Objective： The aim of this study was to investigate the prognostic factors and to evaluate the impact of adjuvant therapy on clinical outcome for early-stage cervical cancer. Methods： The clinical-pathological data ...Objective： The aim of this study was to investigate the prognostic factors and to evaluate the impact of adjuvant therapy on clinical outcome for early-stage cervical cancer. Methods： The clinical-pathological data of all 1,335 patients with the International Federation of Gynecology and Obstetrics （FIGO） Ib-[Ia cervical cancer treated with primary radical surgery at the Chinese National Cancer Center between May 2007 and Dec 2013 were retrospectively reviewed. The median follow-up was 70 months. Results： Of all the patients, 61.6% of the cases received adjuvant therapy, with 5-year disease-free survival （DFS） of 92.1% and 5-year overall survival （OS） of 95.0%. In multivariate analysis, differentiation of G3 （P〈0.05）, lymph node metastasis （LNM, P〈0.05） and lymphovascular space invasion （LVSI, P〈0.05） were independent predictors for OS, while LNM （P〈0.05）, deep stroma invasion （DSI, P〈0.05） and LVSI （P〈0.05） were independent factors for DFS. The samples were stratified by histologic type, and cervical squamous cell carcinoma （SCC） was found to share the same independent factors except for differentiation of OS. As to patients with cervical adenocarcinoma/adenosquamons carcinoma （AC/ASC）, differentiation was the independent predictor of OS （P〈0.05）; and LVSI of DFS （P〈0.05）. Of 236 patients with high-risk factors, there was no significant difference in survival between concurrent chemoradiotherapy （CCRT, n=195）, radiotherapy （RT, n=24）, and chemotherapy （CT, n=17）. Among the 190 patients with LNM who underwent CCRT, 124 cases showed improved DFS after sequential CT （P=0.118）, with a recurrence rate decrease of 14%, though the difference was not statistically significant. Patients with single intermediate-risk factors like DSI or LVSI were found to partially benefit from adjuvant therapy, but the difference was not statistically significant. Conclusions： LNM, LVSI, DSI and differentiation were found to be independent prognostic factors for operable cervical cancer. Aggressive postoperative adjuvant therapy based on single risk factors in Chinese National Cancer Center could benefit survival. CCRT＋CT outperformed CCRT in high-risk patients. For patients with single non-high-risk factor, the role of adjuvant therapy needs to be further discussed.展开更多
AIM: To examine the impact of body mass index(BMI)on outcomes following pancreatic resection in the Chinese population.METHODS: A retrospective cohort study using prospectively collected data was conducted at the Canc...AIM: To examine the impact of body mass index(BMI)on outcomes following pancreatic resection in the Chinese population.METHODS: A retrospective cohort study using prospectively collected data was conducted at the Cancer Hospital of the Chinese Academy of Medical Sciences, China National Cancer Center. Individuals who underwent pancreatic resection between January2004 and December 2013 were identified and included in the study. Persons were classified as having a normal weight if their BMI was < 24 kg/m2 and overweight/obese if their BMI was ≥ 24 kg/m2 as defined by the International Life Sciences Institute Focal Point in China. A χ 2 test(for categorical variables) or a t test(for continuous variables) was used to examine the differences in patients' characteristics between normal weight and overweight/obese groups. Multiple logistic regression models were used to assess the associationsof postoperative complications, operative difficulty,length of hospital stay, and cost with BMI, adjusting for age, sex, and type of surgery procedures.RESULTS: A total of 362 consecutive patients with data available for BMI calculation underwent pancreatic resection for benign or malignant disease from January1, 2004 to December 31, 2013. Of the 362 patients,156 were overweight or obese and 206 were of normal weight. One or more postoperative complications occurred in 35.4% of the patients following pancreatic resection. Among patients who were overweight or obese, 42.9% experienced one or more complications,significantly higher than normal weight(29.6%)individuals(P = 0.0086). Compared with individuals who had normal weight, those with a BMI ≥ 24.0kg/m2 had higher delayed gastric emptying(19.9% vs5.8%, P < 0.0001) and bile leak(7.7% vs 1.9%, P =0.0068). There were no significant differences seen in pancreatic fistula, gastrointestinal hemorrhage, reoperation,readmission, or other complications. BMI did not show a significant association with intraoperative blood loss, operative time, length of hospital stay, or cost.CONCLUSION: Higher BMI increases the risk for postoperative complications after pancreatectomy in the Chinese population. The findings require replication in future studies with larger sample sizes.展开更多
The journey to implement cancer genomic medicine(CGM)in oncology practice began in the 1980s,which is considered the dawn of genetic and genomic cancer research.At the time,a variety of activating oncogenic alteration...The journey to implement cancer genomic medicine(CGM)in oncology practice began in the 1980s,which is considered the dawn of genetic and genomic cancer research.At the time,a variety of activating oncogenic alterations and their functional significance were unveiled in cancer cells,which led to the development of molecular targeted therapies in the 2000s and beyond.Although CGM is still a relatively new discipline and it is difficult to predict to what extent CGM will benefit the diverse pool of cancer patients,the National Cancer Center(NCC)of Japan has already contributed considerably to CGM advancement for the conquest of cancer.Looking back at these past achievements of the NCC,we predict that the future of CGM will involve the following:1)A biobank of paired cancerous and non-cancerous tissues and cells from various cancer types and stages will be developed.The quantity and quality of these samples will be compatible with omics analyses.All biobank samples will be linked to longitudinal clinical information.2)New technologies,such as whole-genome sequencing and artificial intelligence,will be introduced and new bioresources for functional and pharmacologic analyses(e.g.,a patient-derived xenograft library)will be systematically deployed.3)Fast and bidirectional translational research(bench-to-bedside and bedside-to-bench)performed by basic researchers and clinical investigators,preferably working alongside each other at the same institution,will be implemented;4)Close collaborations between academia,industry,regulatory bodies,and funding agencies will be established.5)There will be an investment in the other branch of CGM,personalized preventive medicine,based on the individual's genetic predisposition to cancer.展开更多
Precision medicine is a growing field worldwide.Despite its potential benefit to many patients,several major obstacles must be overcome before precision medicine can be more widely used in clinical practice.The main o...Precision medicine is a growing field worldwide.Despite its potential benefit to many patients,several major obstacles must be overcome before precision medicine can be more widely used in clinical practice.The main obstacles are associated with the quality of samples used for genomic analysis。展开更多
The authors regret that there was an error in Fig.3 of the published article.The area under the curve(AUC)and 95%confidence interval(CI)values for the prediction of N2 disease were incorrectly displayed in the figure....The authors regret that there was an error in Fig.3 of the published article.The area under the curve(AUC)and 95%confidence interval(CI)values for the prediction of N2 disease were incorrectly displayed in the figure.This graphical error does not affect the study conclusions or the reported results elsewhere in the manuscript.The corrected version of Fig.3 is provided below.展开更多
