Objective： To evaluate the efficacy and feasibility of screening procedure for upper gastrointestinal cancer in both high-risk and non-high-risk areas in China. Setting： Seven cities/counties, representing three eco...Objective： To evaluate the efficacy and feasibility of screening procedure for upper gastrointestinal cancer in both high-risk and non-high-risk areas in China. Setting： Seven cities/counties, representing three economical-geographical regions （Eastern, Central and Western） in China, were selected as screening centers： three in high-risk areas and four in non-high-risk areas. Participants： Villages/communities in these seven centers regarded as clusters were randomly assigned to either intervention group （screening by endoscopic examination） or control group （with normal community care） in a 1：1 ratio stratified by each center. Eligible participants are local residents aged 40-69 years in the selected villages/communities with no history of cancer or endoscopic examination in the latest 3 years who are mentally and physically competent. Those who are not willing to take endoscopic examination or are unwilling to sign the consent form are excluded from the study. Totally 140,000 participants will be enrolled. Interventions： In high-risk areas of upper gastrointestinal cancer, all subjects in screening group will be screened by endoscopy. In non-high-risk areas, 30% of the subjects in screening group, identified through a survey, will be screened by endoscopy. Primary and secondary outcome measures： The primary outcome is the mortality caused by upper gastrointestinal cancer. The secondary outcomes include detection rate, incidence rate, survival rate, and clinical stage distribution. Additional data on quality of life and cost-effectiveness will also be collected to answer important questions regarding screening effects. Conclusions： Screening strategy evaluated in those areas with positive findings may be promoted nationally and applied to the majority of Chinese people. On the other hand, negative findings will provide scientific evidence for abandoning a test and shifting resources elsewhere. Trial registration： The study has been registered with the Protocol Registration System in Chinese Clinical Trial Registry （identifier： ChiCTR-EOR-16008577）.展开更多
Objective:Cervical cancer is a growing concern in China,especially among women who reside in rural areas and older women.Understanding age-and region-specific trends in cervical cancer is vital for informing policy an...Objective:Cervical cancer is a growing concern in China,especially among women who reside in rural areas and older women.Understanding age-and region-specific trends in cervical cancer is vital for informing policy and assessing progress toward WHO elimination targets.Methods:The 2000±2020 data from 22 long-standing registries contributing to the China national cancer registry was analyzed to estimate age-standardized incidence and mortality rates(ASIR and ASMR,respectively).Joinpoint regression yielded an average annual percentage change(AAPC)stratified by age group(<35,35±64,65±74,and≥75 y)and by urban-rural area.The comparative analysis included GLOBOCAN Overtime data from selected Asia-Pacific countries.Results:The ASIR tripled in China between 2000 and 2020 before stabilizing(AAPC=6.5%),while the ASMR rose steadily(AAPC=3.9%).The urban incidence declined after 2009 among women<35 y,while rural trends were broadly stable.The ASIR and ASMR increased in urban areas among women 35±64 y of age,while rural areas had a rising ASIR and a stable ASMR,suggesting potential screening effects.In contrast,women≥65 y of age had a steadily increasing incidence and mortality in rural and urban areas.Australia and Republic of Korea had consistent declines in the ASIRs and ASMRs compared to other Asia-Pacific countries,whereas Japan exhibited rising trends.The Philippines experienced a surge in mortality rates,despite incidence rates remaining stable or declining.Conclusions:The cervical cancer burden in China has begun to plateau but large disparities persist by age and geography.To achieve elimination of cervical cancer,it is imperative to implement tailored strategies that prioritize the urgent expansion of HPV vaccination programs,the deployment of high-efficacy screening methods,and the universal access to treatment throughout the nation.展开更多
Human enterovirus A71(EV-A71)is a major causative agent of hand,foot and mouth disease(HFMD),which poses a significant public health threat,particularly among young children.Mitochondrial antiviral signaling protein(M...Human enterovirus A71(EV-A71)is a major causative agent of hand,foot and mouth disease(HFMD),which poses a significant public health threat,particularly among young children.Mitochondrial antiviral signaling protein(MAVS)and interferon regulatory factor 3(IRF3)are vital proteins for the induction of type I interferons(IFN-I)and downstream interferon-stimulated genes(ISGs)during EVA71 infection.While posttranslational modifications are known to critically influence viral infection processes,the mechanisms by which EV-A71 exploits host deubiquitinases(DUBs)for immune evasion remain poorly understood.In this study,we demonstrated that EV-A71 infection upregulated ubiquitinspecific protease 5(USP5)expression.Knockdown of USP5 not only inhibited EV-A71 replication but also observably increased the production of IFN-I and ISGs.Furthermore,USP5 also regulated the replication of EV-D68 and CVA16 and the production of IFN-I and ISGs.Mechanistically,USP5 physically interacted with MAVS and IRF3 and reduced the K63-linked polyubiquitination of MAVS and IRF3.Conversely,USP5 knockdown increased the K63-linked polyubiquitination of MAVS and IRF3,thereby accelerating the phosphorylation of IRF3 and increasing IFN-I production during EV-A71 infection.Furthermore,pharmacological inhibition of USP5 with the small-molecule inhibitor PR-619 significantly potentiated the antiviral effects of IFN against EV-A71.Collectively,our findings reveal a previously unrecognized role of USP5 in facilitating EV-A71 immune evasion by dampening MAVSand IRF3-mediated antiviral signaling.These insights provide a novel therapeutic avenue for combating EV-A71 infection through targeted modulation of the USP5-IRF3 axis.展开更多
Objective: Liver cancer is one of the most common cancers and major cause of cancer deaths in China,which accounts for over 50% of new cases and deaths worldwide.The systematic liver cancer statistics including of pro...Objective: Liver cancer is one of the most common cancers and major cause of cancer deaths in China,which accounts for over 50% of new cases and deaths worldwide.The systematic liver cancer statistics including of projection through 2030 could provide valuable information for prevention and control strategies in China,and experience for other countries.Methods: The burden of liver cancer in China in 2014 was estimated using 339 cancer registries’ data selected from Chinese National Cancer Center(NCC).Incident cases of 22 cancer registries were applied for temporal trends from 2000 to 2014.The burden of liver cancer through 2030 was projected using age-period-cohort model.Results: About 364,800 new cases of liver cancer(268,900 males and 95,900 females) occurred in China,and about 318,800 liver cancer deaths(233,500 males and 85,300 females) in 2014.Western regions of China had the highest incidence and mortality rates.Incidence and mortality rates decreased by about 2.3% and 2.6% per year during the period of 2000-2014,respectively,and would decrease by more than 44% between 2014 and 2030 in China.The young generation,particularly for those aged under 40 years,showed a faster down trend.Conclusions: Based on the analysis,incidence and mortality rates of liver cancer are expected to decrease through 2030,but the burden of liver cancer is still serious in China,especially in rural and western areas.Most cases of liver cancer in China can be prevented through vaccination and more prevention efforts should be focused on high risk groups.展开更多
Objective:Breast cancer was the most common cancer and the fifth cause of cancer deaths among women in China in 2015.The evaluation of the long-term incidence and mortality trends and the prediction of the future burd...Objective:Breast cancer was the most common cancer and the fifth cause of cancer deaths among women in China in 2015.The evaluation of the long-term incidence and mortality trends and the prediction of the future burden of breast cancer could provide valuable information for developing prevention and control strategies.Methods:The burden of breast cancer in China in 2015 was estimated by using qualified data from 368 cancer registries from the National Central Cancer Registry.Incident cases and deaths in 22 cancer registries were used to assess the time trends from 2000 to 2015.A Bayesian age-period-cohort model was used to project the burden of breast cancer to 2030.Results:Approximately 303,600 new cases of breast cancer(205,100 from urban areas and 98,500 from rural areas)and 70,400 breast cancer deaths(45,100 from urban areas and 24,500 from rural areas)occurred in China in 2015.Urban regions of China had the highest incidence and mortality rates.The most common histological subtype of breast cancer was invasive ductal carcinoma,followed by invasive lobular carcinoma.The age-standardized incidence and mortality rates increased by 3.3%and 1.0%per year during 2000–2015,and were projected to increase by more than 11%until 2030.Changes in risk and demographic factors between 2015 and 2030 in cases are predicted to increase by approximately 13.3%and 22.9%,whereas deaths are predicted to increase by 13.1%and 40.9%,respectively.Conclusions:The incidence and mortality of breast cancer continue to increase in China.There are no signs that this trend will stop by 2030,particularly in rural areas.Effective breast cancer prevention strategies are therefore urgently needed in China.展开更多
