In this review,we offer a concise overview of liver cancer epidemiology in China and worldwide from the official databases of GLOBOCAN 2020 and the National Cancer Registry in China.We also summarized the evidence for...In this review,we offer a concise overview of liver cancer epidemiology in China and worldwide from the official databases of GLOBOCAN 2020 and the National Cancer Registry in China.We also summarized the evidence for the main risk factors associated with liver cancer risk and discuss strategies implemented in China to control the liver cancer burden.Overall,liver cancer was the sixth most commonly diagnosed cancer and the third leading cause of cancer-related death worldwide in 2020.Although China contributed to nearly half of cases across the world alone,the incidence and mortality rates of liver cancer presented a declining trend owing to the persistent efforts from the governments at all levels.The current liver cancer burden in China still faces an arduous challenge due to the relatively large population base as well as the substantially low survival rate(12.1%).To better control the liver cancer burden with the lowest cost,specific measures should be conducted by reducing exposure to established risk factors such as hepatitis B infection and aflatoxin.The promotion of surveillance is also an important method to prolong the survival of liver cancer.This review will provide basic information for future direction on the control of liver cancer burden.展开更多
Background:Esophageal cancer(EC)remains a global health challenge due to its poor prognosis.China and the United States of America(USA)represent two distinct epicenters of EC burden.Understanding the EC disparities in...Background:Esophageal cancer(EC)remains a global health challenge due to its poor prognosis.China and the United States of America(USA)represent two distinct epicenters of EC burden.Understanding the EC disparities in these two countries is vital for tailoring prevention strategies,optimizing treatment,and enhancing outcomes in both countries.Yet,there lacks a comprehensive comparison of EC characteristics between the two countries.Methods:In this multicenter,retrospective hospital-based study,we enrolled primary EC patients who received their initial treatment at one of 23 hospitals in China during 2016-2017.Using electronic medical records and cancer registration records,information on demographics,lifestyle,and clinicopathological characteristics(in-cluding tumor site,pathology,stage,metastases,differentiation,and treatment)were collected.Additionally,we compared these data with the clinicopathological information of invasive EC patients diagnosed in 2016-2017 from the Surveillance,Epidemiology,and End Results(SEER)database in the USA.Results:A total of 6,658 EC patients in China and 8,555 EC patients in the USA were included finally.85.5%(n=5,694)of EC were esophageal squamous cell carcinoma(ESCC)in China,while esophageal adenocarcinoma(EAC)was prominent in the USA(58.9%,n=5,041).Among EC patients with known staging,the proportion of early stage was higher in China compared to the USA(48.3%vs.30.5%).Among ESCC patients,early-stage cases were higher in China than in the USA(49.8%vs.31.8%),while among EAC patients,late-stage cases were higher in China than in the USA(77.3%vs.68.5%)(all P<0.001).In China,EC mainly occurred in the middle third(60.2%)of the esophagus,whereas in the USA,it was more common in the lower third(59.9%)of the organ.Compared with EC patients with known metastatic status in the USA,China had fewer cases of lymph node metastases(51.4%vs.57.7%)and distant metastases(7.9%vs.33.8%).Regarding treatment,China had more surgical therapy(53.7%vs.22.6%),less radiotherapy(35.6%vs.53.3%),and less chemotherapy(46.7%vs.59.7%)compared to the USA.Conclusions:This study reveals notable disparities in EC between China and the USA,encompassing epidemi-ological,clinicopathological,and treatment dimensions.These findings provide insight for tailored strategies addressing regional variations in clinicopathological and therapeutic characteristics.展开更多
Objective:Accurate prognosis prediction is critical for individualized-therapy making of gastric cancer patients.We aimed to develop and test 6-month,1-,2-,3-,5-,and 10-year overall survival(OS)and cancer-specific sur...Objective:Accurate prognosis prediction is critical for individualized-therapy making of gastric cancer patients.We aimed to develop and test 6-month,1-,2-,3-,5-,and 10-year overall survival(OS)and cancer-specific survival(CSS)prediction models for gastric cancer patients following gastrectomy.Methods:We derived and tested Survival Quilts,a machine learning-based model,to develop 6-month,1-,2-,3-,5-,and 10-year OS and CSS prediction models.Gastrectomy patients in the development set(n=20,583)and the internal validation set(n=5,106)were recruited from the Surveillance,Epidemiology,and End Re-sults(SEER)database,while those in the external validation set(n=6,352)were recruited from the China National Cancer Center Gastric Cancer(NCCGC)database.Furthermore,we selected gastrectomy patients with-out neoadjuvant therapy as a subgroup to train and test the prognostic models in order to keep the accuracy of tumor-node-metastasis(TNM)stage.Prognostic performances of these OS and CSS models were assessed using the Concordance Index(C-index)and area under the curve(AUC)values.Results:The machine learning model had a consistently high accuracy in predicting 6-month,1-,2-,3-,5-,and 10-year OS in the SEER development set(C-index=0.861,0.832,0.789,0.766,0.740,and 0.709;AUC=0.784,0.828,0.840,0.849,0.869,and 0.902,respectively),SEER validation set(C-index=0.782,0.739,0.712,0.698,0.681,and 0.660;AUC=0.751,0.772,0.767,0.762,0.766,and 0.787,respectively),and NCCGC set(C-index=0.691,0.756,0.751,0.737,0.722,and 0.701;AUC=0.769,0.788,0.790,0.790,0.787,and 0.788,respectively).The model was able to predict 6-month,1-,2-,3-,5-,and 10-year CSS in the SEER development set(C-index=0.879,0.858,0.820,0.802,0.784,and 0.774;AUC=0.756,0.827,0.852,0.863,0.874,and 0.884,respectively)and SEER validation set(C-index=0.790,0.763,0.741,0.729,0.718,and 0.708;AUC=0.706,0.758,0.767,0.766,0.766,and 0.764,respectively).In multivariate analysis,the high-risk group with risk score output by 5-year OS model was proved to be a strong survival predictor both in the SEER development set(hazard ratio[HR]=14.59,95%confidence interval[CI]:1.872-2.774,P<0.001),SEER validation set(HR=2.28,95%CI:13.089-16.293,P<0.001),and NCCGC set(HR=1.98,95%CI:1.617-2.437,P<0.001).We further explored the prognostic value of risk score resulted 5-year CSS model of gastrectomy patients,and found that high-risk group remained as an independent CSS factor in the SEER development set(HR=12.81,95%CI:11.568-14.194,P<0.001)and SEER validation set(HR=1.61,95%CI:1.338-1.935,P<0.001).Conclusion:Survival Quilts could allow accurate prediction of 6-month,1-,2-,3-,5-,and 10-year OS and CSS in gastric cancer patients following gastrectomy.展开更多
As the most populous country in the world,China has made strides in health promotion in the past few decades.With the aging population,the burden of cancer in China continues to grow.Changes in risk factors for cancer...As the most populous country in the world,China has made strides in health promotion in the past few decades.With the aging population,the burden of cancer in China continues to grow.Changes in risk factors for cancer,especially diet,obesity,diabetes,and air pollution,continue to fuel the shift of cancer transition in China.The burden of upper gastrointestinal cancer in China is decreasing,but still heavy.The rising burden of colorectal,prostate,and breast cancers is also significant.Lung cancer became the top cause of cancer-related deaths,together with smoking as the most important contributor to cancer deaths.The Chinese government has taken several approaches to control cancer and cancer-related risk factors.Many achievements have been made,but some challenges remain.Health China 2030 is ambitious and depicts a bright vision of the future for cancer control in China.The decrease in the cancer burden in China will require cross-sector collaboration and coordinated efforts on primary and secondary preventions by governments,public health organizations,and individuals.In this review,we describe the trends of cancer burden and discuss cancer-related risk factors in China,identifying strategies to reduce the burden of cancer in China.展开更多
Cancer has become the most common cause of death in China.Owing to rapid economic development,improved livelihood,and shifts in risk factors,cancer epidemiology has experienced substantial changes during the past seve...Cancer has become the most common cause of death in China.Owing to rapid economic development,improved livelihood,and shifts in risk factors,cancer epidemiology has experienced substantial changes during the past several decades.In this review,we aim to describe the current cancer epidemiology of the main types of cancer in China,report major risk factors associated with cancer development,and summarize the contributions of the Chinese government to controlling the cancer burden.A total of 4,064,000 new cases were diagnosed in China in 2016.The most frequent types are lung cancer(828,100;20.4%),colorectal cancer(408,000;10.0%),and gastric cancer(396,500;9.8%).Lung(657,000;27.2%),liver(336,400,13.9%),and stomach(288,500;12.0%)cancers are the 3 most deadly cancers in the general population.The 5-year survival rate for cancer has dramatically increased in recent decades.However,liver and particularly pancreatic cancers still have the poorest prognosis.The main modifiable risk factors associated with cancer development include infectious agents,smoking,alcohol consumption,obesity,unhealthful dietary habits,and inadequate physical activity.The Chinese government has made unremitting efforts to decrease the cancer burden,including cancer education and investment in cancer screening programs.展开更多