Objective:The postoperative survival rates of patients with gastric cancer at different stages treated at the National Cancer Center(NCC)of China have not been reported.Therefore,we evaluated the survival of patients ...Objective:The postoperative survival rates of patients with gastric cancer at different stages treated at the National Cancer Center(NCC)of China have not been reported.Therefore,we evaluated the survival of patients with gastric cancer who underwent surgery at the NCC from 2011 to 2018 to provide baseline information for further studies.Methods:We identified 7,301 patients with primary gastric carcinoma who underwent surgery at the NCC be-tween January 2011 and May 2018;among these,5,008 patients were enrolled in this study.Follow up was completed on April 30,2020.We analyzed the 5-year survival according to the stage,sex,age,and other clini-copathological features.Results:Five-year survival rates of patients with pTNM stages ⅠA,ⅠB,ⅡA,ⅡB,ⅢA,ⅢB,ⅢC,and Ⅳ treated at the NCC were 94.9%,91.8%,86.5%,76.1%,61.1%,44.2%,29.7%,and 8.1%,respectively,which were similar to those reported in Japan during the same period.Five-year survival rates of patients with ypTNM stages I,II,III,and IV were 93.1%,63.2%,27.2%,and 0.0%,respectively.In multivariable analysis,age,signet ring cell carcinoma,adjuvant chemotherapy,and degree of differentiation were revealed as important prognostic factors.Conclusion:The survival rates of patients with gastric cancer treated at the NCC have been significantly improved,reaching the levels of Japan in the same period.展开更多
Objective:Neoadjuvant therapy(NAT)has become the standard treatment option for patients with locally advanced breast cancer.How to non-invasively screen out patients with pathological complete response(pCR)after NAT h...Objective:Neoadjuvant therapy(NAT)has become the standard treatment option for patients with locally advanced breast cancer.How to non-invasively screen out patients with pathological complete response(pCR)after NAT has become an urgent world-wide clinical problem.Our work aims to the assessment of neoadjuvant treatment response in breast cancer patients for higher accuracy prediction using innovative artificial intelligence system.Methods:In this study,we retrospectively collected longitudinal(pre-NAT and post-NAT)multi-parametric magnetic resonance imaging(MRI)and clinicopathologic data of a total of 1,315 breast cancer patients(clinical stageⅠ-Ⅲ)who had undergone NAT followed by standard surgery and treated across 5 independent medical centers from January 2010 to January 2023.We used radiomics,3D convolutional neural network technology and clinical data statistical analysis methods to extract and screen multimodal features,and then developed and validated a Clinical-Radiomics-Deep-Learning(CRDL)model to predict patients'pCR outcomes based on multimodal fusion features.Results:We use the area under the receiver operating characteristic curve(AUC)in the primary cohort(PC)and3 external validation cohorts(VC_(1-3))to evaluate the model performance.The results showed that the AUC in the PC composed of 2 medical centers was 0.947[95%confidence interval(95%CI):0.931-0.960],and the AUC values in VC_(1-3)were 0.857(95%CI:0.810-0.901),0.883(95%CI:0.841-0.918)and 0.904(95%CI:0.860-0.941),respectively.Conclusions:The CRDL model demonstrated high accuracy and robustness in predicting pCR to NAT using multimodal fusion data.This study provides a strong foundation for non-invasive assessment of pCR status in breast cancer patients following NAT and offers critical insights to guide clinical decision-making in post-NAT treatment planning.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
BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gas...BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gastrectomy(PG)or total gastrectomy(TG)should be used for advanced proximal GC,and the choice of postoperative gastrointestinal reconstruction method remains controversial.AIM To compare the short-term efficacy,long-term survival,and postoperative reflux outcomes of PG with tubular stomach reconstruction vs TG with Roux-en-Y re-construction in patients with proximal GC following neoadjuvant chemotherapy(NACT)in an effort to provide valuable insights for clinical decision-making regarding the optimal surgical approach.METHODS A multicenter retrospective cohort study was conducted at two Chinese medical centers between December,2012 and December,2022.Patients with histologically confirmed proximal GC who received NACT followed by either PG with tubular stomach reconstruction or TG with Roux-en-Y reconstruction were included.Propensity score matching(PSM)was performed to balance baseline characteristics,and the primary endpoint was 5-year overall survival(OS).Se-condary endpoints included recurrence-free survival(RFS),postoperative complications,and reflux severity.RESULTS After PSM,244 patients(122 PG,122 TG)were finally included and all baseline characteristics were comparable between groups.The PG group had a significantly shorter operation time compared to the TG group(189.50 vs 215.00 minutes,P<0.001),with no differences in intraoperative blood loss or postoperative complications(19.68%vs 14.75%,P=0.792).The 5-year OS rates were 52.7%vs 45.5%(P=0.330),and 5-year RFS rates were 54.3%vs 47.6%(P=0.356)for the PG and TG groups,respectively.Reflux symptoms(18.0%vs 31.1%,P=0.017)and clinically significant reflux based on gastroesophageal reflux disease questionnaire scores≥8(7.4%vs 21.3%,P<0.001)were significantly less frequent in the PG group.Multivariate analysis identified histological differentiation(HR=2.98,95%CI:2.03-4.36,P<0.001)and tumor size(HR=0.26,95%CI:0.17-0.41 for tumors≤4 cm,P<0.001)as independent prognostic factors.CONCLUSION PG with tubular stomach reconstruction is comparable to TG in terms of surgical safety and long-term oncological outcomes for proximal GC patients following NACT.Additionally,PG has the advantages of shorter operation time and lower rates of postoperative reflux,suggesting potential benefits for patient quality of life.Notably,the analysis of postoperative prognostic factors,including histological differentiation and tumor size,further informs clinical decision-making and highlights the importance of individualized treatment strategies.展开更多
Objective:This study aims to estimate the thyroid cancer(TC)burden and trends from 1990 and 2021 among working-age population(WAP),at the global,regional,and national levels.Methods:Based on the Global Burden of Disea...Objective:This study aims to estimate the thyroid cancer(TC)burden and trends from 1990 and 2021 among working-age population(WAP),at the global,regional,and national levels.Methods:Based on the Global Burden of Disease 2021 study,this cross-sectional study included data on TC incidence and mortality for WAP aged 15-64 years across 204 countries and territories from 1990 to 2021.The age-standardized incidence rate(ASIR)and age-standardized mortality rate(ASMR)of TC were used to estimate the disease burden.Temporal trends of ASIR and ASMR were estimated by average annual percentage changes(AAPCs)based on age-period-cohort models.Relative inequality of TC burden across 204 countries was estimated by the slope index of concentration index.Results:Globally,ASIR of TC increased from 2.27 per 100,000 population to 3.41 per 100,000 population from1990 to 2021,with AAPC of 1.59%[95%confidence interval(95%CI):1.54,1.64];in contrast,ASMRs were stable at 0.31 per 100,000 population.Females had a higher disease burden than males,and adults aged 45-64 years accounted for more than 55%of the TC cases.Across regions and countries,North Africa and Comoros experienced the highest increase in ASIR,with AAPCs of 2.97%and 7.73%,respectively.All socio-demographic index(SDI)regions experienced a significant increase in ASIR,and regions with high and high-middle SDI experienced a significant decrease in ASMR.Global ASIR burden and ASMR burden were revealed to be concentrated mainly in higher-SDI and lower-SDI countries,respectively,with the concentration index in both sexes of 0.16(95%CI:0.13,0.19)and-0.14(95%CI:-0.18,-0.10)in 2021.Conclusions:Over the past three decades,the incidence burden of TC among the global WAP remarkably increased.International and regional policies for TC controls are supposed to be updated timely,to handle the current increasing burden and geographic disparities among WAP.展开更多