Objective: Using data from cancer registries to estimate laryngeal cancer incidence and mortality in China, 2015.Methods: Data submitted from 501 cancer registries were checked and evaluated according to the criteria ...Objective: Using data from cancer registries to estimate laryngeal cancer incidence and mortality in China, 2015.Methods: Data submitted from 501 cancer registries were checked and evaluated according to the criteria of data quality control and 368 registries’ data were qualified for the final analysis. Data were stratified by area(urban/rural), sex, age group and combined with national population data to estimate laryngeal cancer incidence and mortality in China, 2015. China population census in 2000 and Segi’s population were used for agestandardized.Results: The percentage of cases morphological verified(MV%) of laryngeal cancer was 74.18%. The percentage of death certificate-only cases(DCO%) was 2.10%. And the mortality to incidence(M/I) ratio was 0.55.About 25,300 new cases of laryngeal cancer were diagnosed in 2015 and 13,700 deaths were reported. The crude rate of laryngeal cancer was 1.84 per 100,000(males and females were 3.20 and 0.42 per 100,000, respectively).Age-standardized incidence rates by Chinese standard population(ASIRC) and by world standard population(ASIRW) were 1.18 and 1.19 per 100,000, respectively. The cumulative incidence rate(0-74 years old) was 0.15%.The crude mortality rate was 1.00 per 100,000. Age-standardized mortality rates by Chinese standard population(ASMRC) and by world standard population(ASMRW) were 0.61 and 0.61 per 100,000, respectively, with the cumulative rate(0-74 years old) was 0.07%. Incidence and mortality of laryngeal cancer in males were higher than those in females. And the rates in urban areas were higher than those in rural areas.Conclusions: The incidence and mortality of laryngeal cancer in China were low. And the rates were significantly higher in males than in females. Risk factor control and targeted prevention should be strengthened.展开更多
Objective:To summarize the colorectal cancer(CRC)burden and trend in the world,and compare the difference of CRC burden between other countries and China.Methods:Incidence and mortality data were extracted from the GL...Objective:To summarize the colorectal cancer(CRC)burden and trend in the world,and compare the difference of CRC burden between other countries and China.Methods:Incidence and mortality data were extracted from the GLOBOCAN2018 and Cancer Incidence in Five Continents.Age-specific incidence trend was conducted by Joinpoint analysis and average annual percent changes were calculated.Results:About 1.85 million new cases and 0.88 million deaths were expected in 2018 worldwide,including 0.52 million(28.20%)new cases and 0.25 million(28.11%)deaths in China.Hungary had the highest age-standardized incidence and mortality rates in the world,while for China,the incidence and mortality rates were only half of that.CRC incidence and mortality were highly correlated with human development index(HDI).Unlike the rapid increase in Republic of Korea and the downward trend in Canada and Australia,the age-standardized incidence rates by world standard population in China and Norway were rising gradually.The age-specific incidence rate in the age group of 50-59 years in China was increasing rapidly,while in Republic of Korea and Canada,the fastest growing age group was 30-39 years.Conclusions:The variations of CRC burden reflect the difference of risk factors,as well as levels of HDI and screening(early detection activities).The burden of CRC in China is high,and the incidence of CRC continues to increase,which may lead to a sustained increase in the burden of CRC in China in the future.Screening should be expanded to control CRC,and focused on young people in China.展开更多
Objective: To report the incidence and mortality rates of oral and oropharyngeal cancer in Chinese population.Methods: Data were taken from a population-based cancer registry collected by the National Central Cancer R...Objective: To report the incidence and mortality rates of oral and oropharyngeal cancer in Chinese population.Methods: Data were taken from a population-based cancer registry collected by the National Central Cancer Registry of China(NCCRC) in 2015. The data collected from 501 local cancer registries in China were assessed using NCCRC screening methods and criteria. Incidence and mortality rates of oral and oropharyngeal cancer were stratified by age group, gender, and area. Age-standardized incidence and mortality rates were adjusted using the Chinese standard population in 2000 and Segi’s world population.Results: In 2015, it was estimated that there were 51,765 oral and oropharyngeal cancer incident cases and 23,830 deaths in China. The crude incidence rate of oral and oropharyngeal cancer was 3.77/100,000, and the agestandardized incidence rate by Chinese standard population and by Segi’s world standard population were 2.55/100,000 and 2.49/100,000, respectively. The crude mortality rate and the age-standardized mortality rates by Chinese standard population and by Segi’s world standard population were 1.73/100,000, 1.09/100,000 and1.08/100,000, respectively. Both incidence and mortality rates of oral and oropharyngeal cancer were higher in males and in urban areas. Residents in eastern areas had the highest incidence and mortality rates, followed by those from middle areas and western areas. The rates of oral and oropharyngeal cancer increased greatly with age,especially after the age of 40 years.Conclusions: This study reports the latest incidence and mortality rates of oral and oropharyngeal cancer in China. Prevention intervention including early detection, treatment, and regular follow-ups is encouraged to be set up to reduce incidence and mortality rates of oral and oropharyngeal cancer in the future.展开更多
Objective: Esophageal squamous cell carcinoma(ESCC) is one of the dominant malignances worldwide, but currently there is less focus on the microbiota with ESCC and its precancerous lesions.Methods: Paired esophageal b...Objective: Esophageal squamous cell carcinoma(ESCC) is one of the dominant malignances worldwide, but currently there is less focus on the microbiota with ESCC and its precancerous lesions.Methods: Paired esophageal biopsy and swab specimens were obtained from 236 participants in Linzhou, China.Data from 16 S ribosomal RNA gene sequencing were processed using quantitative insights into microbial ecology(QIIME2) and R Studio to evaluate differences. The Wilcoxon rank sum test and Kruskal-Wallis rank sum test were used to compare diversity and characteristic genera by specimens and participant groups. Ordinal logistic regression model was used to build microbiol prediction model.Results: Microbial diversity was similar between biopsy and swab specimens, including operational taxonomic unit(OTU) numbers and Shannon index. There were variations and similarities of esophageal microbiota among different pathological characteristics of ESCC. Top 10 relative abundance genera in all groups include Streptococcus, Prevotella, Veillonella, Actinobacillus, Haemophilus, Neisseria, Alloprevotella, Rothia, Gemella and Porphyromonas. Genus Streptococcus, Haemophilus, Neisseria and Porphyromonas showed significantly difference in disease groups when compared to normal control, whereas Streptococcus showed an increasing tendency with the progression of ESCC and others showed a decreasing tendency. About models based on all combinations of characteristic genera, only taken Streptococcus and Neisseria into model, the prediction performance was the ideal one, of which the area under the curve(AUC) was 0.738.Conclusions: Esophageal biopsy and swab specimens could yield similar microbial characterization. The combination of Streptococcus and Neisseria has the potential to predict the progression of ESCC, which is needed to confirm by large-scale, prospective cohort studies.展开更多