Objective: Breast cancer in young females was usually considered more aggressive and requires aggressive therapy. We investigated whether early detection and improved treatments changed the patterns of characteristics...Objective: Breast cancer in young females was usually considered more aggressive and requires aggressive therapy. We investigated whether early detection and improved treatments changed the patterns of characteristics,management and outcomes of young breast cancer patients over time.Methods: Females under 40 years of age diagnosed with breast cancer during the periods 1999-2017 and1999-2015 were identified in the Hehai University Shanghai Cancer Center(FUSCC) and the population-based Surveillance, Epidemiology, and End Results(SEER) registry, respectively. Clinicopathologic characteristics and treatment information were collected. Patients diagnosed before 2013 were followed up.Results: The proportions of young breast cancer patients were 15.0% and 5.3% in the FUSCC and SEER cohorts, respectively. In the FUSCC cohort, there was a significant increase in the proportion of ductal carcinoma in situ(DCIS)(from 8.8% to 16.9%;P<0.0001) and it remained stable in SEER cohort. The proportion of T1-stage tumors increased dramatically in the FUSCC cohort(from 35.3% to 41.9%;P=0.008), whereas it decreased in SEER cohort(from 42.4% to 33.0%;P<0.0001). The percentage of estrogen receptor(ER)-positive cancers was consistently increased in both the invasive ductal carcinoma(IDC) and DCIS patients in the two cohorts. Breastconserving surgery and immediate implant reconstruction after mastectomy both exhibited increased use over time in the FUSCC cohort. Both the FUSCC and SEER cohorts showed a significantly better prognosis in the recent time period.Conclusions: With the increased early-stage and ER-positive diseases in young patients as well as better systemic treatment strategies, improved survival has been observed in recent years. There has been a substantial deescalation in surgical therapies in young breast cancer patients.展开更多
China is faced with heavy burdens caused by lung cancer,which has climbed to the top of both cancer incidence and mortality spectrums.The age-standardized rates of incidence and mortality have shown a trend of gradual...China is faced with heavy burdens caused by lung cancer,which has climbed to the top of both cancer incidence and mortality spectrums.The age-standardized rates of incidence and mortality have shown a trend of gradual uptrends in the last decades,while the crude rates rise much quickly due to the aging of population.Although the improvement in health care has contributed to better survival of lung cancer,its prognosis is still challenging.Apart from the common risk factors such as tobacco use,air pollution,and occupational hazards,some specific factors like Chinese-style cooking also have posed great threats to human health.In light of such national conditions,specific interventions should be conducted to curb the burden of lung cancer including smoking cessation,improvement of air quality,early detection and effective treatment of lung cancer.展开更多
In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cance...In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cancer is still a threat in China, and accounts for nearly half of the cases worldwide. Fortunately, in China, the incidence and mortality rates of stomach cancer presented a declining trend owing to the change of individual life styles and the persistent efforts to prevent stomach cancer from the governments at all levels. Helicobacter pylori(H. pylori)infection, poor eating habits, smoking, history of gastrointestinal disorders, and family history of stomach cancer are the main risk factors for stomach cancer in China. As a result, by taking risk factors for stomach cancer into account, specific preventive measures, such as eradicating H. pylori and implementing stomach cancer screening projects, should be taken to better prevent and decrease the burden of stomach cancer.展开更多
Objective: This study aimed at evaluating the efficacy of the questionnaire-based prediction model in an independent prospective cohort.Methods: A cluster-randomized controlled trial was conducted in Changsha, Harbin,...Objective: This study aimed at evaluating the efficacy of the questionnaire-based prediction model in an independent prospective cohort.Methods: A cluster-randomized controlled trial was conducted in Changsha, Harbin, Luoshan, and Sheyang in eastern China in 2015-2017. A total of 182 villages/communities were regarded as clusters, and allocated to screening arm or control arm randomly. Face-to-face interview through a questionnaire interview, including of relevant risk factors of gastric cancer, was administered for each subject. Participants were further classified into high-risk or low-risk groups based on their exposure to risk factors. All participants were followed up until December 31, 2019. Cumulative incidence rates from gastric cancer between high-risk and low-risk groups were calculated and compared using the log-rank test. Cox proportional hazard regression models were applied to estimate hazard ratio(HR) and 95% confidence interval(95% CI).Results: Totally, 89,914 residents were recruited with a mean follow-up of 3.47 years. And 42,015(46.73%)individuals were classified into high-risk group and 47,899(53.27%) subjects were categorized into low-risk group.Gastric cancer was diagnosed in 131 participants, of which 91 were in high-risk group. Compared with the low-risk participants, high-risk individuals were more likely to develop gastric cancer(adjusted HR=2.15, 95% CI,1.23-3.76). The sensitivity of the questionnaire-based model was estimated at 61.82%(95% CI, 47.71-74.28) in a general population.Conclusions: Our questionnaire-based model is effective at identifying high-risk individuals for gastric cancer.展开更多
Objective：Extranodal extension in cervical lymph nodes is an important risk factor for the progression and prognosis of papillary thyroid cancer.The purpose of this study was to identify the common and characteristic...Objective：Extranodal extension in cervical lymph nodes is an important risk factor for the progression and prognosis of papillary thyroid cancer.The purpose of this study was to identify the common and characteristic preoperative ultrasonography features that are associated with the pathologic extranodal extension of metastatic papillary thyroid carcinoma.Methods：We retrospectively assessed and compared clinicopathologic and ultrasound features between 60 papillary thyroid cancer patients with extranodal extension and 120 control patients with papillary thyroid cancer without extranodal extension.Results：With respect to the pathological N stage and clinicopathologic features,N1b stage papillary thyroid carcinomas were more frequently found in patients who were extranodal extension-positive,in comparison with those who were extranodal extension-negative（78.3%vs.63.3%,P=0.043）.Extranodal extension was detected most frequently in level VI cervical lymph nodes（48.7%）.In our univariate analysis of patients with papillary thyroid carcinoma,cervical lymph nodes with extranodal extension showed higher incidences of node matting,microcalcification,cystic area,aspect ratio＆lt;2,and larger diameter than those without extranodal extension（all P〈0.05）.Our multivariate analysis demonstrated that node matting and cystic area were independent risk factors for the presence of extranodal extension[odds ratio（OR）：4.751,95%confidence interval（CI）：1.212~18.626,P=0.025;OR：2.707,95%CI：1.127~6.502,P=0.026].Conclusions：Common ultrasound features may indicate the presence of extranodal extension in patients with metastatic cervical lymph nodes of papillary thyroid carcinoma.展开更多
Background:With industrial and economic development in recent decades in South China,cancer incidence may have changed due to the changing lifestyle and environment.However,the trends of lung cancer and the roles of s...Background:With industrial and economic development in recent decades in South China,cancer incidence may have changed due to the changing lifestyle and environment.However,the trends of lung cancer and the roles of smoking and other environmental risk factors in the development of lung cancer in rural areas of South China remain unclear.The purpose of this study was to explore the lung cancer incidence trends and the possible causes of these trends.Methods:Joinpoint regression analysis and the age-period-cohort(APC) model were used to analyze the lung cancer incidence trends in Sihui,Guangdong province,China between 1987 and 2011,and explore the possible causes of these trends.Results:A total of 2,397 lung cancer patients were involved in this study.A 3-fold increase in the incidence of lung cancer in both sexes was observed over the 25-year period.Joinpoint regression analysis showed that while the incidence continued to increase steadily in females during the entire period,a sharp acceleration was observed in males starting in 2005.The full APC model was selected to describe age,period,and birth cohort effects on lung cancer incidence trends in Sihui.The age cohorts in both sexes showed a continuously significant increase in the relative risk(RR)of lung cancer,with a peak in the eldest age group(80-84 years).The RR of lung cancer showed a fluctuating curve in both sexes.The birth cohorts identified an increased trend in both males and females;however,males had a plateau in the youngest cohorts who were born during 1955-1969.Conclusions:Increasing trends of the incidence of lung cancer in Sihui were dominated by the effects of age and birth cohorts.Social aging,smoking,and environmental changes may play important roles in such trends.展开更多