BACKGROUND The survival rate of pancreatic cancer is low,and there is a lack of effective treatment.AIM To explore the epidemiological characteristics of patients with pancreatic cancer in China and compare multiple c...BACKGROUND The survival rate of pancreatic cancer is low,and there is a lack of effective treatment.AIM To explore the epidemiological characteristics of patients with pancreatic cancer in China and compare multiple chemotherapy regimens at different stages.METHODS This was a retrospective study conducted from 2005 to 2014,involving six cancer hospitals and eight general hospitals across seven geographical regions of China(East,South,North,Central,Southwest,Northwest,and Northeast).Stratified sampling was used based on the population distribution of each region.Efficacy assessments were conducted by Cox proportional hazards regression models.When assessing the effectiveness of various chemotherapy regimens,traditional drugs such as gemcitabine used as monotherapy served as the reference.RESULTS A total of 3256 patients were included.The median follow-up time was 407 days,and the median overall survival was 183 days.At diagnosis,56%of patients were already in stage IV.Chemotherapy was administered to 39.73%of patients.In the adjuvant therapy phase,gemcitabine+fluorouracil was superior to gemcitabine monotherapy[hazard ratio(HR)=0.35,95%confidence interval(CI):0.14-0.89].In fluorouracil-based regimens,other combination regimens did not show effectiveness relative to monotherapy.For first-line treatment in patients with advanced disease,tegafur alone(HR=0.20,95%CI:0.06-0.66),gemcitabine plus cisplatin(HR=0.16,95%CI:0.04-0.70),and tegafur,gemcitabine plus platinum-based agents(HR=0.32,95%CI:0.11-0.91)were associated with a lower risk of death compared to gemcitabine alone.In second-line treatment,there were no significant differences in efficacy among various drugs,but FOLFIRINOX(irinotecan+oxaliplatin+leucovorin+5-fluorouracil)had an outstanding point estimate(HR=0.10,95%CI:0.01-1.27).CONCLUSION In China,pancreatic cancer is often diagnosed at advanced stages,emphasizing the need for early diagnosis and treatment.Combined therapies in adjuvant and first-line settings may reduce the risk of death compared with monotherapy,and FOLFIRINOX might offer more significant benefits in second-line treatment.展开更多
Background:The level of premature deaths(deaths among those aged 30-69 years)caused by cancer is an important indicator of evaluating the level of cancer prevention and control.However,the current burden and temporal ...Background:The level of premature deaths(deaths among those aged 30-69 years)caused by cancer is an important indicator of evaluating the level of cancer prevention and control.However,the current burden and temporal trends in cancer-related premature deaths,and their impact on life expectancy at the global,regional,and national levels are not clear.Methods:Cancer mortality data for 185 countries were obtained from the GLOBOCAN 2022 database.High-quality cancer mortality data and national population statistics for 47 countries were extracted from the United Nations and national cancer registry databases,covering the period 2003-2022.Countries were classified based on the human development index(HDI).The death probability,the year of life lost(YLL),and the potential gain in life expectancy(PGLE)attributable to premature deaths from site-specific and all-cancers combined were calculated.Results:Globally,the probability of premature cancer deaths was 6.49%(95%UI 6.49-6.50).The YLLs caused by cancer-related premature death were 163.86 million(95%UI 163.70-164.03),constituting 65.58%of the total cancer-related YLLs.The PGLEs were 1.16 years(95%UI 1.16-1.16).The premature death probability increased with higher HDI levels in men,but decreased in women.Cancer-related premature deaths as a proportion of total cancer deaths varied from 18.31%(95%UI 18.20-18.43)in Japan to 84.44%(95%UI 76.10-91.16)in São Toméand Príncipe.Lung cancer was the leading cause of cancer-related premature deaths in men,and breast cancer ranked first in women.By eradicating premature deaths attributable to lung,liver,colorectal,and stomach cancer in men,and to breast,cervical,and lung cancer in women,0.55 years(95%UI 0.55-0.55)and 0.49 years(95%UI 0.49-0.49)of PGLEs could be achieved,accounting for 48.67%and 42.24%of the total PGLEs,respectively.Cancer-related premature deaths decreased significantly in 38 countries during 2003-2022(P<0.05).The probability of premature cancer-related deaths decreased by more than 15.50%from 2015 to 2022 in 16 countries.Conclusions:Cancer-related premature deaths declined in many countries,with 16 of them having achieved the expected reduction by 2022.The current burden of cancer-related premature deaths is profound but varies around the world.Eliminating premature deaths from major cancer types could substantially increase life expectancy,underscoring the importance of prevention and treatment efforts for these cancers.展开更多
Objective To develop a prognostic prediction model for early-stage triple-negative breast cancer(TNBC)using H&E-stained pathological images and to investigate its underlying biological interpretability.Methods A d...Objective To develop a prognostic prediction model for early-stage triple-negative breast cancer(TNBC)using H&E-stained pathological images and to investigate its underlying biological interpretability.Methods A deep learning model was trained on 340 WSIs and externally validated using 81 TCGA cases.Image-derived features extracted through convolutional neural networks were integrated with clinicopathological variables.Model performance was assessed using ROC curve analysis,and interpretability was evaluated by correlating image features with mRNA-seq data and characteristics of the immune microenvironment.Results The model achieved AUCs of 0.86 and 0.75 in the training and validation cohorts,respectively.Analysis using HoVer-Net indicated that lymphocyte abundance was associated with recurrence risk.Texture-related features showed significant correlations with immune cell infiltration and prognostic gene expression profiles.Conclusion This study demonstrates that deep learning can enable accurate prognostic prediction in early-stage TNBC,with interpretable image features that reflect the tumor immune microenvironment and gene expression profiles.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
Background:Laparoscopic anatomic hepatectomy of segment 7(LAH-S7)is a challenging surgery.In this study we aimed to investigate surgical and oncological outcomes of various approaches of LAH-S7 in patients with hepato...Background:Laparoscopic anatomic hepatectomy of segment 7(LAH-S7)is a challenging surgery.In this study we aimed to investigate surgical and oncological outcomes of various approaches of LAH-S7 in patients with hepatocellular carcinoma(HCC).A particular focus was placed on identifying the Glissonean pedicle of segment 7(G7)and the intersegmental plane.Given the scarcity of comprehensive reviews or comparative studies on clinical outcomes,we also sought to analyze the experiences and advantages associated with different approaches in relation to the anatomic variations of G7.Methods:The clinical data of 124 patients who underwent LAH-S7 for HCC across seven tertiary referral medical centers in China were retrospectively analyzed.Three surgical approaches were categorized based on the procedures used for G7 identification:the indocyanine green(ICG)fluorescence positive staining approach(IFPA),the Glissonean approach(GA),and the hepatic vein-guided approach(HVGA).Subsequently,the postoperative short-term results and oncological outcomes of the three different approaches were compared.Results:The distribution of surgical approaches among the patients was as follows:IFPA in 16(12.9%),GA in 62(50.0%),and HVGA in 46(37.1%)patients.Complications were observed in 27(21.8%)patients.The 1-,3-,and 5-year overall survival(OS)rates were 99.1%,89.2%,and 84.7%,respectively.The 1-,3-,and 5-year recurrence-free survival(RFS)rates were 99.0%,84.7%,and 69.3%,respectively.The OS and RFS rates were comparable across the three approaches.Conclusions:Following a standardized surgical procedure,LAH-S7 is demonstrated to be safe and yields favorable oncological outcomes.Surgeons performing LAH-S7 should select the appropriate surgical approach based on the anatomical characteristics and variations of G7.展开更多
The publisher regrets that some of the authors’affiliations were mistakenly annotated in the manuscript.Hence,the authors of the below article were contacted after publication to request a correction of the author af...The publisher regrets that some of the authors’affiliations were mistakenly annotated in the manuscript.Hence,the authors of the below article were contacted after publication to request a correction of the author affliction and responded with the correct by the time this erratum is being published.展开更多