Objective： Stomach and esophageal cancer are imposing huge threats to the health of Chinese people whereasthere were few studies on the financial burden of the two cancers.Methods： Costs per hospitalization of all p...Objective： Stomach and esophageal cancer are imposing huge threats to the health of Chinese people whereasthere were few studies on the financial burden of the two cancers.Methods： Costs per hospitalization of all patients with stomach or esophageal cancer discharged betweenSeptember 2015 and August 2016 in seven cities/counties in China were collected, together with their demographicinformation and clinical details. Former patients in the same hospitals were sampled to collect information onannual direct non-medical cost, indirect costs and annual number of hospitalization. Annual direct medical cost wasobtained by multiplying cost per hospitalization by annual number of hospitalization. Annual cost of illness （ACI）was obtained by adding the average value of annual direct medical cost, direct non-medical cost and indirect cost,stratified by sex, age, clinical stage, therapy and pathologic type in urban and rural areas. Costs per hospitalizationwere itemized into eight parts to calculate the proportion of each part. All costs were converted to 2016 US dollars（1 USD：6.6423 RMB）.Results： Totally 19,986 cases were included, predominately male. Mean ages of stomach cancer and urbanpatients were lower than that of esophageal cancer and rural patients. ACI of stomach and esophageal cancerpatients were $10,449 and $13,029 in urban areas, and $2,927 and $3,504 in rural areas, respectively. Greater ACIwas associated with male, non-elderly patients as well as those who were in stage I and underwent surgeries.Western medicine fee took the largest proportion of cost per hospitalization.Conclusions： The ACI of stomach and esophageal cancer was tremendous and varied substantially among thepopulation in China. Preferential policies of medical insurance should be designed to tackle with this burden andfurther reduce the health care inequalities.展开更多
Objective： To evaluate the feasibility of DNA image cytometry （DNA-ICM） as a primary screening method for esophageal squamous cell cancer （ESCC）. Methods： A total of 5,382 local residents aged 40-69 years from t...Objective： To evaluate the feasibility of DNA image cytometry （DNA-ICM） as a primary screening method for esophageal squamous cell cancer （ESCC）. Methods： A total of 5,382 local residents aged 40-69 years from three high-risk areas in China （Linzhou in Henan province, Feicheng in Shandong province and Cixian in Hebei province） from 2008 to 2011 were recruited in this population-based screening study. And 2,526 subjects declined to receive endoscopic biopsy examination with Lugol＇s iodine staining, while 9 and 815 subjects were excluded from liquid-based cytology and DNA-ICM test respectively due to slide quality. Finally, 2,856, 5,373 and 4,567 subjects were enrolled in the analysis for endoscopic biopsy examination, liquid-based cytology and DNA-ICM test, respectively. Sensitivity （SE）, specificity （SP）, negative predictive values （NPV） and positive predictive values （PPV） as well as their 95% confidence intervals （95% CI） for DNA-ICM, liquid-based cytology and the combination of the two methods were calculated. Receiver operating characteristic （ROC） curves were applied to determine the cutoff point of DNA-ICM for esophageal cancer. Results： DNA-ICM results were significantly correlative with esophageal cancer and precancer lesions （X2= 18.016, P〈0.001）. The cutoff points were 5,802, 5,803 and 8,002 based on dissimilar pathological types of low grade intraepithelial neoplasia （LGIN）, high grade intraepithelial neoplasia （HGIN）, and ESCC, respectively, and 5,803 was chosen in this study considering the SE and SP. The SE, SP, PPV, NPV of DNA-ICM test （cutoff point 5,803） combined with liquid-based cytology [threshold atypical squamous cells of undetermined significance （ASCUS）] were separately 72.1% （95% CI： 70.3%-73.9%）, 43.3% （95% CI. 41.3%-45.3%）, 22.8% （95% CI： 21.1%-24.5%） and 87.0% （95% CI： 85.7%-88.3%） for LGIN, 85.7% （95% CI： 84.3%-87.1%）, 41.3% （95% CI： 39.3%-43.3%）, 4.6% （95% CI： 3.8%-5.4%） and 98.9% （95% CI： 98.5%-99.3%） for HGIN, and 96.0% （95% CI： 95.2%-96.8%）, 40.8% （95% CI： 38.8%-42.8%）, 1.7% （95% CI： 1.2%-2.2%） and 99.9% （95% CI： 99.8%-100.0%） for ESCC. Conclusions： It is possible to use DNA-ICM test as a primary screening method before endoscopic screening for esophageal cancer.展开更多
Objective: To explore the natural history of severe dysplasia/carcinoma in situ(SD/CIS) patients and to evaluate the efficacy of endoscopic treatment to SD/CIS patients.Methods: Between January 2005 and December 2009,...Objective: To explore the natural history of severe dysplasia/carcinoma in situ(SD/CIS) patients and to evaluate the efficacy of endoscopic treatment to SD/CIS patients.Methods: Between January 2005 and December 2009, a population-based prospective screening program on esophageal squamous cell carcinoma(ESCC) was performed in Linzhou, China, with endoscopic screening plus iodine staining. All the eligible histologically confirmed SD/CIS patients were followed up through the door-todoor follow-up and local cancer registry. The endpoint was diagnosed as ESCC or the December 31 st, 2016.Kaplan-Meier survival analysis and Log-rank test were used to compare the survival rates among treated and untreated patients.Results: A total of 175 SD/CIS patients were enrolled and grouped by whether they received endoscopic treatment. Eleven-year cumulative incidence rates for untreated and treated SD/CIS patients were 10.7% [95%confidence interval(95% CI): 6.9-16.1] and 3.2%(95% CI: 1.4-7.0), respectively. The ESCC incidence free survival rate, and all-cause incidence and mortality free survival rates were all significantly higher in the treated patients vs. untreated patients(P=0.043, P=0.008 and P=0.015, respectively). The ESCC mortality free survival rate showed no significant differences between the two groups(P=0.847).Conclusions: The cumulative incidence rate of SD/CIS patients to ESCC was much lower than previously reported. The Kaplan-Meier survival analysis showed that endoscopic treatment could increase the ESCC and allcause disease-free survival rates of SD/CIS patients significantly.展开更多
Objective: Plant-based diets have multiple health benefits for cancers;however, little is known about the association between plant-based dietary patterns and esophageal cancer(EC).This study presents an investigation...Objective: Plant-based diets have multiple health benefits for cancers;however, little is known about the association between plant-based dietary patterns and esophageal cancer(EC).This study presents an investigation of the prospective associations among three predefined indices of plant-based dietary patterns and the risk of EC.Methods: We performed endoscopic screening for 15,709 participants aged 40-69 years from two high-risk areas of China from January 2005 to December 2009 and followed the cohort until December 31, 2022. The overall plant-based diet index(PDI), healthful plant-based diet index(h PDI), and unhealthful plant-based diet index(u PDI), were calculated using survey responses to assess dietary patterns. We applied Cox proportional hazard regression to estimate the multivariable hazard ratios(HRs) and 95% confidence intervals(95% CIs) of EC across 3plant-based diet indices and further stratified the analysis by subgroups.Results: The final study sample included 15,184 participants in the cohort. During a follow-up of 219,365person-years, 176 patients with EC were identified. When the highest quartile was compared with the lowest quartile, the pooled multivariable-adjusted HR of EC was 0.50(95% CI, 0.32-0.77) for h PDI. In addition, the HR per 10-point increase in the h PDI score was 0.42(95% CI, 0.27-0.66) for ECs. Conversely, u PDI was positively associated with the risk of EC, and the HR was 1.80(95% CI, 1.16-2.82). The HR per 10-point increase in the u PDI score was 1.90(95% CI, 1.26-2.88) for ECs. The associations between these scores and the risk of EC were consistent in most subgroups. These results remained robust in sensitivity analyses.Conclusions: A healthy plant-based dietary pattern was associated with a reduced risk of EC. Emphasizing the healthiness and quality of plant-based diets may be important for preventing the development of EC.展开更多
Objective:To investigate what extent lead-time bias is likely to affect endoscopic screening effectiveness for esophageal cancer in the high-risk area in China.Methods:A screening model based on the epidemiological ca...Objective:To investigate what extent lead-time bias is likely to affect endoscopic screening effectiveness for esophageal cancer in the high-risk area in China.Methods:A screening model based on the epidemiological cancer registry data,yielding a population-level incidence and mortality rates,was carried out to simulate study participants in the high-risk area in China,and investigate the effect of lead-time bias on endoscopic screening with control for length bias.Results:Of 100,000 participants,6,150(6.15%)were diagnosed with esophageal squamous dysplasia during the 20-year follow-up period.The estimated lead time ranged from 1.67 to 5.78 years,with a median time of 4.62 years[interquartile range(IQR):4.07-5.11 years]in the high-risk area in China.Lead-time bias exaggerated screening effectiveness severely,causing more than a 10%overestimation in 5-year cause-specific survival rate and around a 43%reduction in cause-specific hazard ratio.The magnitude of lead-time bias on endoscopic screening for esophageal cancer varied depending on the screening strategies,in which an inverted U-shaped and U-shaped effects were observed in the 5-year cause-specific survival rate and cause-specific hazard ratio respectively concerning a range of ages for primary screening.Conclusions:Lead-time bias,usually causing an overestimation of screening effectiveness,is an elementary and fundamental issue in cancer screening.Quantification and correction of lead-time bias are essential when evaluating the effectiveness of endoscopic screening in the high-risk area in China.展开更多