Objective： The automated breast ultrasound system（ABUS） is a potential method for breast cancer detection;however, its diagnostic performance remains unclear. We conducted a hospital-based multicenter diagnostic st...Objective： The automated breast ultrasound system（ABUS） is a potential method for breast cancer detection;however, its diagnostic performance remains unclear. We conducted a hospital-based multicenter diagnostic study to evaluate the clinical performance of the ABUS for breast cancer detection by comparing it to handheld ultrasound（HHUS） and mammography（MG）.Methods： Eligible participants underwent HHUS and ABUS testing; women aged 40–69 years additionally underwent MG. Images were interpreted using the Breast Imaging Reporting and Data System（BI-RADS）.Women in the BI-RADS categories 1–2 were considered negative. Women classified as BI-RADS 3 underwent magnetic resonance imaging to distinguish true-and false-negative results. Core aspiration or surgical biopsy was performed in women classified as BI-RADS 4–5, followed by a pathological diagnosis. Kappa values and agreement rates were calculated between ABUS, HHUS and MG.Results： A total of 1,973 women were included in the final analysis. Of these, 1,353（68.6%） and 620（31.4%）were classified as BI-RADS categories 1–3 and 4–5, respectively. In the older age group, the agreement rate and Kappa value between the ABUS and HHUS were 94.0% and 0.860（P〈0.001）, respectively; they were 89.2% and0.735（P〈0.001） between the ABUS and MG, respectively. Regarding consistency between imaging and pathology results, 78.6% of women classified as BI-RADS 4–5 based on the ABUS were diagnosed with precancerous lesions or cancer; which was 7.2% higher than that of women based on HHUS. For BI-RADS 1–2, the false-negative rates of the ABUS and HHUS were almost identical and were much lower than those of MG.Conclusions： We observed a good diagnostic reliability for the ABUS. Considering its performance for breast cancer detection in women with high-density breasts and its lower operator dependence, the ABUS is a promising option for breast cancer detection in China.展开更多
Objective:Integration of risk stratification into fecal immunochemical test(FIT)might aid in the suboptimal detection of advanced neoplasms by FIT in colorectal cancer(CRC)screening.A comparative study was conducted t...Objective:Integration of risk stratification into fecal immunochemical test(FIT)might aid in the suboptimal detection of advanced neoplasms by FIT in colorectal cancer(CRC)screening.A comparative study was conducted to evaluate the participation and diagnostic yield of the parallel combination of questionnaire-based risk assessment(QRA)and FIT,FIT-only and QRA-only strategies in a CRC screening program in China.Methods:The study included 29,626 individuals aged 40-74 years and invited to participate in a CRC screening program in China.Participants were first invited to undertake QRA and one-time FIT(OC-sensor).Participants with positive QRA or FIT were deemed to be high-risk individuals who were recommended for subsequent colonoscopy.Participation,detection rate,and resource demand for colonoscopy were calculated and compared.Results:Of the 29,626 invitees,20,203 completed the parallel combination,8,592 completed the QRA-only,and11 completed the FIT-only strategy.For the parallel combination,FIT-only,and QRA-only strategies,the overall positivity rates were 10.2%(2,928/28,806),5.4%(1,096/20,214),and 6.8%(1,944/28,795),respectively;the yield of advanced neoplasm per 10,000 invitees were 46.9[95%confidence interval(95%CI):39.8-55.4],36.8(95%CI:30.5-44.4),and 12.2(95%CI:8.8-16.8),respectively;the positive predictive values for detecting advanced neoplasms among participants who completed colonoscopy were 4.7%(95%CI:4.0%-5.6%),9.9%(95%CI:8.3%-11.9%),and 1.9%(95%CI:1.3%-2.6%),respectively;the number of colonoscopies required to detect one advanced neoplasm was 11.4(95%CI:9.8-13.4),5.7(95%CI:4.8-6.7),and 28.4(95%CI:20.7-39.2),respectively.Conclusions:The parallel combination of QRA and FIT did not show superior efficacy for detecting advanced neoplasm compared with FIT alone in this CRC screening program.展开更多
Background:Surveying regional cancer incidence and mortality provides significant data that can assist in making health policy for local areas;however,the province- and region-based cancer burden in China is seldom re...Background:Surveying regional cancer incidence and mortality provides significant data that can assist in making health policy for local areas;however,the province- and region-based cancer burden in China is seldom reported.In this study,we estimated cancer incidence and mortality in Guangdong Province,China and presented basic information for making policies related to health resource allocation and disease control.Methods:A log-linear model was used to calculate the sex-,age-,and registry-specific ratios of incidence to mortality(l/M) based on cancer registry data from Guangzhou,Zhongshan,and Sihui between 2004 and 2008.The cancer incidences in 2009 were then estimated according to representative l/M ratios and the mortality records from eight death surveillance sites in Guangdong Province.The cancer incidences in each city were estimated by the corresponding sex- and age-specific incidences from cancer registries or death surveillance sites in each area.Finally,the total and region-based cancer incidences and mortalities for the entire population of Guangdong Province were summarized.Results:The estimated l/M ratios in Guangzhou(3.658),Zhongshan(2.153),and Sihui(1.527) were significantly different(P < 0.001),with an average l/M ratio of 2.446.Significant differences in the estimated l/M ratios were observed between distinct age groups and the three cancer registries.The estimated l/M ratio in females was significantly higher than that in males(2.864 vs.2.027,P < 0.001).It was estimated that there were 163,376 new cancer cases(99,689 males and 63,687 females) in 2009;it was further estimated that 115,049 people(75,054 males and 39,995females) died from cancer in Guangdong Province in 2009.The estimated crude and age-standardized rate of incidences(ASRI) in Guangdong Province were 231.34 and 246.87 per 100,000 males,respectively,and 156.98 and 163.57 per 100,000 females,respectively.The estimated crude and age-standardized rate of mortalities(ASRM) in Guangdong Province were 174.17 and 187.46 per 100,000 males,respectively,and 98.59 and 102.00 per 100,000 females,respectively.In comparison with the western area and the northern mountain area,higher ASRI and ASRM were recorded in the Pearl River Delta area and the eastern area in both males and females.Conclusions:Cancer imposes a heavy disease burden,and cancer patterns are unevenly distributed throughout Guangdong Province.More health resources should be allocated to cancer control,especially in the western and northern mountain areas.展开更多
Objective:This study aims to analyze how changes in pathological diagnosis practice and molecular detection technology have affected clinical outcomes for colorectal cancer(CRC)patients in Hehai University Shanghai Ca...Objective:This study aims to analyze how changes in pathological diagnosis practice and molecular detection technology have affected clinical outcomes for colorectal cancer(CRC)patients in Hehai University Shanghai Cancer Center(FUSCC).Methods:This retrospective cohort study analyzed 21,141 pathologically confirmed CRC cases diagnosed at FUSCC from 2008 to 2020.Patients were divided into five groups for different analytical purposes:(1)the before vs.since 2014 groups to analyze the influence of the changes in the classification criteria of pT3 and pT4 staging on the survival of patients;(2)the partial vs.total mesorectal excision(TME)groups to analyze whether evaluation of completeness of the mesorectum have impact on the survival of patients;(3)the tumor deposit(TD)(+)N0 vs.TD(+)N1c groups to analyze the influence of the changes in the pN staging on the survival of patients with positive TD and negative regional lymph node metastasis(LNM);(4)the before vs.since 2013 groups to analyze the influence of the changes in the testing process of deficient mismatch repair on the survival of patients;and(5)the groups with vs.without RAS/BRAF gene mutation testing to analyze the influence of these testing on the survival of patients.Patients’clinicopathological parameters,including age at diagnosis,sex,tumor size,location,differentiation,mucinous subtype,TD,lymphovascular invasion,perineural invasion,tumor depth,LNM and distant metastasis,and tumor-node-metastasis(TNM)stage,were compared between groups.Kaplan-Meier analysis with log rank method was performed for patients’overall survival(OS)and disease-free survival(DFS)analyses.Results:In pathological reports,there were three parameter changes that impacted patient outcomes.Firstly,changes in the pT staging criteria led to a shift of the ratio of patients with stage pT3 to stage pT4 from 1:110.9 to 1:0.26.In comparison to patients admitted before 2014(n=4,754),a significant difference in prognosis between pT3 and pT4 stages was observed since 2014(n=9,965).Secondly,we began to evaluate the completeness of the mesorectum since 2016.As a result,91.0%of patients with low rectal cancer underwent TME(n=4,111)surgery,and patients with TME had significantly better OS compared with partial mesorectal excision(PME,n=409).Thirdly,we began to stage TD(+)LNM(-)as N1c since 2017.The results showed that N1c(n=127)but not N0(n=39)can improve the prognosis of patients without LNM and distal metastasis.In molecular testing,there have been three and five iterations of updates regarding mismatch repair(MMR)/microsatellite instability(MSI)status and RAS/BRAF gene mutation detection,respectively.The standardization of MMR status testing has sharply decreased the proportion of deficient MMR(dMMR)patients(from 32.5%to 7.4%)since 2013.The prognosis of patients underwent MMR status testing since 2013(n=867)were significantly better than patients before 2013(n=1,313).In addition,detection of RAS/BRAF gene mutation status(n=5,041)resulted in better DFS but not OS,for patients with stage I-III disease(n=16,557).Conclusion:Over the past few decades,updates in elements in pathological reports,as well as the development of standardized tests for MMR/MSI status and RAS/BRAF gene mutations have significantly improved patient outcomes.展开更多