Background： Population-based cancer registration data in 2012 from all available cancer registries were collected by the National Central Cancer Registry （NCCR）. NCCR estimated the numbers of new cancer cases and c...Background： Population-based cancer registration data in 2012 from all available cancer registries were collected by the National Central Cancer Registry （NCCR）. NCCR estimated the numbers of new cancer cases and cancer deaths in China with compiled cancer incidence and mortality rates. Methods： In 2015, there were 261 cancer registries submitted cancer incidence and deaths occurred in 2012. All the data were checked and evaluated based on the NCCR criteria of data quality. Qualified data from 193 registries were used for cancer statistics analysis as national estimation. The pooled data were stratified by area （urban/rural）, gender, age group [0, 1-4, 5-9, 10-14, ..., 85＋] and cancer type. New cancer cases and deaths were estimated using age-specific rates and corresponding national population in 2012. The Chinese census data in 2000 and Segi＇s population were applied for age-standardized rates. All the rates were expressed per 100,000 person-year. Results： Qualified 193 cancer registries （74 urban and 119 rural registries） covered 198,060,406 populations （100,450,109 in urban and 97,610,297 in rural areas）. The percentage of cases morphologically verified （NIV%） and death certificate-only cases （DCO%） were 69.13% and 2.38%, respectively, and the mortality to incidence rate ratio （M/I） was 0.62. A total of 3,586,200 new cancer cases and 2,186,600 cancer deaths were estimated in China in 2012. The incidence rate was 264.85/100,000 （289.30/100,000 in males, 239.15/100,000 in females）, the age-standardized incidence rates by Chinese standard population （ASIRC） and by world standard population （ASIRW） were 191.89/100,000 and 187.83/100,000 with the cumulative incidence rate （0-74 age years old） of 21.82%. The cancer incidence, ASIRC and ASIRW in urban areas were 277.17/100,000, 195.56/100,000 and 190.88/100,000 compared to 251.20/100,000, 187.10/100,000 and 183.91/100,000 in rural areas, respectively. The cancer mortality was 161.49/ 100,000 （ 198.99/100,000 in males, 122.06/ 100,000 in females）, the age-standardized mortality rates by Chinese standard population （ASMRC） and by world standard population （ASMRW） were 112.34/100,000 and 111.25/100,000, and the cumulative mortality rate （0-74 years old） was 12.61%. The cancer mortality, ASMRC and ASMRW were 159.00/100,000, 107.23 1/100,000 and 106.13/100,000 in urban areas, 164.24/100,000, 118.22/100,000 and 117.06/100,000 in rural areas, respectively. Cancers of lung, stomach, liver, eolorectum, esophagus, female breast, thyroid cervix, brain tumor and pancreas were the most common cancers, accounting for about 77.4% of all cancer new cases. Lung cancer, liver cancer, stomach cancer, esophageal cancer, colorectal cancer, pancreatic cancer, female breast cancer, brain tumor, leukemia and lymphoma were the leading causes of cancer death, accounting for about 84.5% of all cancer deaths. The cancer spectrum showed difference between urban and rural, males and females both in incidence and mortality rates. Conclusions： Cancer surveillance information in China is making great progress with the increasing number of cancer registries, population coverage and the improving data quality. Cancer registration plays a fundamental role in cancer control by providing basic information on population-based cancer incidence, mortality, survival and time trend. The disease burden of cancer is serious in China, so that, cancer prevention and control, including health education, health promotiou, cancer screening and cancer care services in China, should be enhanced.展开更多
Background: Stage at diagnosis and molecular subtype are important clinical factors associated with breast cancer patient survival. However, subgroup survival data from a large study sample are limited in China.To est...Background: Stage at diagnosis and molecular subtype are important clinical factors associated with breast cancer patient survival. However, subgroup survival data from a large study sample are limited in China.To estimate the survival differences among patients with different stages and various subtypes of breast cancer, we conducted a hospital-based multi-center study on breast cancer in Beijing, China.Methods: All resident patients diagnosed with primary, invasive breast cancer between January 1,2006 and December 31,2010 from four selected hospitals in Beijing were included and followed up until December 31,2015. Hospitalbased data of stage at diagnosis, hormone receptor status, and selected clinical characteristics, including body mass index(BMI), menopausal status, histological grade, and histological type, were collected from the medical records of the study subjects. Overall survival(OS) and cancer-specific survival(CSS) were estimated. Cox proportional hazards models were employed to evaluate the associations of stage at diagnosis and molecular subtype with patient survival.Results: The 5-year OS and CSS rates for all patients were 89.4% and 90.3%. Survival varied by stage and molecular subtype. The 5-year OS rates for patients with stage I, Ⅱ, Ⅲ, and IV diseases were 96.5%, 91.6%, 74.8%, and 40.7%,respectively, and the corresponding estimates of 5-year CSS rates were 97.1%, 92.6%, 75.6%, and 42.7%, respectively.The 5-year OS rates for patients with luminal A, luminal B, HER2, and triple-negative subtypes of breast cancer were92.6%, 88.4%, 83.6%, and 82.9%, respectively, and the corresponding estimates of 5-year CSS rates were 93.2%, 89.1 %,85.4%, and 83.5%, respectively. Multivariate analysis showed that stage at diagnosis and molecular subtype were important prognostic factors for breast cancer.Conclusions: Survival of breast cancer patients varied significantly by stage and molecular subtype. Cancer screening is encouraged for the early detection and early diagnosis of breast cancer. More advanced therapies and health care policies are needed on HER2 and triple-negative subtypes.展开更多
Objective： Laparoscopic gastrectomy has been established as a standard treatment for early gastric cancer, and its use is increasing recently. Compared with the conventional laparoscopy-assisted distal gastrectomy （...Objective： Laparoscopic gastrectomy has been established as a standard treatment for early gastric cancer, and its use is increasing recently. Compared with the conventional laparoscopy-assisted distal gastrectomy （LADG）, totally laparoscopic distal gastrectomy （TLDG） involves intracorporeal reconstruction, which can avoid the additional incision, resulting in pain reduction and early recovery. This study aimed to compare the short-term postoperative outcomes of TLDG vs. LADG in gastric cancer in a high-volume center.Methods： A retrospective cohort study was conducted on 1,322 patients who underwent laparoscopic distal gastrectomy from June 2012 to June 2017 at the National Cancer Center, Korea. LAD G was performed in the early period before July 2015, and TLDG was applied in the later period. Postoperative short-term outcomes were compared in terms of complication and clinical course between the two groups. Pain score was measured by rating the pain intensity from 0 to 10 points on postoperative day （POD） 1 and 3. Results： A total of 667 patients underwent LADG and 655 patients underwent TLDG. Clinieopathologic characteristics were not different in both groups. Intraoperative estimated blood loss （EBL） was significantly lower in the TLDG group （P〈0.001）. Postoperative pain scores were significantly lower in the TLDG group than in the LADG group on POD 1 （5.1±1.5 vs. 4.8±1.4, P=0.015）. First flatus passage after operation was significantly earlier in the TLDG group （3.4±0.8 d vs. 3.2±0.6 d, P〈0.001）. There were no differences in postoperative complications and hospital stay between the two groups. Conclusions： Based on the reported short-term postoperative outcomes, TLDG is safe and feasible as well as LADG. Moreover, compared with LADG, TLDG can reduce intraoperative EBL and postoperative pain and enhance the bowel motility in gastric cancer surgery.展开更多