The numbers of new cancer cases and deaths in China were the largest in the world,causing a huge social and economic burden.We attempt to use more intuitive indicators to measure the probabilities of being diagnosed o...The numbers of new cancer cases and deaths in China were the largest in the world,causing a huge social and economic burden.We attempt to use more intuitive indicators to measure the probabilities of being diagnosed of or dying from cancer in China and compare these probabilities with those in Japan and the United States(US).We obtained the cancer data from GLOBOCAN 2022 for China,Japan,and the US and the all-cause mortality and population data from the United Nations.The lifetime risks of developing and dying from cancer were estimated with adjusted actual life expectancy,multiple primaries,and death-competing risks from causes other than cancers.Approximately 27.61%of Chinese people developed cancer and 1 in 5 persons were likely to die from cancer.The highest-risk cancer among men and women was lung cancer in China,but in the US and Japan,prostate cancer among men and breast cancer among women posed the highest risk.Lung cancer presented the highest likelihood of death,but women in Japan had the highest likelihood of dying from colorectal cancer.China had a lower lifetime risk of developing cancer compared with Japan and the US,but a higher probability of dying from cancer than the US.Although the probability of developing cancer was not as high as that in Japan and the US,China was still faced with enormous pressure due to its huge population and contradictory cancer patterns.Estimating lifetime risks can provide essential information to formulate appropriate cancer prevention and control plans.展开更多
Introduction:Esophageal squamous cell carcinoma(ESCC)and adenocarcinoma(EAC)are the two primary subtypes of esophageal cancer.Historically,ESCC incidence has exceeded EAC,particularly in East Asia,Southern Africa,and ...Introduction:Esophageal squamous cell carcinoma(ESCC)and adenocarcinoma(EAC)are the two primary subtypes of esophageal cancer.Historically,ESCC incidence has exceeded EAC,particularly in East Asia,Southern Africa,and parts of South America.However,in recent decades,EAC incidence has risen markedly in high-income countries due to lifestyle changes.Using the latest Cancer Incidence in Five Continents(CI5)data,we aimed to analyze global temporal trends and sex differences in the burden of ESCC and EAC.Methods:We extracted ESCC and EAC incidence data from 25 countries in CI5 Volumes VIII-XII(1993–2017)for trend analysis.Age-standardized incidence rates(ASIRs)and ESCC-to-EAC ASIR ratios were calculated using Segi’s World Standard Population,and annual percentage changes were estimated using Joinpoint regression.Additionally,we evaluated male-to-female ASIR ratios using data from 53 countries in CI5 Volume XII(2013–2017).Results:Between 1993–2017,ESCC ASIRs declined in 19 countries but increased in Japan,the Czech Republic,Latvia,Denmark,and Lithuania.Conversely,EAC ASIRs increased in 17 countries,with the Republic of Korea being the only country reporting a decline.ESCC-to-EAC ASIR ratios narrowed in most countries,with EAC surpassing ESCC among males in 10 countries,including the United States,and among females only in the Philippines.From 2013–2017,males exhibited consistently higher ASIRs than females for both subtypes,with more pronounced sex differences observed for EAC.Conclusions:This study highlights the changing epidemiology of ESCC and EAC globally and provides important scientific evidence for tailoring prevention and control strategies based on regional and histological-specific trends.展开更多
Introduction:This study aims to report the epidemiological trends and provide updated estimates and lifetime risks for breast and cervical cancers among women in Guangdong province.Methods:A Bayesian age-period-cohort...Introduction:This study aims to report the epidemiological trends and provide updated estimates and lifetime risks for breast and cervical cancers among women in Guangdong province.Methods:A Bayesian age-period-cohort model was applied to project incidence and mortality rates for 2023.The adjusted for multiple primaries(AMP)method was used to calculate the lifetime risks of developing and dying from breast and cervical cancer.Joinpoint analysis was employed to describe the temporal trends.Results:The age-standardized incidence rate(ASIR)of female breast cancer increased from 2012 to 2019 in Guangdong province,with a particularly pronounced increase noted in the rural areas.The ASIR for cervical cancer among women aged over 55 increased in both urban and rural areas,whereas a declining trend was observed among women under the age of 55.The age-standardized mortality rates(ASMRs)for both breast cancer and cervical cancer demonstrated upward trends among women aged over 55,while no significant trend in ASMR was found for women under 55 years.In 2023,the estimated incidence rates of breast cancer and cervical cancer would be 50.81/10^(5)(ASIR would be 35.57/10^(5))and 15.31/10^(5)(ASIR would be 10.41/10^(5))respectively,with corresponding mortality rates of 10.78/10^(5)(ASMR would be 7.15/10^(5))and 6.11/10^(5)(ASMR would be 3.93/10^(5))for these cancers.Conclusions:Breast cancer continues to pose a significant threat to women’s health in both rural and urban areas of Guangdong,whereas cancer prevention and control programs for cervical cancer have shown positive impacts among the younger population.Greater emphasis should be placed on women aged over 55 to halt the rising mortality rates of both cancers within this population.展开更多
Background:3-field lymph node dissection(3FL)frequently lead to much more perioperative complications than 2-field lymph node dissection(2FL).This study was designed as a non-inferiority trial to evaluate whether 3FL ...Background:3-field lymph node dissection(3FL)frequently lead to much more perioperative complications than 2-field lymph node dissection(2FL).This study was designed as a non-inferiority trial to evaluate whether 3FL could be omitted without compromising overall survival(OS)and disease-free survival(DFS)in the patients with resectable thoracic esophageal squamous cell cancer(ESCC)and negative right recurrent laryngeal nerve lymph nodes(RRLN-LNs).Methods:cT1b-3N0-1M0 thoracic ESCC patients were managed in 3 arms during open or minimally invasive McKeown esophagectomy according to the results of frozen section examination for RRLN-LNs:if positive,direct 3FL(RRLN[+]-3FL);if negative,2FL(RRLN[-]-2FL)or 3FL(RRLN[-]-3FL)by randomization.Results:Based on frozen section,of the 829 finally recruited patients,121(13.6%)had positive RRLN-LNs and direct 3FL(RRLN[+]-3FL);766 had negative RRLN-LNs and were randomized into the RRLN[-]-2FL(386 cases)or RRLN[-]-3FL(380 cases)group.The cervical LN metastasis rate in the RRLN[+]-3FL group(28.9%)was significantly higher than that in the RRLN[-]-3FL group(8.3%)(P<0.001).The 5-year OS and DFS were 72.2%and 65.1%in the RRLN[-]-3FL group and 68.8%and 62.8%in the RRLN[-]-2FL group(OS,P=0.163;DFS,P=0.378),versus 50.3%and 41.2%in the RRLN[+]-3FL group(both P<0.001),respectively.Conclusions:Additional cervical lymphadenectomy can be avoided in the patients with middle or lower thoracic ESCC and negative RRLN-LNs by frozen section treated by upfront surgery.展开更多
基金supported by the Special Fund for Health Research in the Public Interest(No.201502001)
文摘Objective： To evaluate the efficacy and feasibility of screening procedure for upper gastrointestinal cancer in both high-risk and non-high-risk areas in China. Setting： Seven cities/counties, representing three economical-geographical regions （Eastern, Central and Western） in China, were selected as screening centers： three in high-risk areas and four in non-high-risk areas. Participants： Villages/communities in these seven centers regarded as clusters were randomly assigned to either intervention group （screening by endoscopic examination） or control group （with normal community care） in a 1：1 ratio stratified by each center. Eligible participants are local residents aged 40-69 years in the selected villages/communities with no history of cancer or endoscopic examination in the latest 3 years who are mentally and physically competent. Those who are not willing to take endoscopic examination or are unwilling to sign the consent form are excluded from the study. Totally 140,000 participants will be enrolled. Interventions： In high-risk areas of upper gastrointestinal cancer, all subjects in screening group will be screened by endoscopy. In non-high-risk areas, 30% of the subjects in screening group, identified through a survey, will be screened by endoscopy. Primary and secondary outcome measures： The primary outcome is the mortality caused by upper gastrointestinal cancer. The secondary outcomes include detection rate, incidence rate, survival rate, and clinical stage distribution. Additional data on quality of life and cost-effectiveness will also be collected to answer important questions regarding screening effects. Conclusions： Screening strategy evaluated in those areas with positive findings may be promoted nationally and applied to the majority of Chinese people. On the other hand, negative findings will provide scientific evidence for abandoning a test and shifting resources elsewhere. Trial registration： The study has been registered with the Protocol Registration System in Chinese Clinical Trial Registry （identifier： ChiCTR-EOR-16008577）.