Objective:To synthesize the knowledge about the association of total physical activity(TPA),leisure-time phys-ical activity(LTPA),occupational physical activity(OPA)and lung cancer risk and explore the dose-response r...Objective:To synthesize the knowledge about the association of total physical activity(TPA),leisure-time phys-ical activity(LTPA),occupational physical activity(OPA)and lung cancer risk and explore the dose-response relationship between LTPA level and lung cancer.Methods:PubMed and Web of Science were searched up to 17 November 2021.The summary relative risks(RRs)and 95%confidence intervals(CIs)were calculated by random-effects or fixed-effects model.The dose-response analysis was conducted with restricted cubic splines.Results:We identified 25 articles(42 cohort studies)that assessed the physical activity-lung cancer association,including 9,983,295 study participants and 85,988 incident cases of lung cancer.When comparing the highest to the lowest level of TPA and LTPA,lung cancer risk reduced 22%(RR,0.78;95%CI:0.70,0.86)and 12%(RR,0.88;95%CI:0.83,0.93),respectively.We found an approximately U-shaped association between LTPA and lung cancer(P non-linearity<0.001),with the lowest risk at 15 metabolic equivalent of task hours per week(h/wk)of LTPA.Compared to participants with sitting occupations,lung cancer risk significantly increased among those being unemployed(RR,1.33;95%CI:1.17,1.51)or with standing occupations(RR,1.37;95%CI:1.15,1.63),but not among those with light or high OPA.Conclusions:Our meta-analysis supported a protective effect of TPA and LTPA,but not OPA,on lung cancer risk.The novel finding of a U-shaped association between LTPA and lung cancer risk warrants further investigation.展开更多
Background:This study aimed to provide a detailed analysis of the temporal trends of cancer incidence rates for individuals aged 0-19 years in selected regions globally from 1978 to 2012.Methods:Data were obtained fro...Background:This study aimed to provide a detailed analysis of the temporal trends of cancer incidence rates for individuals aged 0-19 years in selected regions globally from 1978 to 2012.Methods:Data were obtained from Volumes V-XI of Cancer Incidence in Five Continents(CI5),published by the International Agency for Research on Cancer.A total of 53 registries in 23 regions from the Americas,Asia,Europe,and Oceania that contained information on cancer incidence throughout 1978-2012(35 years)were included in this study.Joinpoint regression was used for the analysis of trends.Results:Most regions showed increasing trends in overall childhood cancer among children(aged 0-14 years)and adolescents(aged 15-19 years).Nearly all regions showed rising trends in childhood and adolescent leukemia incidence rates,whereas the incidence of lymphoma among children generally decreased.Only France,Australia,and New Zealand showed decreasing trends for malignant central nervous system(CNS)tumors among adoles-cents.Kidney cancer and bone cancer incidence rates remained stable for most regions.The incidence of thyroid cancer among adolescents increased in most regions and that of testicular cancer decreased in approximately one-half of the regions studied.Conclusion:The international temporal trends of cancer incidents among children and adolescents are varied by region,cancer type,age group,and gender,and have changed over time.展开更多
Objective:This is a comprehensive overview of long-term cancer survival in Zhejiang Province,China.Hybrid analysis,a combination of cohort and period analysis,has been proposed to derive up-to-date cancer survival est...Objective:This is a comprehensive overview of long-term cancer survival in Zhejiang Province,China.Hybrid analysis,a combination of cohort and period analysis,has been proposed to derive up-to-date cancer survival estimates.Using this approach,we aimed to timely and accurately analyze the 5-year relative survival(RS)and net survival(NS)in cancer registries of Zhejiang Province,China.Methods:A total of 255,725 new cancer cases diagnosed during 2013-2017 were included in 14 cancer registries in Zhejiang Province,China,with a follow-up on vital status until the end of 2019.The hybrid analysis was used to calculate the 5-year RS and 5-year NS during 2018-2019 for overall and stratifications by sex,cancer type,region,and age at diagnosis.Results:During 2018-2019,the age-standardized 5-year RS and NS for overall cancer in Zhejiang was 47.5%and 48.6%,respectively.The age-standardized 5-year RS for cancers of women(55.4%)was higher than that of men(40.0%),and the rate of urban areas(49.7%)was higher than that of rural areas(43.1%).The 5-year RS declined along with age,from 84.4%for ages<45 years to 23.7%for ages>74 years.Our results of the RS and NS showed the similar trend and no significant difference.The top five cancers with top age-standardized 5-year RS were thyroid cancer(96.0%),breast cancer(84.3%),testicular cancer(79.9%),prostate cancer(77.2%),and bladder cancer(70.6%),and the five cancers with the lowest age-standardized 5-year RS were pancreatic cancer(6.0%),liver cancer(15.6%),gallbladder cancer(17.1%),esophageal cancer(22.7%),and leukemia(31.0%).Conclusions:We reported the most up-to-date 5-year cancer RS and NS in Zhejiang Province,China for the first time,and found that the 5-year survival for cancer patients in Zhejiang during 2018-2019 was relatively high.The population-based cancer registries are recognized as key policy tools that can be used to evaluate both the impact of cancer prevention strategies and the effectiveness of health systems.展开更多
Objective:To provide the most up-to-date data on the burden of malignant mesothelioma(MM)and the projections through 2029 in China.Methods:Data on patients diagnosed with MM from China during 1990-2019 were obtained f...Objective:To provide the most up-to-date data on the burden of malignant mesothelioma(MM)and the projections through 2029 in China.Methods:Data on patients diagnosed with MM from China during 1990-2019 were obtained from the Global Burden of Disease(GBD)2019 database,including annual cases and deaths data and age-standardized rates of incidence,mortality,and disability-adjusted life-years(DALYs)associated with MM among different age groups.Temporal trends during 1990-2019 were analyzed by the Joinpoint regression models using 95%confidence interval(CI),while the projections through 2029 were calculated by the Bayesian age-period-cohort model.Data on the production and consumption of asbestos in China were obtained from the United States Geological Survey on Mineral Commodity Summaries during 1996-2023.Results:We observed a significant elevation in incident new cases and deaths over the last 3 decades,increasing from 1193 in 1990 to 2815 in 2019 for incident cases and from 1134 in 1990 to 2773 in 2019 for death cases.We found a roughly 6%increase in the proportion of incident cases for those aged>70 years(30%in 2019 versus 24%in 1990),while for the proportion of deaths similar elevation for those aged>70 years was found.Additionally,men had significantly higher DALYs due to MM across age groups compared with women.Asbestos consumption in China dramatically dropped since 2012 and reached the bottom in 2017 with 230 kilotons.By 2029,the projected age-standardized rate for incidence and mortality is expected to reach 1.2 per million for both.Conclusion:We found,for the first time using GBD data on the Chinese population,that the burden of MM has been significantly increasing in China over the last three decades and will continue to increase in the upcoming decade,suggesting an urgent need for a complete ban on chrysotile asbestos in China.展开更多
Introduction:In the past several decades,declining incidences of nasopharyngeal carcinoma(NPC) have been observed in Chinese populations in Hong Kong,Taiwan,Los Angeles,and Singapore.A previous study indicated that th...Introduction:In the past several decades,declining incidences of nasopharyngeal carcinoma(NPC) have been observed in Chinese populations in Hong Kong,Taiwan,Los Angeles,and Singapore.A previous study indicated that the incidence of NPC in Sihui County,South China remained stable until 2002,but whether age,diagnosis period,and birth cohort affect the incidence of NPC remains unknown.Methods:Age-standardized rates(ASRs) of NPC incidence based on the world standard population were examined in both males and females in Sihui County from 1987 to 2011.Joinpoint regression analysis was conducted to quantify the changes in incidence trends.A Poisson regression age-period-cohort model was used to assess the effects of age,diagnosis period,and birth cohort on the risk of NPC.Results:The ASRs of NPC incidence during the study period were 30.29/100,000 for males and 13.09/100,000 for females.The incidence of NPC remained stable at a non-significant average annual percent change of 0.2%for males and-1.6%for females throughout the entire period.A significantly increased estimated annual percent change of 6.8%(95%confidence interval,0.1%-14.0%) was observed from 2003 to 2009 for males.The relative risk of NPC increased with advancing age up to 50-59 and decreased at ages >60 years.The period effect curves on NPC were nearly flat for males and females.The birth cohort effect curve for males showed an increase from the1922 cohort to the 1957 cohort and a decrease thereafter.In females,there was an undulating increase in the relative risk from the 1922 cohort to the 1972 cohort.Conclusions:The incidence trends for NPC remained generally stable in Sihui from 1987 to 2011,with an increase from 2003 to 2009.The relative risks of NPC increased in younger females.展开更多
基金supported by the National Natural Science Foundation of China(No.81974492)the National Natural Science Foundation of China(No.82273721)the Sanming project of Medicine in Shenzhen(No.SZSM201911015)。
文摘In this review,we offer a concise overview of liver cancer epidemiology in China and worldwide from the official databases of GLOBOCAN 2020 and the National Cancer Registry in China.We also summarized the evidence for the main risk factors associated with liver cancer risk and discuss strategies implemented in China to control the liver cancer burden.Overall,liver cancer was the sixth most commonly diagnosed cancer and the third leading cause of cancer-related death worldwide in 2020.Although China contributed to nearly half of cases across the world alone,the incidence and mortality rates of liver cancer presented a declining trend owing to the persistent efforts from the governments at all levels.The current liver cancer burden in China still faces an arduous challenge due to the relatively large population base as well as the substantially low survival rate(12.1%).To better control the liver cancer burden with the lowest cost,specific measures should be conducted by reducing exposure to established risk factors such as hepatitis B infection and aflatoxin.The promotion of surveillance is also an important method to prolong the survival of liver cancer.This review will provide basic information for future direction on the control of liver cancer burden.