BACKGROUND The necessity of additional gastrectomy for early gastric cancer (EGC) patients who do not meet curative criteria after endoscopic submucosal dissection (ESD) is controversial. AIM To examine the clinicopat...BACKGROUND The necessity of additional gastrectomy for early gastric cancer (EGC) patients who do not meet curative criteria after endoscopic submucosal dissection (ESD) is controversial. AIM To examine the clinicopathologic characteristics of patients who underwent additional laparoscopic gastrectomy after ESD and to determine the appropriate strategy for treating those after noncurative ESD. METHODS We retrospectively studied 45 patients with EGC who underwent additional laparoscopic gastrectomy after noncurative ESD from January 2013 to January 2019 at the Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the patients’ clinicopathological data and identified the predictors of residual cancer (RC) and lymph node metastasis (LNM). RESULTS Surgical specimens showed RC in ten (22.2%) patients and LNM in five (11.1%).Multivariate analysis revealed that positive horizontal margin [odds ratio (OR)=13.393, 95% confidence interval (CI): 1.435-125, P=0.023] and neural invasion (OR=14.714, 95%CI: 1.087-199, P=0.043) were independent risk factors for RC. Undifferentiated type was an independent risk factor for LNM (OR=12.000, 95%CI: 1.197-120, P=0.035). Tumors in all patients with LNM showed submucosal invasion more than 500 μm. Postoperative complications after additional laparoscopic gastrectomy occurred in five (11.1%) patients, and no deaths occurred among patients with complications. CONCLUSION Gastrectomy is necessary not only for patients who have a positive margin after ESD, but also for cases with neural invasion, undifferentiated type, and submucosal invasion more than 500 μm. Laparoscopic gastrectomy is a safe, minimally invasive, and feasible procedure for additional surgery after noncurative ESD. However, further studies are needed to apply these results to clinical practice.展开更多
文摘Objective： The aim of this study was to investigate the prognostic factors and to evaluate the impact of adjuvant therapy on clinical outcome for early-stage cervical cancer. Methods： The clinical-pathological data of all 1,335 patients with the International Federation of Gynecology and Obstetrics （FIGO） Ib-[Ia cervical cancer treated with primary radical surgery at the Chinese National Cancer Center between May 2007 and Dec 2013 were retrospectively reviewed. The median follow-up was 70 months. Results： Of all the patients, 61.6% of the cases received adjuvant therapy, with 5-year disease-free survival （DFS） of 92.1% and 5-year overall survival （OS） of 95.0%. In multivariate analysis, differentiation of G3 （P〈0.05）, lymph node metastasis （LNM, P〈0.05） and lymphovascular space invasion （LVSI, P〈0.05） were independent predictors for OS, while LNM （P〈0.05）, deep stroma invasion （DSI, P〈0.05） and LVSI （P〈0.05） were independent factors for DFS. The samples were stratified by histologic type, and cervical squamous cell carcinoma （SCC） was found to share the same independent factors except for differentiation of OS. As to patients with cervical adenocarcinoma/adenosquamons carcinoma （AC/ASC）, differentiation was the independent predictor of OS （P〈0.05）; and LVSI of DFS （P〈0.05）. Of 236 patients with high-risk factors, there was no significant difference in survival between concurrent chemoradiotherapy （CCRT, n=195）, radiotherapy （RT, n=24）, and chemotherapy （CT, n=17）. Among the 190 patients with LNM who underwent CCRT, 124 cases showed improved DFS after sequential CT （P=0.118）, with a recurrence rate decrease of 14%, though the difference was not statistically significant. Patients with single intermediate-risk factors like DSI or LVSI were found to partially benefit from adjuvant therapy, but the difference was not statistically significant. Conclusions： LNM, LVSI, DSI and differentiation were found to be independent prognostic factors for operable cervical cancer. Aggressive postoperative adjuvant therapy based on single risk factors in Chinese National Cancer Center could benefit survival. CCRT＋CT outperformed CCRT in high-risk patients. For patients with single non-high-risk factor, the role of adjuvant therapy needs to be further discussed.
基金Supported by National Natural Science Foundation of China,No.81401947the Specialized Research Fund for the Doctoral Program of Higher Education,No.20131106120011The Cancer Hospital/Institute of the Chinese Academy of Medical Sciences,No.JK2011B13,Beijing Nova Program
文摘AIM: To examine the impact of body mass index(BMI)on outcomes following pancreatic resection in the Chinese population.METHODS: A retrospective cohort study using prospectively collected data was conducted at the Cancer Hospital of the Chinese Academy of Medical Sciences, China National Cancer Center. Individuals who underwent pancreatic resection between January2004 and December 2013 were identified and included in the study. Persons were classified as having a normal weight if their BMI was < 24 kg/m2 and overweight/obese if their BMI was ≥ 24 kg/m2 as defined by the International Life Sciences Institute Focal Point in China. A χ 2 test(for categorical variables) or a t test(for continuous variables) was used to examine the differences in patients' characteristics between normal weight and overweight/obese groups. Multiple logistic regression models were used to assess the associationsof postoperative complications, operative difficulty,length of hospital stay, and cost with BMI, adjusting for age, sex, and type of surgery procedures.RESULTS: A total of 362 consecutive patients with data available for BMI calculation underwent pancreatic resection for benign or malignant disease from January1, 2004 to December 31, 2013. Of the 362 patients,156 were overweight or obese and 206 were of normal weight. One or more postoperative complications occurred in 35.4% of the patients following pancreatic resection. Among patients who were overweight or obese, 42.9% experienced one or more complications,significantly higher than normal weight(29.6%)individuals(P = 0.0086). Compared with individuals who had normal weight, those with a BMI ≥ 24.0kg/m2 had higher delayed gastric emptying(19.9% vs5.8%, P < 0.0001) and bile leak(7.7% vs 1.9%, P =0.0068). There were no significant differences seen in pancreatic fistula, gastrointestinal hemorrhage, reoperation,readmission, or other complications. BMI did not show a significant association with intraoperative blood loss, operative time, length of hospital stay, or cost.CONCLUSION: Higher BMI increases the risk for postoperative complications after pancreatectomy in the Chinese population. The findings require replication in future studies with larger sample sizes.
文摘The journey to implement cancer genomic medicine(CGM)in oncology practice began in the 1980s,which is considered the dawn of genetic and genomic cancer research.At the time,a variety of activating oncogenic alterations and their functional significance were unveiled in cancer cells,which led to the development of molecular targeted therapies in the 2000s and beyond.Although CGM is still a relatively new discipline and it is difficult to predict to what extent CGM will benefit the diverse pool of cancer patients,the National Cancer Center(NCC)of Japan has already contributed considerably to CGM advancement for the conquest of cancer.Looking back at these past achievements of the NCC,we predict that the future of CGM will involve the following:1)A biobank of paired cancerous and non-cancerous tissues and cells from various cancer types and stages will be developed.The quantity and quality of these samples will be compatible with omics analyses.All biobank samples will be linked to longitudinal clinical information.2)New technologies,such as whole-genome sequencing and artificial intelligence,will be introduced and new bioresources for functional and pharmacologic analyses(e.g.,a patient-derived xenograft library)will be systematically deployed.3)Fast and bidirectional translational research(bench-to-bedside and bedside-to-bench)performed by basic researchers and clinical investigators,preferably working alongside each other at the same institution,will be implemented;4)Close collaborations between academia,industry,regulatory bodies,and funding agencies will be established.5)There will be an investment in the other branch of CGM,personalized preventive medicine,based on the individual's genetic predisposition to cancer.