基金supported by a grant from the National Key Research and Development Program of China(No.2022YFC2409901)the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2021-I2M-1-011)。
文摘Objective:Cervical cancer is a growing concern in China,especially among women who reside in rural areas and older women.Understanding age-and region-specific trends in cervical cancer is vital for informing policy and assessing progress toward WHO elimination targets.Methods:The 2000±2020 data from 22 long-standing registries contributing to the China national cancer registry was analyzed to estimate age-standardized incidence and mortality rates(ASIR and ASMR,respectively).Joinpoint regression yielded an average annual percentage change(AAPC)stratified by age group(<35,35±64,65±74,and≥75 y)and by urban-rural area.The comparative analysis included GLOBOCAN Overtime data from selected Asia-Pacific countries.Results:The ASIR tripled in China between 2000 and 2020 before stabilizing(AAPC=6.5%),while the ASMR rose steadily(AAPC=3.9%).The urban incidence declined after 2009 among women<35 y,while rural trends were broadly stable.The ASIR and ASMR increased in urban areas among women 35±64 y of age,while rural areas had a rising ASIR and a stable ASMR,suggesting potential screening effects.In contrast,women≥65 y of age had a steadily increasing incidence and mortality in rural and urban areas.Australia and Republic of Korea had consistent declines in the ASIRs and ASMRs compared to other Asia-Pacific countries,whereas Japan exhibited rising trends.The Philippines experienced a surge in mortality rates,despite incidence rates remaining stable or declining.Conclusions:The cervical cancer burden in China has begun to plateau but large disparities persist by age and geography.To achieve elimination of cervical cancer,it is imperative to implement tailored strategies that prioritize the urgent expansion of HPV vaccination programs,the deployment of high-efficacy screening methods,and the universal access to treatment throughout the nation.
基金supported by the National Natural Science Foundation of China(32300133 to SZ.and 32100106 to YR)the China Postdoctoral Science Foundation(2023M730965 to SZ.)+3 种基金the Science and Technology Department of Henan Province(232102311103 to SZ.)the Chinese Academy of Sciences(CAS)Youth Innovation Promotion Association(2023351 to YR)the Hubei Province Natural Science Funds(2023AFA008 and 2023AFB582 to YR)the Open project of the State Key Laboratory of Antiviral Drugs,Henan University(FX3020A030002).
文摘Human enterovirus A71(EV-A71)is a major causative agent of hand,foot and mouth disease(HFMD),which poses a significant public health threat,particularly among young children.Mitochondrial antiviral signaling protein(MAVS)and interferon regulatory factor 3(IRF3)are vital proteins for the induction of type I interferons(IFN-I)and downstream interferon-stimulated genes(ISGs)during EVA71 infection.While posttranslational modifications are known to critically influence viral infection processes,the mechanisms by which EV-A71 exploits host deubiquitinases(DUBs)for immune evasion remain poorly understood.In this study,we demonstrated that EV-A71 infection upregulated ubiquitinspecific protease 5(USP5)expression.Knockdown of USP5 not only inhibited EV-A71 replication but also observably increased the production of IFN-I and ISGs.Furthermore,USP5 also regulated the replication of EV-D68 and CVA16 and the production of IFN-I and ISGs.Mechanistically,USP5 physically interacted with MAVS and IRF3 and reduced the K63-linked polyubiquitination of MAVS and IRF3.Conversely,USP5 knockdown increased the K63-linked polyubiquitination of MAVS and IRF3,thereby accelerating the phosphorylation of IRF3 and increasing IFN-I production during EV-A71 infection.Furthermore,pharmacological inhibition of USP5 with the small-molecule inhibitor PR-619 significantly potentiated the antiviral effects of IFN against EV-A71.Collectively,our findings reveal a previously unrecognized role of USP5 in facilitating EV-A71 immune evasion by dampening MAVSand IRF3-mediated antiviral signaling.These insights provide a novel therapeutic avenue for combating EV-A71 infection through targeted modulation of the USP5-IRF3 axis.
基金supported by National Natural Science Foundation of China(No.81602931)Ministry of Science and Technology(No.2014FY121100)State Key Projects Specialized on Infectious Diseases(No.2012ZX10002008)
文摘Objective: Liver cancer is one of the most common cancers and major cause of cancer deaths in China,which accounts for over 50% of new cases and deaths worldwide.The systematic liver cancer statistics including of projection through 2030 could provide valuable information for prevention and control strategies in China,and experience for other countries.Methods: The burden of liver cancer in China in 2014 was estimated using 339 cancer registries’ data selected from Chinese National Cancer Center(NCC).Incident cases of 22 cancer registries were applied for temporal trends from 2000 to 2014.The burden of liver cancer through 2030 was projected using age-period-cohort model.Results: About 364,800 new cases of liver cancer(268,900 males and 95,900 females) occurred in China,and about 318,800 liver cancer deaths(233,500 males and 85,300 females) in 2014.Western regions of China had the highest incidence and mortality rates.Incidence and mortality rates decreased by about 2.3% and 2.6% per year during the period of 2000-2014,respectively,and would decrease by more than 44% between 2014 and 2030 in China.The young generation,particularly for those aged under 40 years,showed a faster down trend.Conclusions: Based on the analysis,incidence and mortality rates of liver cancer are expected to decrease through 2030,but the burden of liver cancer is still serious in China,especially in rural and western areas.Most cases of liver cancer in China can be prevented through vaccination and more prevention efforts should be focused on high risk groups.