基金supported by the National Key R&D Program of China(grant number:2022YFC3600805,2016YFC1302502).
文摘Background:Esophageal cancer(EC)remains a global health challenge due to its poor prognosis.China and the United States of America(USA)represent two distinct epicenters of EC burden.Understanding the EC disparities in these two countries is vital for tailoring prevention strategies,optimizing treatment,and enhancing outcomes in both countries.Yet,there lacks a comprehensive comparison of EC characteristics between the two countries.Methods:In this multicenter,retrospective hospital-based study,we enrolled primary EC patients who received their initial treatment at one of 23 hospitals in China during 2016-2017.Using electronic medical records and cancer registration records,information on demographics,lifestyle,and clinicopathological characteristics(in-cluding tumor site,pathology,stage,metastases,differentiation,and treatment)were collected.Additionally,we compared these data with the clinicopathological information of invasive EC patients diagnosed in 2016-2017 from the Surveillance,Epidemiology,and End Results(SEER)database in the USA.Results:A total of 6,658 EC patients in China and 8,555 EC patients in the USA were included finally.85.5%(n=5,694)of EC were esophageal squamous cell carcinoma(ESCC)in China,while esophageal adenocarcinoma(EAC)was prominent in the USA(58.9%,n=5,041).Among EC patients with known staging,the proportion of early stage was higher in China compared to the USA(48.3%vs.30.5%).Among ESCC patients,early-stage cases were higher in China than in the USA(49.8%vs.31.8%),while among EAC patients,late-stage cases were higher in China than in the USA(77.3%vs.68.5%)(all P<0.001).In China,EC mainly occurred in the middle third(60.2%)of the esophagus,whereas in the USA,it was more common in the lower third(59.9%)of the organ.Compared with EC patients with known metastatic status in the USA,China had fewer cases of lymph node metastases(51.4%vs.57.7%)and distant metastases(7.9%vs.33.8%).Regarding treatment,China had more surgical therapy(53.7%vs.22.6%),less radiotherapy(35.6%vs.53.3%),and less chemotherapy(46.7%vs.59.7%)compared to the USA.Conclusions:This study reveals notable disparities in EC between China and the USA,encompassing epidemi-ological,clinicopathological,and treatment dimensions.These findings provide insight for tailored strategies addressing regional variations in clinicopathological and therapeutic characteristics.
基金supported by grant from the National Key R&D Program of China(grant number:2017YFC0908300)the Fun-damental Research Funds for the Central Universities(grant number:3332023136).
文摘Objective:Accurate prognosis prediction is critical for individualized-therapy making of gastric cancer patients.We aimed to develop and test 6-month,1-,2-,3-,5-,and 10-year overall survival(OS)and cancer-specific survival(CSS)prediction models for gastric cancer patients following gastrectomy.Methods:We derived and tested Survival Quilts,a machine learning-based model,to develop 6-month,1-,2-,3-,5-,and 10-year OS and CSS prediction models.Gastrectomy patients in the development set(n=20,583)and the internal validation set(n=5,106)were recruited from the Surveillance,Epidemiology,and End Re-sults(SEER)database,while those in the external validation set(n=6,352)were recruited from the China National Cancer Center Gastric Cancer(NCCGC)database.Furthermore,we selected gastrectomy patients with-out neoadjuvant therapy as a subgroup to train and test the prognostic models in order to keep the accuracy of tumor-node-metastasis(TNM)stage.Prognostic performances of these OS and CSS models were assessed using the Concordance Index(C-index)and area under the curve(AUC)values.Results:The machine learning model had a consistently high accuracy in predicting 6-month,1-,2-,3-,5-,and 10-year OS in the SEER development set(C-index=0.861,0.832,0.789,0.766,0.740,and 0.709;AUC=0.784,0.828,0.840,0.849,0.869,and 0.902,respectively),SEER validation set(C-index=0.782,0.739,0.712,0.698,0.681,and 0.660;AUC=0.751,0.772,0.767,0.762,0.766,and 0.787,respectively),and NCCGC set(C-index=0.691,0.756,0.751,0.737,0.722,and 0.701;AUC=0.769,0.788,0.790,0.790,0.787,and 0.788,respectively).The model was able to predict 6-month,1-,2-,3-,5-,and 10-year CSS in the SEER development set(C-index=0.879,0.858,0.820,0.802,0.784,and 0.774;AUC=0.756,0.827,0.852,0.863,0.874,and 0.884,respectively)and SEER validation set(C-index=0.790,0.763,0.741,0.729,0.718,and 0.708;AUC=0.706,0.758,0.767,0.766,0.766,and 0.764,respectively).In multivariate analysis,the high-risk group with risk score output by 5-year OS model was proved to be a strong survival predictor both in the SEER development set(hazard ratio[HR]=14.59,95%confidence interval[CI]:1.872-2.774,P<0.001),SEER validation set(HR=2.28,95%CI:13.089-16.293,P<0.001),and NCCGC set(HR=1.98,95%CI:1.617-2.437,P<0.001).We further explored the prognostic value of risk score resulted 5-year CSS model of gastrectomy patients,and found that high-risk group remained as an independent CSS factor in the SEER development set(HR=12.81,95%CI:11.568-14.194,P<0.001)and SEER validation set(HR=1.61,95%CI:1.338-1.935,P<0.001).Conclusion:Survival Quilts could allow accurate prediction of 6-month,1-,2-,3-,5-,and 10-year OS and CSS in gastric cancer patients following gastrectomy.
基金supported by the National Key Research and Development Program of China(Grant No.2018YFC1313100)the National Natural Science Foundation of China(Grant No.81602931)+1 种基金the CAMS Innovation Fund for Medical Sciences(Grant No.2016-I2M-2-004)the Sanming Project of Medicine in Shenzhen(Grant No.SZSM201911015)。
文摘As the most populous country in the world,China has made strides in health promotion in the past few decades.With the aging population,the burden of cancer in China continues to grow.Changes in risk factors for cancer,especially diet,obesity,diabetes,and air pollution,continue to fuel the shift of cancer transition in China.The burden of upper gastrointestinal cancer in China is decreasing,but still heavy.The rising burden of colorectal,prostate,and breast cancers is also significant.Lung cancer became the top cause of cancer-related deaths,together with smoking as the most important contributor to cancer deaths.The Chinese government has taken several approaches to control cancer and cancer-related risk factors.Many achievements have been made,but some challenges remain.Health China 2030 is ambitious and depicts a bright vision of the future for cancer control in China.The decrease in the cancer burden in China will require cross-sector collaboration and coordinated efforts on primary and secondary preventions by governments,public health organizations,and individuals.In this review,we describe the trends of cancer burden and discuss cancer-related risk factors in China,identifying strategies to reduce the burden of cancer in China.
基金supported by grants from the Sanming Project of Medicine in Shenzhen(Grant No.SZSM201911015).
文摘Cancer has become the most common cause of death in China.Owing to rapid economic development,improved livelihood,and shifts in risk factors,cancer epidemiology has experienced substantial changes during the past several decades.In this review,we aim to describe the current cancer epidemiology of the main types of cancer in China,report major risk factors associated with cancer development,and summarize the contributions of the Chinese government to controlling the cancer burden.A total of 4,064,000 new cases were diagnosed in China in 2016.The most frequent types are lung cancer(828,100;20.4%),colorectal cancer(408,000;10.0%),and gastric cancer(396,500;9.8%).Lung(657,000;27.2%),liver(336,400,13.9%),and stomach(288,500;12.0%)cancers are the 3 most deadly cancers in the general population.The 5-year survival rate for cancer has dramatically increased in recent decades.However,liver and particularly pancreatic cancers still have the poorest prognosis.The main modifiable risk factors associated with cancer development include infectious agents,smoking,alcohol consumption,obesity,unhealthful dietary habits,and inadequate physical activity.The Chinese government has made unremitting efforts to decrease the cancer burden,including cancer education and investment in cancer screening programs.