基金the Japan Agency for Medical Research and Development(Grant Nos.20lk0201002j0001,21lk0201005j0001,and 22lk0201007j0001)。
文摘Precision medicine is a growing field worldwide.Despite its potential benefit to many patients,several major obstacles must be overcome before precision medicine can be more widely used in clinical practice.The main obstacles are associated with the quality of samples used for genomic analysis。
文摘The authors regret that there was an error in Fig.3 of the published article.The area under the curve(AUC)and 95%confidence interval(CI)values for the prediction of N2 disease were incorrectly displayed in the figure.This graphical error does not affect the study conclusions or the reported results elsewhere in the manuscript.The corrected version of Fig.3 is provided below.
基金the National Central Cancer Registry for matching patient survival outcomessupported by National Natural Science Foundation of China(grant number 82072734).
文摘Objective:The postoperative survival rates of patients with gastric cancer at different stages treated at the National Cancer Center(NCC)of China have not been reported.Therefore,we evaluated the survival of patients with gastric cancer who underwent surgery at the NCC from 2011 to 2018 to provide baseline information for further studies.Methods:We identified 7,301 patients with primary gastric carcinoma who underwent surgery at the NCC be-tween January 2011 and May 2018;among these,5,008 patients were enrolled in this study.Follow up was completed on April 30,2020.We analyzed the 5-year survival according to the stage,sex,age,and other clini-copathological features.Results:Five-year survival rates of patients with pTNM stages ⅠA,ⅠB,ⅡA,ⅡB,ⅢA,ⅢB,ⅢC,and Ⅳ treated at the NCC were 94.9%,91.8%,86.5%,76.1%,61.1%,44.2%,29.7%,and 8.1%,respectively,which were similar to those reported in Japan during the same period.Five-year survival rates of patients with ypTNM stages I,II,III,and IV were 93.1%,63.2%,27.2%,and 0.0%,respectively.In multivariable analysis,age,signet ring cell carcinoma,adjuvant chemotherapy,and degree of differentiation were revealed as important prognostic factors.Conclusion:The survival rates of patients with gastric cancer treated at the NCC have been significantly improved,reaching the levels of Japan in the same period.
基金supported by the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(No.2023-JKCS-23)the Special Research Fund for Central Universities,Peking Union Medical College[No.2022-I2M-C&T-A-014,CAMS Innovation Fund for Medical Sciences(CIFMS)]。
文摘Objective:Neoadjuvant therapy(NAT)has become the standard treatment option for patients with locally advanced breast cancer.How to non-invasively screen out patients with pathological complete response(pCR)after NAT has become an urgent world-wide clinical problem.Our work aims to the assessment of neoadjuvant treatment response in breast cancer patients for higher accuracy prediction using innovative artificial intelligence system.Methods:In this study,we retrospectively collected longitudinal(pre-NAT and post-NAT)multi-parametric magnetic resonance imaging(MRI)and clinicopathologic data of a total of 1,315 breast cancer patients(clinical stageⅠ-Ⅲ)who had undergone NAT followed by standard surgery and treated across 5 independent medical centers from January 2010 to January 2023.We used radiomics,3D convolutional neural network technology and clinical data statistical analysis methods to extract and screen multimodal features,and then developed and validated a Clinical-Radiomics-Deep-Learning(CRDL)model to predict patients'pCR outcomes based on multimodal fusion features.Results:We use the area under the receiver operating characteristic curve(AUC)in the primary cohort(PC)and3 external validation cohorts(VC_(1-3))to evaluate the model performance.The results showed that the AUC in the PC composed of 2 medical centers was 0.947[95%confidence interval(95%CI):0.931-0.960],and the AUC values in VC_(1-3)were 0.857(95%CI:0.810-0.901),0.883(95%CI:0.841-0.918)and 0.904(95%CI:0.860-0.941),respectively.Conclusions:The CRDL model demonstrated high accuracy and robustness in predicting pCR to NAT using multimodal fusion data.This study provides a strong foundation for non-invasive assessment of pCR status in breast cancer patients following NAT and offers critical insights to guide clinical decision-making in post-NAT treatment planning.
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 Special Fund for the Beijing Hope Marathon of the China Cancer Foundation,No.LC2019 L05and the Capital Health Development Research Special Fund Project,No.2024-2-4026.
文摘BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gastrectomy(PG)or total gastrectomy(TG)should be used for advanced proximal GC,and the choice of postoperative gastrointestinal reconstruction method remains controversial.AIM To compare the short-term efficacy,long-term survival,and postoperative reflux outcomes of PG with tubular stomach reconstruction vs TG with Roux-en-Y re-construction in patients with proximal GC following neoadjuvant chemotherapy(NACT)in an effort to provide valuable insights for clinical decision-making regarding the optimal surgical approach.METHODS A multicenter retrospective cohort study was conducted at two Chinese medical centers between December,2012 and December,2022.Patients with histologically confirmed proximal GC who received NACT followed by either PG with tubular stomach reconstruction or TG with Roux-en-Y reconstruction were included.Propensity score matching(PSM)was performed to balance baseline characteristics,and the primary endpoint was 5-year overall survival(OS).Se-condary endpoints included recurrence-free survival(RFS),postoperative complications,and reflux severity.RESULTS After PSM,244 patients(122 PG,122 TG)were finally included and all baseline characteristics were comparable between groups.The PG group had a significantly shorter operation time compared to the TG group(189.50 vs 215.00 minutes,P<0.001),with no differences in intraoperative blood loss or postoperative complications(19.68%vs 14.75%,P=0.792).The 5-year OS rates were 52.7%vs 45.5%(P=0.330),and 5-year RFS rates were 54.3%vs 47.6%(P=0.356)for the PG and TG groups,respectively.Reflux symptoms(18.0%vs 31.1%,P=0.017)and clinically significant reflux based on gastroesophageal reflux disease questionnaire scores≥8(7.4%vs 21.3%,P<0.001)were significantly less frequent in the PG group.Multivariate analysis identified histological differentiation(HR=2.98,95%CI:2.03-4.36,P<0.001)and tumor size(HR=0.26,95%CI:0.17-0.41 for tumors≤4 cm,P<0.001)as independent prognostic factors.CONCLUSION PG with tubular stomach reconstruction is comparable to TG in terms of surgical safety and long-term oncological outcomes for proximal GC patients following NACT.Additionally,PG has the advantages of shorter operation time and lower rates of postoperative reflux,suggesting potential benefits for patient quality of life.Notably,the analysis of postoperative prognostic factors,including histological differentiation and tumor size,further informs clinical decision-making and highlights the importance of individualized treatment strategies.