基金supported by grants from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(CIFMS,Grant No.2018-I2M-3-003)the National Key Research and Development Program of China(Grant No.2018YFC1315305)。
文摘Objective:Breast cancer was the most common cancer and the fifth cause of cancer deaths among women in China in 2015.The evaluation of the long-term incidence and mortality trends and the prediction of the future burden of breast cancer could provide valuable information for developing prevention and control strategies.Methods:The burden of breast cancer in China in 2015 was estimated by using qualified data from 368 cancer registries from the National Central Cancer Registry.Incident cases and deaths in 22 cancer registries were used to assess the time trends from 2000 to 2015.A Bayesian age-period-cohort model was used to project the burden of breast cancer to 2030.Results:Approximately 303,600 new cases of breast cancer(205,100 from urban areas and 98,500 from rural areas)and 70,400 breast cancer deaths(45,100 from urban areas and 24,500 from rural areas)occurred in China in 2015.Urban regions of China had the highest incidence and mortality rates.The most common histological subtype of breast cancer was invasive ductal carcinoma,followed by invasive lobular carcinoma.The age-standardized incidence and mortality rates increased by 3.3%and 1.0%per year during 2000–2015,and were projected to increase by more than 11%until 2030.Changes in risk and demographic factors between 2015 and 2030 in cases are predicted to increase by approximately 13.3%and 22.9%,whereas deaths are predicted to increase by 13.1%and 40.9%,respectively.Conclusions:The incidence and mortality of breast cancer continue to increase in China.There are no signs that this trend will stop by 2030,particularly in rural areas.Effective breast cancer prevention strategies are therefore urgently needed in China.
基金supported by Major State Basic Innovation Program of the Chinese Academy of Medical Sciences (No. 2018-I2M-3-003).
文摘Objective: Using data from cancer registries to estimate laryngeal cancer incidence and mortality in China, 2015.Methods: Data submitted from 501 cancer registries were checked and evaluated according to the criteria of data quality control and 368 registries’ data were qualified for the final analysis. Data were stratified by area(urban/rural), sex, age group and combined with national population data to estimate laryngeal cancer incidence and mortality in China, 2015. China population census in 2000 and Segi’s population were used for agestandardized.Results: The percentage of cases morphological verified(MV%) of laryngeal cancer was 74.18%. The percentage of death certificate-only cases(DCO%) was 2.10%. And the mortality to incidence(M/I) ratio was 0.55.About 25,300 new cases of laryngeal cancer were diagnosed in 2015 and 13,700 deaths were reported. The crude rate of laryngeal cancer was 1.84 per 100,000(males and females were 3.20 and 0.42 per 100,000, respectively).Age-standardized incidence rates by Chinese standard population(ASIRC) and by world standard population(ASIRW) were 1.18 and 1.19 per 100,000, respectively. The cumulative incidence rate(0-74 years old) was 0.15%.The crude mortality rate was 1.00 per 100,000. Age-standardized mortality rates by Chinese standard population(ASMRC) and by world standard population(ASMRW) were 0.61 and 0.61 per 100,000, respectively, with the cumulative rate(0-74 years old) was 0.07%. Incidence and mortality of laryngeal cancer in males were higher than those in females. And the rates in urban areas were higher than those in rural areas.Conclusions: The incidence and mortality of laryngeal cancer in China were low. And the rates were significantly higher in males than in females. Risk factor control and targeted prevention should be strengthened.
基金supported by the Chinese Academic of Medical Sciences Innovation Fund for Medical Sciences(No.2018-I2M-3-003 and No.2019-I2M-2-002)。
文摘Objective:To summarize the colorectal cancer(CRC)burden and trend in the world,and compare the difference of CRC burden between other countries and China.Methods:Incidence and mortality data were extracted from the GLOBOCAN2018 and Cancer Incidence in Five Continents.Age-specific incidence trend was conducted by Joinpoint analysis and average annual percent changes were calculated.Results:About 1.85 million new cases and 0.88 million deaths were expected in 2018 worldwide,including 0.52 million(28.20%)new cases and 0.25 million(28.11%)deaths in China.Hungary had the highest age-standardized incidence and mortality rates in the world,while for China,the incidence and mortality rates were only half of that.CRC incidence and mortality were highly correlated with human development index(HDI).Unlike the rapid increase in Republic of Korea and the downward trend in Canada and Australia,the age-standardized incidence rates by world standard population in China and Norway were rising gradually.The age-specific incidence rate in the age group of 50-59 years in China was increasing rapidly,while in Republic of Korea and Canada,the fastest growing age group was 30-39 years.Conclusions:The variations of CRC burden reflect the difference of risk factors,as well as levels of HDI and screening(early detection activities).The burden of CRC in China is high,and the incidence of CRC continues to increase,which may lead to a sustained increase in the burden of CRC in China in the future.Screening should be expanded to control CRC,and focused on young people in China.
基金supported by the Sanming Project of Medicine in Shenzhen (No. SZSM201911015)the Natural Science Foundation of Guangdong Province (No. 2020A151501478)+1 种基金Major State Basic Innovation Program of the Chinese Academy of Medical Sciences (No. 2018-I2M-3-003)supported by a National Health and Medical Research Council Early Career Fellowship (No. GNT1139826).
文摘Objective: To report the incidence and mortality rates of oral and oropharyngeal cancer in Chinese population.Methods: Data were taken from a population-based cancer registry collected by the National Central Cancer Registry of China(NCCRC) in 2015. The data collected from 501 local cancer registries in China were assessed using NCCRC screening methods and criteria. Incidence and mortality rates of oral and oropharyngeal cancer were stratified by age group, gender, and area. Age-standardized incidence and mortality rates were adjusted using the Chinese standard population in 2000 and Segi’s world population.Results: In 2015, it was estimated that there were 51,765 oral and oropharyngeal cancer incident cases and 23,830 deaths in China. The crude incidence rate of oral and oropharyngeal cancer was 3.77/100,000, and the agestandardized incidence rate by Chinese standard population and by Segi’s world standard population were 2.55/100,000 and 2.49/100,000, respectively. The crude mortality rate and the age-standardized mortality rates by Chinese standard population and by Segi’s world standard population were 1.73/100,000, 1.09/100,000 and1.08/100,000, respectively. Both incidence and mortality rates of oral and oropharyngeal cancer were higher in males and in urban areas. Residents in eastern areas had the highest incidence and mortality rates, followed by those from middle areas and western areas. The rates of oral and oropharyngeal cancer increased greatly with age,especially after the age of 40 years.Conclusions: This study reports the latest incidence and mortality rates of oral and oropharyngeal cancer in China. Prevention intervention including early detection, treatment, and regular follow-ups is encouraged to be set up to reduce incidence and mortality rates of oral and oropharyngeal cancer in the future.
基金the National Natural Science Foundation of China (No.81974493)the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (No.2016-I2M-3-001)。
文摘Objective: Esophageal squamous cell carcinoma(ESCC) is one of the dominant malignances worldwide, but currently there is less focus on the microbiota with ESCC and its precancerous lesions.Methods: Paired esophageal biopsy and swab specimens were obtained from 236 participants in Linzhou, China.Data from 16 S ribosomal RNA gene sequencing were processed using quantitative insights into microbial ecology(QIIME2) and R Studio to evaluate differences. The Wilcoxon rank sum test and Kruskal-Wallis rank sum test were used to compare diversity and characteristic genera by specimens and participant groups. Ordinal logistic regression model was used to build microbiol prediction model.Results: Microbial diversity was similar between biopsy and swab specimens, including operational taxonomic unit(OTU) numbers and Shannon index. There were variations and similarities of esophageal microbiota among different pathological characteristics of ESCC. Top 10 relative abundance genera in all groups include Streptococcus, Prevotella, Veillonella, Actinobacillus, Haemophilus, Neisseria, Alloprevotella, Rothia, Gemella and Porphyromonas. Genus Streptococcus, Haemophilus, Neisseria and Porphyromonas showed significantly difference in disease groups when compared to normal control, whereas Streptococcus showed an increasing tendency with the progression of ESCC and others showed a decreasing tendency. About models based on all combinations of characteristic genera, only taken Streptococcus and Neisseria into model, the prediction performance was the ideal one, of which the area under the curve(AUC) was 0.738.Conclusions: Esophageal biopsy and swab specimens could yield similar microbial characterization. The combination of Streptococcus and Neisseria has the potential to predict the progression of ESCC, which is needed to confirm by large-scale, prospective cohort studies.
