%to 51.1%]and right thoracic esophagectomy[from 12.4%to 86.4%],etc.).Simulation analysis further demonstrated that integrating both downstaging and high-quality treatment would lead to the best survival.Tumor downstaging and high-quality clinical treatment have a joint impact on ESCC patient survival.Establishing a comprehensive strategy that inte-grates cancer prevention with optimal clinical treatment is crucial for alleviating the ESCC burden.