文摘Objective:This study aims to estimate the thyroid cancer(TC)burden and trends from 1990 and 2021 among working-age population(WAP),at the global,regional,and national levels.Methods:Based on the Global Burden of Disease 2021 study,this cross-sectional study included data on TC incidence and mortality for WAP aged 15-64 years across 204 countries and territories from 1990 to 2021.The age-standardized incidence rate(ASIR)and age-standardized mortality rate(ASMR)of TC were used to estimate the disease burden.Temporal trends of ASIR and ASMR were estimated by average annual percentage changes(AAPCs)based on age-period-cohort models.Relative inequality of TC burden across 204 countries was estimated by the slope index of concentration index.Results:Globally,ASIR of TC increased from 2.27 per 100,000 population to 3.41 per 100,000 population from1990 to 2021,with AAPC of 1.59%[95%confidence interval(95%CI):1.54,1.64];in contrast,ASMRs were stable at 0.31 per 100,000 population.Females had a higher disease burden than males,and adults aged 45-64 years accounted for more than 55%of the TC cases.Across regions and countries,North Africa and Comoros experienced the highest increase in ASIR,with AAPCs of 2.97%and 7.73%,respectively.All socio-demographic index(SDI)regions experienced a significant increase in ASIR,and regions with high and high-middle SDI experienced a significant decrease in ASMR.Global ASIR burden and ASMR burden were revealed to be concentrated mainly in higher-SDI and lower-SDI countries,respectively,with the concentration index in both sexes of 0.16(95%CI:0.13,0.19)and-0.14(95%CI:-0.18,-0.10)in 2021.Conclusions:Over the past three decades,the incidence burden of TC among the global WAP remarkably increased.International and regional policies for TC controls are supposed to be updated timely,to handle the current increasing burden and geographic disparities among WAP.
文摘BACKGROUND The survival rate of pancreatic cancer is low,and there is a lack of effective treatment.AIM To explore the epidemiological characteristics of patients with pancreatic cancer in China and compare multiple chemotherapy regimens at different stages.METHODS This was a retrospective study conducted from 2005 to 2014,involving six cancer hospitals and eight general hospitals across seven geographical regions of China(East,South,North,Central,Southwest,Northwest,and Northeast).Stratified sampling was used based on the population distribution of each region.Efficacy assessments were conducted by Cox proportional hazards regression models.When assessing the effectiveness of various chemotherapy regimens,traditional drugs such as gemcitabine used as monotherapy served as the reference.RESULTS A total of 3256 patients were included.The median follow-up time was 407 days,and the median overall survival was 183 days.At diagnosis,56%of patients were already in stage IV.Chemotherapy was administered to 39.73%of patients.In the adjuvant therapy phase,gemcitabine+fluorouracil was superior to gemcitabine monotherapy[hazard ratio(HR)=0.35,95%confidence interval(CI):0.14-0.89].In fluorouracil-based regimens,other combination regimens did not show effectiveness relative to monotherapy.For first-line treatment in patients with advanced disease,tegafur alone(HR=0.20,95%CI:0.06-0.66),gemcitabine plus cisplatin(HR=0.16,95%CI:0.04-0.70),and tegafur,gemcitabine plus platinum-based agents(HR=0.32,95%CI:0.11-0.91)were associated with a lower risk of death compared to gemcitabine alone.In second-line treatment,there were no significant differences in efficacy among various drugs,but FOLFIRINOX(irinotecan+oxaliplatin+leucovorin+5-fluorouracil)had an outstanding point estimate(HR=0.10,95%CI:0.01-1.27).CONCLUSION In China,pancreatic cancer is often diagnosed at advanced stages,emphasizing the need for early diagnosis and treatment.Combined therapies in adjuvant and first-line settings may reduce the risk of death compared with monotherapy,and FOLFIRINOX might offer more significant benefits in second-line treatment.
基金supported by the Capital’s Funds for Health Improvement and Research(CFH2024-2G-40214)the CAMS Innovation Fund for Medical Sciences(2021-I2M-1-011,2021-I2M-1-061).
文摘Background:The level of premature deaths(deaths among those aged 30-69 years)caused by cancer is an important indicator of evaluating the level of cancer prevention and control.However,the current burden and temporal trends in cancer-related premature deaths,and their impact on life expectancy at the global,regional,and national levels are not clear.Methods:Cancer mortality data for 185 countries were obtained from the GLOBOCAN 2022 database.High-quality cancer mortality data and national population statistics for 47 countries were extracted from the United Nations and national cancer registry databases,covering the period 2003-2022.Countries were classified based on the human development index(HDI).The death probability,the year of life lost(YLL),and the potential gain in life expectancy(PGLE)attributable to premature deaths from site-specific and all-cancers combined were calculated.Results:Globally,the probability of premature cancer deaths was 6.49%(95%UI 6.49-6.50).The YLLs caused by cancer-related premature death were 163.86 million(95%UI 163.70-164.03),constituting 65.58%of the total cancer-related YLLs.The PGLEs were 1.16 years(95%UI 1.16-1.16).The premature death probability increased with higher HDI levels in men,but decreased in women.Cancer-related premature deaths as a proportion of total cancer deaths varied from 18.31%(95%UI 18.20-18.43)in Japan to 84.44%(95%UI 76.10-91.16)in São Toméand Príncipe.Lung cancer was the leading cause of cancer-related premature deaths in men,and breast cancer ranked first in women.By eradicating premature deaths attributable to lung,liver,colorectal,and stomach cancer in men,and to breast,cervical,and lung cancer in women,0.55 years(95%UI 0.55-0.55)and 0.49 years(95%UI 0.49-0.49)of PGLEs could be achieved,accounting for 48.67%and 42.24%of the total PGLEs,respectively.Cancer-related premature deaths decreased significantly in 38 countries during 2003-2022(P<0.05).The probability of premature cancer-related deaths decreased by more than 15.50%from 2015 to 2022 in 16 countries.Conclusions:Cancer-related premature deaths declined in many countries,with 16 of them having achieved the expected reduction by 2022.The current burden of cancer-related premature deaths is profound but varies around the world.Eliminating premature deaths from major cancer types could substantially increase life expectancy,underscoring the importance of prevention and treatment efforts for these cancers.
基金Supported by Capital’s Funds for Health Improvement and Research(CFH2024-1-4021)。
文摘Objective To develop a prognostic prediction model for early-stage triple-negative breast cancer(TNBC)using H&E-stained pathological images and to investigate its underlying biological interpretability.Methods A deep learning model was trained on 340 WSIs and externally validated using 81 TCGA cases.Image-derived features extracted through convolutional neural networks were integrated with clinicopathological variables.Model performance was assessed using ROC curve analysis,and interpretability was evaluated by correlating image features with mRNA-seq data and characteristics of the immune microenvironment.Results The model achieved AUCs of 0.86 and 0.75 in the training and validation cohorts,respectively.Analysis using HoVer-Net indicated that lymphocyte abundance was associated with recurrence risk.Texture-related features showed significant correlations with immune cell infiltration and prognostic gene expression profiles.Conclusion This study demonstrates that deep learning can enable accurate prognostic prediction in early-stage TNBC,with interpretable image features that reflect the tumor immune microenvironment and gene expression profiles.
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 grants from the Scientific Research Fund of Education Department of Yunnan Province(2023J767)the National Natural Science Foundation of China(82272963 and 82472718)+6 种基金Health Research Project of Hunan Provincial Health Commission(W20242019)Hunan Provincial Health High-Level Talent Scientific Research Project(R2023096)Hunan Provincial Department of Science and Technology Health Industry Joint Fund(2024JJ9479)Guangdong Province Basic and Applied Basic Research Foundation Project-Guangdong Province Natural Science Foundation(2024A1515220154)"Leading Goose"Project of the Science and Technology Department of Zhejiang Province(2024C03049)Major Project of Health Science and Technology Program of Zhejiang Province(WKJ-ZJ-2407)the National Key Research and Development Program(2024YFB331170204).