基金supported by the Special Fund for Health Research in the Public Interest (No. 201502001)
文摘Objective： Stomach and esophageal cancer are imposing huge threats to the health of Chinese people whereasthere were few studies on the financial burden of the two cancers.Methods： Costs per hospitalization of all patients with stomach or esophageal cancer discharged betweenSeptember 2015 and August 2016 in seven cities/counties in China were collected, together with their demographicinformation and clinical details. Former patients in the same hospitals were sampled to collect information onannual direct non-medical cost, indirect costs and annual number of hospitalization. Annual direct medical cost wasobtained by multiplying cost per hospitalization by annual number of hospitalization. Annual cost of illness （ACI）was obtained by adding the average value of annual direct medical cost, direct non-medical cost and indirect cost,stratified by sex, age, clinical stage, therapy and pathologic type in urban and rural areas. Costs per hospitalizationwere itemized into eight parts to calculate the proportion of each part. All costs were converted to 2016 US dollars（1 USD：6.6423 RMB）.Results： Totally 19,986 cases were included, predominately male. Mean ages of stomach cancer and urbanpatients were lower than that of esophageal cancer and rural patients. ACI of stomach and esophageal cancerpatients were $10,449 and $13,029 in urban areas, and $2,927 and $3,504 in rural areas, respectively. Greater ACIwas associated with male, non-elderly patients as well as those who were in stage I and underwent surgeries.Western medicine fee took the largest proportion of cost per hospitalization.Conclusions： The ACI of stomach and esophageal cancer was tremendous and varied substantially among thepopulation in China. Preferential policies of medical insurance should be designed to tackle with this burden andfurther reduce the health care inequalities.
基金granted by the National Natural Science Foundation of China (No.81241091)
文摘Objective： To evaluate the feasibility of DNA image cytometry （DNA-ICM） as a primary screening method for esophageal squamous cell cancer （ESCC）. Methods： A total of 5,382 local residents aged 40-69 years from three high-risk areas in China （Linzhou in Henan province, Feicheng in Shandong province and Cixian in Hebei province） from 2008 to 2011 were recruited in this population-based screening study. And 2,526 subjects declined to receive endoscopic biopsy examination with Lugol＇s iodine staining, while 9 and 815 subjects were excluded from liquid-based cytology and DNA-ICM test respectively due to slide quality. Finally, 2,856, 5,373 and 4,567 subjects were enrolled in the analysis for endoscopic biopsy examination, liquid-based cytology and DNA-ICM test, respectively. Sensitivity （SE）, specificity （SP）, negative predictive values （NPV） and positive predictive values （PPV） as well as their 95% confidence intervals （95% CI） for DNA-ICM, liquid-based cytology and the combination of the two methods were calculated. Receiver operating characteristic （ROC） curves were applied to determine the cutoff point of DNA-ICM for esophageal cancer. Results： DNA-ICM results were significantly correlative with esophageal cancer and precancer lesions （X2= 18.016, P〈0.001）. The cutoff points were 5,802, 5,803 and 8,002 based on dissimilar pathological types of low grade intraepithelial neoplasia （LGIN）, high grade intraepithelial neoplasia （HGIN）, and ESCC, respectively, and 5,803 was chosen in this study considering the SE and SP. The SE, SP, PPV, NPV of DNA-ICM test （cutoff point 5,803） combined with liquid-based cytology [threshold atypical squamous cells of undetermined significance （ASCUS）] were separately 72.1% （95% CI： 70.3%-73.9%）, 43.3% （95% CI. 41.3%-45.3%）, 22.8% （95% CI： 21.1%-24.5%） and 87.0% （95% CI： 85.7%-88.3%） for LGIN, 85.7% （95% CI： 84.3%-87.1%）, 41.3% （95% CI： 39.3%-43.3%）, 4.6% （95% CI： 3.8%-5.4%） and 98.9% （95% CI： 98.5%-99.3%） for HGIN, and 96.0% （95% CI： 95.2%-96.8%）, 40.8% （95% CI： 38.8%-42.8%）, 1.7% （95% CI： 1.2%-2.2%） and 99.9% （95% CI： 99.8%-100.0%） for ESCC. Conclusions： It is possible to use DNA-ICM test as a primary screening method before endoscopic screening for esophageal cancer.
基金supported by the National Key Research and Development Program of China (No. 2016YFC 0901404)the Youth Research Fund by Peking Union Medical College (No. 2017310044)+1 种基金the National Natural Science Foundation of China (No. 81573224)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (No. 2017PT32001 and 2016ZX310178)
文摘Objective: To explore the natural history of severe dysplasia/carcinoma in situ(SD/CIS) patients and to evaluate the efficacy of endoscopic treatment to SD/CIS patients.Methods: Between January 2005 and December 2009, a population-based prospective screening program on esophageal squamous cell carcinoma(ESCC) was performed in Linzhou, China, with endoscopic screening plus iodine staining. All the eligible histologically confirmed SD/CIS patients were followed up through the door-todoor follow-up and local cancer registry. The endpoint was diagnosed as ESCC or the December 31 st, 2016.Kaplan-Meier survival analysis and Log-rank test were used to compare the survival rates among treated and untreated patients.Results: A total of 175 SD/CIS patients were enrolled and grouped by whether they received endoscopic treatment. Eleven-year cumulative incidence rates for untreated and treated SD/CIS patients were 10.7% [95%confidence interval(95% CI): 6.9-16.1] and 3.2%(95% CI: 1.4-7.0), respectively. The ESCC incidence free survival rate, and all-cause incidence and mortality free survival rates were all significantly higher in the treated patients vs. untreated patients(P=0.043, P=0.008 and P=0.015, respectively). The ESCC mortality free survival rate showed no significant differences between the two groups(P=0.847).Conclusions: The cumulative incidence rate of SD/CIS patients to ESCC was much lower than previously reported. The Kaplan-Meier survival analysis showed that endoscopic treatment could increase the ESCC and allcause disease-free survival rates of SD/CIS patients significantly.
基金supported by grants from the Beijing Nova Program (No. Z201100006820069)CAMS Innovation Fund for Medical Sciences (CIFMS, No. 2021-I2M-1-023, 2021-I2M-1-010)Talent Incentive Program of Cancer Hospital Chinese Academy of Medical Sciences (Hope Star)。
文摘Objective: Plant-based diets have multiple health benefits for cancers;however, little is known about the association between plant-based dietary patterns and esophageal cancer(EC).This study presents an investigation of the prospective associations among three predefined indices of plant-based dietary patterns and the risk of EC.Methods: We performed endoscopic screening for 15,709 participants aged 40-69 years from two high-risk areas of China from January 2005 to December 2009 and followed the cohort until December 31, 2022. The overall plant-based diet index(PDI), healthful plant-based diet index(h PDI), and unhealthful plant-based diet index(u PDI), were calculated using survey responses to assess dietary patterns. We applied Cox proportional hazard regression to estimate the multivariable hazard ratios(HRs) and 95% confidence intervals(95% CIs) of EC across 3plant-based diet indices and further stratified the analysis by subgroups.Results: The final study sample included 15,184 participants in the cohort. During a follow-up of 219,365person-years, 176 patients with EC were identified. When the highest quartile was compared with the lowest quartile, the pooled multivariable-adjusted HR of EC was 0.50(95% CI, 0.32-0.77) for h PDI. In addition, the HR per 10-point increase in the h PDI score was 0.42(95% CI, 0.27-0.66) for ECs. Conversely, u PDI was positively associated with the risk of EC, and the HR was 1.80(95% CI, 1.16-2.82). The HR per 10-point increase in the u PDI score was 1.90(95% CI, 1.26-2.88) for ECs. The associations between these scores and the risk of EC were consistent in most subgroups. These results remained robust in sensitivity analyses.Conclusions: A healthy plant-based dietary pattern was associated with a reduced risk of EC. Emphasizing the healthiness and quality of plant-based diets may be important for preventing the development of EC.