基金supported in part by grants from the Shenkang center city hospital emerging frontier technology joint research project (No. SHDC12015119)National Key R&D Program of China (No. 2017YFC1311004)
文摘Objective: Breast cancer in young females was usually considered more aggressive and requires aggressive therapy. We investigated whether early detection and improved treatments changed the patterns of characteristics,management and outcomes of young breast cancer patients over time.Methods: Females under 40 years of age diagnosed with breast cancer during the periods 1999-2017 and1999-2015 were identified in the Hehai University Shanghai Cancer Center(FUSCC) and the population-based Surveillance, Epidemiology, and End Results(SEER) registry, respectively. Clinicopathologic characteristics and treatment information were collected. Patients diagnosed before 2013 were followed up.Results: The proportions of young breast cancer patients were 15.0% and 5.3% in the FUSCC and SEER cohorts, respectively. In the FUSCC cohort, there was a significant increase in the proportion of ductal carcinoma in situ(DCIS)(from 8.8% to 16.9%;P<0.0001) and it remained stable in SEER cohort. The proportion of T1-stage tumors increased dramatically in the FUSCC cohort(from 35.3% to 41.9%;P=0.008), whereas it decreased in SEER cohort(from 42.4% to 33.0%;P<0.0001). The percentage of estrogen receptor(ER)-positive cancers was consistently increased in both the invasive ductal carcinoma(IDC) and DCIS patients in the two cohorts. Breastconserving surgery and immediate implant reconstruction after mastectomy both exhibited increased use over time in the FUSCC cohort. Both the FUSCC and SEER cohorts showed a significantly better prognosis in the recent time period.Conclusions: With the increased early-stage and ER-positive diseases in young patients as well as better systemic treatment strategies, improved survival has been observed in recent years. There has been a substantial deescalation in surgical therapies in young breast cancer patients.
基金the CAMS Innovation Fund for Medical Sciences(CIFMS)(No.2016-I2M-2-004)Sanming Project of Medicine in Shenzhen(No.SZSM201911015)。
文摘China is faced with heavy burdens caused by lung cancer,which has climbed to the top of both cancer incidence and mortality spectrums.The age-standardized rates of incidence and mortality have shown a trend of gradual uptrends in the last decades,while the crude rates rise much quickly due to the aging of population.Although the improvement in health care has contributed to better survival of lung cancer,its prognosis is still challenging.Apart from the common risk factors such as tobacco use,air pollution,and occupational hazards,some specific factors like Chinese-style cooking also have posed great threats to human health.In light of such national conditions,specific interventions should be conducted to curb the burden of lung cancer including smoking cessation,improvement of air quality,early detection and effective treatment of lung cancer.
基金supported by the National Natural Science Foundation of China(No.81974492)the National Natural Science Foundation of China(No.82273721)the Sanming project of Medicine in Shenzhen(No.SZSM201911015).
文摘In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cancer is still a threat in China, and accounts for nearly half of the cases worldwide. Fortunately, in China, the incidence and mortality rates of stomach cancer presented a declining trend owing to the change of individual life styles and the persistent efforts to prevent stomach cancer from the governments at all levels. Helicobacter pylori(H. pylori)infection, poor eating habits, smoking, history of gastrointestinal disorders, and family history of stomach cancer are the main risk factors for stomach cancer in China. As a result, by taking risk factors for stomach cancer into account, specific preventive measures, such as eradicating H. pylori and implementing stomach cancer screening projects, should be taken to better prevent and decrease the burden of stomach cancer.
基金supported by the National Key Research and Development Program of China (No.2018YFC 1313100)the CAMS Innovation Fund for Medical Sciences (CIFMS) (No.2019-I2M-2-004)Sanming Project of Medicine in Shenzhen (SZSM201911015)。
文摘Objective: This study aimed at evaluating the efficacy of the questionnaire-based prediction model in an independent prospective cohort.Methods: A cluster-randomized controlled trial was conducted in Changsha, Harbin, Luoshan, and Sheyang in eastern China in 2015-2017. A total of 182 villages/communities were regarded as clusters, and allocated to screening arm or control arm randomly. Face-to-face interview through a questionnaire interview, including of relevant risk factors of gastric cancer, was administered for each subject. Participants were further classified into high-risk or low-risk groups based on their exposure to risk factors. All participants were followed up until December 31, 2019. Cumulative incidence rates from gastric cancer between high-risk and low-risk groups were calculated and compared using the log-rank test. Cox proportional hazard regression models were applied to estimate hazard ratio(HR) and 95% confidence interval(95% CI).Results: Totally, 89,914 residents were recruited with a mean follow-up of 3.47 years. And 42,015(46.73%)individuals were classified into high-risk group and 47,899(53.27%) subjects were categorized into low-risk group.Gastric cancer was diagnosed in 131 participants, of which 91 were in high-risk group. Compared with the low-risk participants, high-risk individuals were more likely to develop gastric cancer(adjusted HR=2.15, 95% CI,1.23-3.76). The sensitivity of the questionnaire-based model was estimated at 61.82%(95% CI, 47.71-74.28) in a general population.Conclusions: Our questionnaire-based model is effective at identifying high-risk individuals for gastric cancer.
文摘Objective：Extranodal extension in cervical lymph nodes is an important risk factor for the progression and prognosis of papillary thyroid cancer.The purpose of this study was to identify the common and characteristic preoperative ultrasonography features that are associated with the pathologic extranodal extension of metastatic papillary thyroid carcinoma.Methods：We retrospectively assessed and compared clinicopathologic and ultrasound features between 60 papillary thyroid cancer patients with extranodal extension and 120 control patients with papillary thyroid cancer without extranodal extension.Results：With respect to the pathological N stage and clinicopathologic features,N1b stage papillary thyroid carcinomas were more frequently found in patients who were extranodal extension-positive,in comparison with those who were extranodal extension-negative（78.3%vs.63.3%,P=0.043）.Extranodal extension was detected most frequently in level VI cervical lymph nodes（48.7%）.In our univariate analysis of patients with papillary thyroid carcinoma,cervical lymph nodes with extranodal extension showed higher incidences of node matting,microcalcification,cystic area,aspect ratio＆lt;2,and larger diameter than those without extranodal extension（all P〈0.05）.Our multivariate analysis demonstrated that node matting and cystic area were independent risk factors for the presence of extranodal extension[odds ratio（OR）：4.751,95%confidence interval（CI）：1.212~18.626,P=0.025;OR：2.707,95%CI：1.127~6.502,P=0.026].Conclusions：Common ultrasound features may indicate the presence of extranodal extension in patients with metastatic cervical lymph nodes of papillary thyroid carcinoma.
基金supported by the National High Technology Research and Development Program of China(No.2012AA02A501)the Special Fund for Public Health Trade(No.201202014)
文摘Background:With industrial and economic development in recent decades in South China,cancer incidence may have changed due to the changing lifestyle and environment.However,the trends of lung cancer and the roles of smoking and other environmental risk factors in the development of lung cancer in rural areas of South China remain unclear.The purpose of this study was to explore the lung cancer incidence trends and the possible causes of these trends.Methods:Joinpoint regression analysis and the age-period-cohort(APC) model were used to analyze the lung cancer incidence trends in Sihui,Guangdong province,China between 1987 and 2011,and explore the possible causes of these trends.Results:A total of 2,397 lung cancer patients were involved in this study.A 3-fold increase in the incidence of lung cancer in both sexes was observed over the 25-year period.Joinpoint regression analysis showed that while the incidence continued to increase steadily in females during the entire period,a sharp acceleration was observed in males starting in 2005.The full APC model was selected to describe age,period,and birth cohort effects on lung cancer incidence trends in Sihui.The age cohorts in both sexes showed a continuously significant increase in the relative risk(RR)of lung cancer,with a peak in the eldest age group(80-84 years).The RR of lung cancer showed a fluctuating curve in both sexes.The birth cohorts identified an increased trend in both males and females;however,males had a plateau in the youngest cohorts who were born during 1955-1969.Conclusions:Increasing trends of the incidence of lung cancer in Sihui were dominated by the effects of age and birth cohorts.Social aging,smoking,and environmental changes may play important roles in such trends.