文摘Objective:To investigate what extent lead-time bias is likely to affect endoscopic screening effectiveness for esophageal cancer in the high-risk area in China.Methods:A screening model based on the epidemiological cancer registry data,yielding a population-level incidence and mortality rates,was carried out to simulate study participants in the high-risk area in China,and investigate the effect of lead-time bias on endoscopic screening with control for length bias.Results:Of 100,000 participants,6,150(6.15%)were diagnosed with esophageal squamous dysplasia during the 20-year follow-up period.The estimated lead time ranged from 1.67 to 5.78 years,with a median time of 4.62 years[interquartile range(IQR):4.07-5.11 years]in the high-risk area in China.Lead-time bias exaggerated screening effectiveness severely,causing more than a 10%overestimation in 5-year cause-specific survival rate and around a 43%reduction in cause-specific hazard ratio.The magnitude of lead-time bias on endoscopic screening for esophageal cancer varied depending on the screening strategies,in which an inverted U-shaped and U-shaped effects were observed in the 5-year cause-specific survival rate and cause-specific hazard ratio respectively concerning a range of ages for primary screening.Conclusions:Lead-time bias,usually causing an overestimation of screening effectiveness,is an elementary and fundamental issue in cancer screening.Quantification and correction of lead-time bias are essential when evaluating the effectiveness of endoscopic screening in the high-risk area in China.
基金supported by Capital’s Funds for Health Improvement and Research(CFH2024-2G-40214)CAMS Innovation Fund for Medical Sciences(2021-I2M-1-011).
文摘The numbers of new cancer cases and deaths in China were the largest in the world,causing a huge social and economic burden.We attempt to use more intuitive indicators to measure the probabilities of being diagnosed of or dying from cancer in China and compare these probabilities with those in Japan and the United States(US).We obtained the cancer data from GLOBOCAN 2022 for China,Japan,and the US and the all-cause mortality and population data from the United Nations.The lifetime risks of developing and dying from cancer were estimated with adjusted actual life expectancy,multiple primaries,and death-competing risks from causes other than cancers.Approximately 27.61%of Chinese people developed cancer and 1 in 5 persons were likely to die from cancer.The highest-risk cancer among men and women was lung cancer in China,but in the US and Japan,prostate cancer among men and breast cancer among women posed the highest risk.Lung cancer presented the highest likelihood of death,but women in Japan had the highest likelihood of dying from colorectal cancer.China had a lower lifetime risk of developing cancer compared with Japan and the US,but a higher probability of dying from cancer than the US.Although the probability of developing cancer was not as high as that in Japan and the US,China was still faced with enormous pressure due to its huge population and contradictory cancer patterns.Estimating lifetime risks can provide essential information to formulate appropriate cancer prevention and control plans.
基金Supported by the Capital’s Funds for Health Improvement and Research[2024-2G-40213]Talent Incentive Program of Cancer Hospital,CAMS[Hope Star],the Beijing Nova Program[Z201100006820069]+1 种基金the National Natural Science Foundation of China[82273704]the CAMS Innovation Fund for Medical Sciences[2021-I2M-1-023].
文摘Introduction:Esophageal squamous cell carcinoma(ESCC)and adenocarcinoma(EAC)are the two primary subtypes of esophageal cancer.Historically,ESCC incidence has exceeded EAC,particularly in East Asia,Southern Africa,and parts of South America.However,in recent decades,EAC incidence has risen markedly in high-income countries due to lifestyle changes.Using the latest Cancer Incidence in Five Continents(CI5)data,we aimed to analyze global temporal trends and sex differences in the burden of ESCC and EAC.Methods:We extracted ESCC and EAC incidence data from 25 countries in CI5 Volumes VIII-XII(1993–2017)for trend analysis.Age-standardized incidence rates(ASIRs)and ESCC-to-EAC ASIR ratios were calculated using Segi’s World Standard Population,and annual percentage changes were estimated using Joinpoint regression.Additionally,we evaluated male-to-female ASIR ratios using data from 53 countries in CI5 Volume XII(2013–2017).Results:Between 1993–2017,ESCC ASIRs declined in 19 countries but increased in Japan,the Czech Republic,Latvia,Denmark,and Lithuania.Conversely,EAC ASIRs increased in 17 countries,with the Republic of Korea being the only country reporting a decline.ESCC-to-EAC ASIR ratios narrowed in most countries,with EAC surpassing ESCC among males in 10 countries,including the United States,and among females only in the Philippines.From 2013–2017,males exhibited consistently higher ASIRs than females for both subtypes,with more pronounced sex differences observed for EAC.Conclusions:This study highlights the changing epidemiology of ESCC and EAC globally and provides important scientific evidence for tailoring prevention and control strategies based on regional and histological-specific trends.
基金Supported by the talent support project established by Guangdong Provincial Center for Disease Control and Prevention[2023D010].
文摘Introduction:This study aims to report the epidemiological trends and provide updated estimates and lifetime risks for breast and cervical cancers among women in Guangdong province.Methods:A Bayesian age-period-cohort model was applied to project incidence and mortality rates for 2023.The adjusted for multiple primaries(AMP)method was used to calculate the lifetime risks of developing and dying from breast and cervical cancer.Joinpoint analysis was employed to describe the temporal trends.Results:The age-standardized incidence rate(ASIR)of female breast cancer increased from 2012 to 2019 in Guangdong province,with a particularly pronounced increase noted in the rural areas.The ASIR for cervical cancer among women aged over 55 increased in both urban and rural areas,whereas a declining trend was observed among women under the age of 55.The age-standardized mortality rates(ASMRs)for both breast cancer and cervical cancer demonstrated upward trends among women aged over 55,while no significant trend in ASMR was found for women under 55 years.In 2023,the estimated incidence rates of breast cancer and cervical cancer would be 50.81/10^(5)(ASIR would be 35.57/10^(5))and 15.31/10^(5)(ASIR would be 10.41/10^(5))respectively,with corresponding mortality rates of 10.78/10^(5)(ASMR would be 7.15/10^(5))and 6.11/10^(5)(ASMR would be 3.93/10^(5))for these cancers.Conclusions:Breast cancer continues to pose a significant threat to women’s health in both rural and urban areas of Guangdong,whereas cancer prevention and control programs for cervical cancer have shown positive impacts among the younger population.Greater emphasis should be placed on women aged over 55 to halt the rising mortality rates of both cancers within this population.
基金supported by National Science and Technology Sup-port Program(grant number:NKTRDP-2015BAI12B08-01).
文摘Background:3-field lymph node dissection(3FL)frequently lead to much more perioperative complications than 2-field lymph node dissection(2FL).This study was designed as a non-inferiority trial to evaluate whether 3FL could be omitted without compromising overall survival(OS)and disease-free survival(DFS)in the patients with resectable thoracic esophageal squamous cell cancer(ESCC)and negative right recurrent laryngeal nerve lymph nodes(RRLN-LNs).Methods:cT1b-3N0-1M0 thoracic ESCC patients were managed in 3 arms during open or minimally invasive McKeown esophagectomy according to the results of frozen section examination for RRLN-LNs:if positive,direct 3FL(RRLN[+]-3FL);if negative,2FL(RRLN[-]-2FL)or 3FL(RRLN[-]-3FL)by randomization.Results:Based on frozen section,of the 829 finally recruited patients,121(13.6%)had positive RRLN-LNs and direct 3FL(RRLN[+]-3FL);766 had negative RRLN-LNs and were randomized into the RRLN[-]-2FL(386 cases)or RRLN[-]-3FL(380 cases)group.The cervical LN metastasis rate in the RRLN[+]-3FL group(28.9%)was significantly higher than that in the RRLN[-]-3FL group(8.3%)(P<0.001).The 5-year OS and DFS were 72.2%and 65.1%in the RRLN[-]-3FL group and 68.8%and 62.8%in the RRLN[-]-2FL group(OS,P=0.163;DFS,P=0.378),versus 50.3%and 41.2%in the RRLN[+]-3FL group(both P<0.001),respectively.Conclusions:Additional cervical lymphadenectomy can be avoided in the patients with middle or lower thoracic ESCC and negative RRLN-LNs by frozen section treated by upfront surgery.