文摘Objective： The automated breast ultrasound system（ABUS） is a potential method for breast cancer detection;however, its diagnostic performance remains unclear. We conducted a hospital-based multicenter diagnostic study to evaluate the clinical performance of the ABUS for breast cancer detection by comparing it to handheld ultrasound（HHUS） and mammography（MG）.Methods： Eligible participants underwent HHUS and ABUS testing; women aged 40–69 years additionally underwent MG. Images were interpreted using the Breast Imaging Reporting and Data System（BI-RADS）.Women in the BI-RADS categories 1–2 were considered negative. Women classified as BI-RADS 3 underwent magnetic resonance imaging to distinguish true-and false-negative results. Core aspiration or surgical biopsy was performed in women classified as BI-RADS 4–5, followed by a pathological diagnosis. Kappa values and agreement rates were calculated between ABUS, HHUS and MG.Results： A total of 1,973 women were included in the final analysis. Of these, 1,353（68.6%） and 620（31.4%）were classified as BI-RADS categories 1–3 and 4–5, respectively. In the older age group, the agreement rate and Kappa value between the ABUS and HHUS were 94.0% and 0.860（P〈0.001）, respectively; they were 89.2% and0.735（P〈0.001） between the ABUS and MG, respectively. Regarding consistency between imaging and pathology results, 78.6% of women classified as BI-RADS 4–5 based on the ABUS were diagnosed with precancerous lesions or cancer; which was 7.2% higher than that of women based on HHUS. For BI-RADS 1–2, the false-negative rates of the ABUS and HHUS were almost identical and were much lower than those of MG.Conclusions： We observed a good diagnostic reliability for the ABUS. Considering its performance for breast cancer detection in women with high-density breasts and its lower operator dependence, the ABUS is a promising option for breast cancer detection in China.
文摘Objective:Integration of risk stratification into fecal immunochemical test(FIT)might aid in the suboptimal detection of advanced neoplasms by FIT in colorectal cancer(CRC)screening.A comparative study was conducted to evaluate the participation and diagnostic yield of the parallel combination of questionnaire-based risk assessment(QRA)and FIT,FIT-only and QRA-only strategies in a CRC screening program in China.Methods:The study included 29,626 individuals aged 40-74 years and invited to participate in a CRC screening program in China.Participants were first invited to undertake QRA and one-time FIT(OC-sensor).Participants with positive QRA or FIT were deemed to be high-risk individuals who were recommended for subsequent colonoscopy.Participation,detection rate,and resource demand for colonoscopy were calculated and compared.Results:Of the 29,626 invitees,20,203 completed the parallel combination,8,592 completed the QRA-only,and11 completed the FIT-only strategy.For the parallel combination,FIT-only,and QRA-only strategies,the overall positivity rates were 10.2%(2,928/28,806),5.4%(1,096/20,214),and 6.8%(1,944/28,795),respectively;the yield of advanced neoplasm per 10,000 invitees were 46.9[95%confidence interval(95%CI):39.8-55.4],36.8(95%CI:30.5-44.4),and 12.2(95%CI:8.8-16.8),respectively;the positive predictive values for detecting advanced neoplasms among participants who completed colonoscopy were 4.7%(95%CI:4.0%-5.6%),9.9%(95%CI:8.3%-11.9%),and 1.9%(95%CI:1.3%-2.6%),respectively;the number of colonoscopies required to detect one advanced neoplasm was 11.4(95%CI:9.8-13.4),5.7(95%CI:4.8-6.7),and 28.4(95%CI:20.7-39.2),respectively.Conclusions:The parallel combination of QRA and FIT did not show superior efficacy for detecting advanced neoplasm compared with FIT alone in this CRC screening program.
基金supported by the Project of Guangdong Science and Technique Plan(No.2012B031800104)Sun Yat-sen University 5010 Clinical Project(No.2013012)
文摘Background:Surveying regional cancer incidence and mortality provides significant data that can assist in making health policy for local areas;however,the province- and region-based cancer burden in China is seldom reported.In this study,we estimated cancer incidence and mortality in Guangdong Province,China and presented basic information for making policies related to health resource allocation and disease control.Methods:A log-linear model was used to calculate the sex-,age-,and registry-specific ratios of incidence to mortality(l/M) based on cancer registry data from Guangzhou,Zhongshan,and Sihui between 2004 and 2008.The cancer incidences in 2009 were then estimated according to representative l/M ratios and the mortality records from eight death surveillance sites in Guangdong Province.The cancer incidences in each city were estimated by the corresponding sex- and age-specific incidences from cancer registries or death surveillance sites in each area.Finally,the total and region-based cancer incidences and mortalities for the entire population of Guangdong Province were summarized.Results:The estimated l/M ratios in Guangzhou(3.658),Zhongshan(2.153),and Sihui(1.527) were significantly different(P < 0.001),with an average l/M ratio of 2.446.Significant differences in the estimated l/M ratios were observed between distinct age groups and the three cancer registries.The estimated l/M ratio in females was significantly higher than that in males(2.864 vs.2.027,P < 0.001).It was estimated that there were 163,376 new cancer cases(99,689 males and 63,687 females) in 2009;it was further estimated that 115,049 people(75,054 males and 39,995females) died from cancer in Guangdong Province in 2009.The estimated crude and age-standardized rate of incidences(ASRI) in Guangdong Province were 231.34 and 246.87 per 100,000 males,respectively,and 156.98 and 163.57 per 100,000 females,respectively.The estimated crude and age-standardized rate of mortalities(ASRM) in Guangdong Province were 174.17 and 187.46 per 100,000 males,respectively,and 98.59 and 102.00 per 100,000 females,respectively.In comparison with the western area and the northern mountain area,higher ASRI and ASRM were recorded in the Pearl River Delta area and the eastern area in both males and females.Conclusions:Cancer imposes a heavy disease burden,and cancer patterns are unevenly distributed throughout Guangdong Province.More health resources should be allocated to cancer control,especially in the western and northern mountain areas.
基金supported by National Natural Science Foundation of China(grant numbers:82273370,82202899,82172702,81972249,81902430,82002543,82002946,U1932145)Shanghai Clinical Science and Technology Innovation Project of Municipal Hospital(grant number:SHDC12020102)+5 种基金Natural Science Foundation of Shanghai(grant numbers:22ZR1413000,21ZR1414900)Artificial Intelligence Medical Hospital Cooperation Project of Xuhui District(grant number:2021-017)Shanghai Science and Technology Development Fund(grant number:19MC1911000)Shanghai Municipal Key Clinical Specialty(grant number:shslczdzk01301)Science and Technology Commission of Shanghai Municipality(grant number:18401933402)“Chenguang Program”supported by Shanghai Education Development Foundation and Shanghai Municipal Education Commission(grant number:20CG08).
文摘Objective:This study aims to analyze how changes in pathological diagnosis practice and molecular detection technology have affected clinical outcomes for colorectal cancer(CRC)patients in Hehai University Shanghai Cancer Center(FUSCC).Methods:This retrospective cohort study analyzed 21,141 pathologically confirmed CRC cases diagnosed at FUSCC from 2008 to 2020.Patients were divided into five groups for different analytical purposes:(1)the before vs.since 2014 groups to analyze the influence of the changes in the classification criteria of pT3 and pT4 staging on the survival of patients;(2)the partial vs.total mesorectal excision(TME)groups to analyze whether evaluation of completeness of the mesorectum have impact on the survival of patients;(3)the tumor deposit(TD)(+)N0 vs.TD(+)N1c groups to analyze the influence of the changes in the pN staging on the survival of patients with positive TD and negative regional lymph node metastasis(LNM);(4)the before vs.since 2013 groups to analyze the influence of the changes in the testing process of deficient mismatch repair on the survival of patients;and(5)the groups with vs.without RAS/BRAF gene mutation testing to analyze the influence of these testing on the survival of patients.Patients’clinicopathological parameters,including age at diagnosis,sex,tumor size,location,differentiation,mucinous subtype,TD,lymphovascular invasion,perineural invasion,tumor depth,LNM and distant metastasis,and tumor-node-metastasis(TNM)stage,were compared between groups.Kaplan-Meier analysis with log rank method was performed for patients’overall survival(OS)and disease-free survival(DFS)analyses.Results:In pathological reports,there were three parameter changes that impacted patient outcomes.Firstly,changes in the pT staging criteria led to a shift of the ratio of patients with stage pT3 to stage pT4 from 1:110.9 to 1:0.26.In comparison to patients admitted before 2014(n=4,754),a significant difference in prognosis between pT3 and pT4 stages was observed since 2014(n=9,965).Secondly,we began to evaluate the completeness of the mesorectum since 2016.As a result,91.0%of patients with low rectal cancer underwent TME(n=4,111)surgery,and patients with TME had significantly better OS compared with partial mesorectal excision(PME,n=409).Thirdly,we began to stage TD(+)LNM(-)as N1c since 2017.The results showed that N1c(n=127)but not N0(n=39)can improve the prognosis of patients without LNM and distal metastasis.In molecular testing,there have been three and five iterations of updates regarding mismatch repair(MMR)/microsatellite instability(MSI)status and RAS/BRAF gene mutation detection,respectively.The standardization of MMR status testing has sharply decreased the proportion of deficient MMR(dMMR)patients(from 32.5%to 7.4%)since 2013.The prognosis of patients underwent MMR status testing since 2013(n=867)were significantly better than patients before 2013(n=1,313).In addition,detection of RAS/BRAF gene mutation status(n=5,041)resulted in better DFS but not OS,for patients with stage I-III disease(n=16,557).Conclusion:Over the past few decades,updates in elements in pathological reports,as well as the development of standardized tests for MMR/MSI status and RAS/BRAF gene mutations have significantly improved patient outcomes.
基金supported by the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(grant number:2021-RC310-009).
文摘Objective:To synthesize the knowledge about the association of total physical activity(TPA),leisure-time phys-ical activity(LTPA),occupational physical activity(OPA)and lung cancer risk and explore the dose-response relationship between LTPA level and lung cancer.Methods:PubMed and Web of Science were searched up to 17 November 2021.The summary relative risks(RRs)and 95%confidence intervals(CIs)were calculated by random-effects or fixed-effects model.The dose-response analysis was conducted with restricted cubic splines.Results:We identified 25 articles(42 cohort studies)that assessed the physical activity-lung cancer association,including 9,983,295 study participants and 85,988 incident cases of lung cancer.When comparing the highest to the lowest level of TPA and LTPA,lung cancer risk reduced 22%(RR,0.78;95%CI:0.70,0.86)and 12%(RR,0.88;95%CI:0.83,0.93),respectively.We found an approximately U-shaped association between LTPA and lung cancer(P non-linearity<0.001),with the lowest risk at 15 metabolic equivalent of task hours per week(h/wk)of LTPA.Compared to participants with sitting occupations,lung cancer risk significantly increased among those being unemployed(RR,1.33;95%CI:1.17,1.51)or with standing occupations(RR,1.37;95%CI:1.15,1.63),but not among those with light or high OPA.Conclusions:Our meta-analysis supported a protective effect of TPA and LTPA,but not OPA,on lung cancer risk.The novel finding of a U-shaped association between LTPA and lung cancer risk warrants further investigation.
基金sponsored by the National Ma-jor Science and Technology Projects of China(2018ZX09721003).
文摘Background:This study aimed to provide a detailed analysis of the temporal trends of cancer incidence rates for individuals aged 0-19 years in selected regions globally from 1978 to 2012.Methods:Data were obtained from Volumes V-XI of Cancer Incidence in Five Continents(CI5),published by the International Agency for Research on Cancer.A total of 53 registries in 23 regions from the Americas,Asia,Europe,and Oceania that contained information on cancer incidence throughout 1978-2012(35 years)were included in this study.Joinpoint regression was used for the analysis of trends.Results:Most regions showed increasing trends in overall childhood cancer among children(aged 0-14 years)and adolescents(aged 15-19 years).Nearly all regions showed rising trends in childhood and adolescent leukemia incidence rates,whereas the incidence of lymphoma among children generally decreased.Only France,Australia,and New Zealand showed decreasing trends for malignant central nervous system(CNS)tumors among adoles-cents.Kidney cancer and bone cancer incidence rates remained stable for most regions.The incidence of thyroid cancer among adolescents increased in most regions and that of testicular cancer decreased in approximately one-half of the regions studied.Conclusion:The international temporal trends of cancer incidents among children and adolescents are varied by region,cancer type,age group,and gender,and have changed over time.
基金funded by Healthy Zhejiang One Million People Cohort(grant number:K-20230085).
文摘Objective:This is a comprehensive overview of long-term cancer survival in Zhejiang Province,China.Hybrid analysis,a combination of cohort and period analysis,has been proposed to derive up-to-date cancer survival estimates.Using this approach,we aimed to timely and accurately analyze the 5-year relative survival(RS)and net survival(NS)in cancer registries of Zhejiang Province,China.Methods:A total of 255,725 new cancer cases diagnosed during 2013-2017 were included in 14 cancer registries in Zhejiang Province,China,with a follow-up on vital status until the end of 2019.The hybrid analysis was used to calculate the 5-year RS and 5-year NS during 2018-2019 for overall and stratifications by sex,cancer type,region,and age at diagnosis.Results:During 2018-2019,the age-standardized 5-year RS and NS for overall cancer in Zhejiang was 47.5%and 48.6%,respectively.The age-standardized 5-year RS for cancers of women(55.4%)was higher than that of men(40.0%),and the rate of urban areas(49.7%)was higher than that of rural areas(43.1%).The 5-year RS declined along with age,from 84.4%for ages<45 years to 23.7%for ages>74 years.Our results of the RS and NS showed the similar trend and no significant difference.The top five cancers with top age-standardized 5-year RS were thyroid cancer(96.0%),breast cancer(84.3%),testicular cancer(79.9%),prostate cancer(77.2%),and bladder cancer(70.6%),and the five cancers with the lowest age-standardized 5-year RS were pancreatic cancer(6.0%),liver cancer(15.6%),gallbladder cancer(17.1%),esophageal cancer(22.7%),and leukemia(31.0%).Conclusions:We reported the most up-to-date 5-year cancer RS and NS in Zhejiang Province,China for the first time,and found that the 5-year survival for cancer patients in Zhejiang during 2018-2019 was relatively high.The population-based cancer registries are recognized as key policy tools that can be used to evaluate both the impact of cancer prevention strategies and the effectiveness of health systems.
基金supported by grants from Zhejiang Provincial Ten-Thousand Talents Plan(grant number:2021R52020)the Horizon 2020 Program of the European Union(grant number:856620).
文摘Objective:To provide the most up-to-date data on the burden of malignant mesothelioma(MM)and the projections through 2029 in China.Methods:Data on patients diagnosed with MM from China during 1990-2019 were obtained from the Global Burden of Disease(GBD)2019 database,including annual cases and deaths data and age-standardized rates of incidence,mortality,and disability-adjusted life-years(DALYs)associated with MM among different age groups.Temporal trends during 1990-2019 were analyzed by the Joinpoint regression models using 95%confidence interval(CI),while the projections through 2029 were calculated by the Bayesian age-period-cohort model.Data on the production and consumption of asbestos in China were obtained from the United States Geological Survey on Mineral Commodity Summaries during 1996-2023.Results:We observed a significant elevation in incident new cases and deaths over the last 3 decades,increasing from 1193 in 1990 to 2815 in 2019 for incident cases and from 1134 in 1990 to 2773 in 2019 for death cases.We found a roughly 6%increase in the proportion of incident cases for those aged>70 years(30%in 2019 versus 24%in 1990),while for the proportion of deaths similar elevation for those aged>70 years was found.Additionally,men had significantly higher DALYs due to MM across age groups compared with women.Asbestos consumption in China dramatically dropped since 2012 and reached the bottom in 2017 with 230 kilotons.By 2029,the projected age-standardized rate for incidence and mortality is expected to reach 1.2 per million for both.Conclusion:We found,for the first time using GBD data on the Chinese population,that the burden of MM has been significantly increasing in China over the last three decades and will continue to increase in the upcoming decade,suggesting an urgent need for a complete ban on chrysotile asbestos in China.
文摘Introduction:In the past several decades,declining incidences of nasopharyngeal carcinoma(NPC) have been observed in Chinese populations in Hong Kong,Taiwan,Los Angeles,and Singapore.A previous study indicated that the incidence of NPC in Sihui County,South China remained stable until 2002,but whether age,diagnosis period,and birth cohort affect the incidence of NPC remains unknown.Methods:Age-standardized rates(ASRs) of NPC incidence based on the world standard population were examined in both males and females in Sihui County from 1987 to 2011.Joinpoint regression analysis was conducted to quantify the changes in incidence trends.A Poisson regression age-period-cohort model was used to assess the effects of age,diagnosis period,and birth cohort on the risk of NPC.Results:The ASRs of NPC incidence during the study period were 30.29/100,000 for males and 13.09/100,000 for females.The incidence of NPC remained stable at a non-significant average annual percent change of 0.2%for males and-1.6%for females throughout the entire period.A significantly increased estimated annual percent change of 6.8%(95%confidence interval,0.1%-14.0%) was observed from 2003 to 2009 for males.The relative risk of NPC increased with advancing age up to 50-59 and decreased at ages >60 years.The period effect curves on NPC were nearly flat for males and females.The birth cohort effect curve for males showed an increase from the1922 cohort to the 1957 cohort and a decrease thereafter.In females,there was an undulating increase in the relative risk from the 1922 cohort to the 1972 cohort.Conclusions:The incidence trends for NPC remained generally stable in Sihui from 1987 to 2011,with an increase from 2003 to 2009.The relative risks of NPC increased in younger females.