文摘Background:Laparoscopic anatomic hepatectomy of segment 7(LAH-S7)is a challenging surgery.In this study we aimed to investigate surgical and oncological outcomes of various approaches of LAH-S7 in patients with hepatocellular carcinoma(HCC).A particular focus was placed on identifying the Glissonean pedicle of segment 7(G7)and the intersegmental plane.Given the scarcity of comprehensive reviews or comparative studies on clinical outcomes,we also sought to analyze the experiences and advantages associated with different approaches in relation to the anatomic variations of G7.Methods:The clinical data of 124 patients who underwent LAH-S7 for HCC across seven tertiary referral medical centers in China were retrospectively analyzed.Three surgical approaches were categorized based on the procedures used for G7 identification:the indocyanine green(ICG)fluorescence positive staining approach(IFPA),the Glissonean approach(GA),and the hepatic vein-guided approach(HVGA).Subsequently,the postoperative short-term results and oncological outcomes of the three different approaches were compared.Results:The distribution of surgical approaches among the patients was as follows:IFPA in 16(12.9%),GA in 62(50.0%),and HVGA in 46(37.1%)patients.Complications were observed in 27(21.8%)patients.The 1-,3-,and 5-year overall survival(OS)rates were 99.1%,89.2%,and 84.7%,respectively.The 1-,3-,and 5-year recurrence-free survival(RFS)rates were 99.0%,84.7%,and 69.3%,respectively.The OS and RFS rates were comparable across the three approaches.Conclusions:Following a standardized surgical procedure,LAH-S7 is demonstrated to be safe and yields favorable oncological outcomes.Surgeons performing LAH-S7 should select the appropriate surgical approach based on the anatomical characteristics and variations of G7.
文摘The publisher regrets that some of the authors’affiliations were mistakenly annotated in the manuscript.Hence,the authors of the below article were contacted after publication to request a correction of the author affliction and responded with the correct by the time this erratum is being published.
文摘Background： Population-based cancer registration data in 2012 from all available cancer registries were collected by the National Central Cancer Registry （NCCR）. NCCR estimated the numbers of new cancer cases and cancer deaths in China with compiled cancer incidence and mortality rates. Methods： In 2015, there were 261 cancer registries submitted cancer incidence and deaths occurred in 2012. All the data were checked and evaluated based on the NCCR criteria of data quality. Qualified data from 193 registries were used for cancer statistics analysis as national estimation. The pooled data were stratified by area （urban/rural）, gender, age group [0, 1-4, 5-9, 10-14, ..., 85＋] and cancer type. New cancer cases and deaths were estimated using age-specific rates and corresponding national population in 2012. The Chinese census data in 2000 and Segi＇s population were applied for age-standardized rates. All the rates were expressed per 100,000 person-year. Results： Qualified 193 cancer registries （74 urban and 119 rural registries） covered 198,060,406 populations （100,450,109 in urban and 97,610,297 in rural areas）. The percentage of cases morphologically verified （NIV%） and death certificate-only cases （DCO%） were 69.13% and 2.38%, respectively, and the mortality to incidence rate ratio （M/I） was 0.62. A total of 3,586,200 new cancer cases and 2,186,600 cancer deaths were estimated in China in 2012. The incidence rate was 264.85/100,000 （289.30/100,000 in males, 239.15/100,000 in females）, the age-standardized incidence rates by Chinese standard population （ASIRC） and by world standard population （ASIRW） were 191.89/100,000 and 187.83/100,000 with the cumulative incidence rate （0-74 age years old） of 21.82%. The cancer incidence, ASIRC and ASIRW in urban areas were 277.17/100,000, 195.56/100,000 and 190.88/100,000 compared to 251.20/100,000, 187.10/100,000 and 183.91/100,000 in rural areas, respectively. The cancer mortality was 161.49/ 100,000 （ 198.99/100,000 in males, 122.06/ 100,000 in females）, the age-standardized mortality rates by Chinese standard population （ASMRC） and by world standard population （ASMRW） were 112.34/100,000 and 111.25/100,000, and the cumulative mortality rate （0-74 years old） was 12.61%. The cancer mortality, ASMRC and ASMRW were 159.00/100,000, 107.23 1/100,000 and 106.13/100,000 in urban areas, 164.24/100,000, 118.22/100,000 and 117.06/100,000 in rural areas, respectively. Cancers of lung, stomach, liver, eolorectum, esophagus, female breast, thyroid cervix, brain tumor and pancreas were the most common cancers, accounting for about 77.4% of all cancer new cases. Lung cancer, liver cancer, stomach cancer, esophageal cancer, colorectal cancer, pancreatic cancer, female breast cancer, brain tumor, leukemia and lymphoma were the leading causes of cancer death, accounting for about 84.5% of all cancer deaths. The cancer spectrum showed difference between urban and rural, males and females both in incidence and mortality rates. Conclusions： Cancer surveillance information in China is making great progress with the increasing number of cancer registries, population coverage and the improving data quality. Cancer registration plays a fundamental role in cancer control by providing basic information on population-based cancer incidence, mortality, survival and time trend. The disease burden of cancer is serious in China, so that, cancer prevention and control, including health education, health promotiou, cancer screening and cancer care services in China, should be enhanced.
基金supported by the Beijing Natural Science Foundation (No. 7142139)the CAMS Innovation Fund for Medical Sciences (CIFMS) (No. 2016-12M-2-004)+1 种基金the PUMC Youth Fund/Fundamental Research Funds for the Central Universities (No. 3332016033)the National Key Research Program of China (No. 2016YFC1302502)
文摘Background: Stage at diagnosis and molecular subtype are important clinical factors associated with breast cancer patient survival. However, subgroup survival data from a large study sample are limited in China.To estimate the survival differences among patients with different stages and various subtypes of breast cancer, we conducted a hospital-based multi-center study on breast cancer in Beijing, China.Methods: All resident patients diagnosed with primary, invasive breast cancer between January 1,2006 and December 31,2010 from four selected hospitals in Beijing were included and followed up until December 31,2015. Hospitalbased data of stage at diagnosis, hormone receptor status, and selected clinical characteristics, including body mass index(BMI), menopausal status, histological grade, and histological type, were collected from the medical records of the study subjects. Overall survival(OS) and cancer-specific survival(CSS) were estimated. Cox proportional hazards models were employed to evaluate the associations of stage at diagnosis and molecular subtype with patient survival.Results: The 5-year OS and CSS rates for all patients were 89.4% and 90.3%. Survival varied by stage and molecular subtype. The 5-year OS rates for patients with stage I, Ⅱ, Ⅲ, and IV diseases were 96.5%, 91.6%, 74.8%, and 40.7%,respectively, and the corresponding estimates of 5-year CSS rates were 97.1%, 92.6%, 75.6%, and 42.7%, respectively.The 5-year OS rates for patients with luminal A, luminal B, HER2, and triple-negative subtypes of breast cancer were92.6%, 88.4%, 83.6%, and 82.9%, respectively, and the corresponding estimates of 5-year CSS rates were 93.2%, 89.1 %,85.4%, and 83.5%, respectively. Multivariate analysis showed that stage at diagnosis and molecular subtype were important prognostic factors for breast cancer.Conclusions: Survival of breast cancer patients varied significantly by stage and molecular subtype. Cancer screening is encouraged for the early detection and early diagnosis of breast cancer. More advanced therapies and health care policies are needed on HER2 and triple-negative subtypes.
基金supported by a grant(NCC 1710160-2)from the National Cancer Center,Republic of Korea
文摘Objective： Laparoscopic gastrectomy has been established as a standard treatment for early gastric cancer, and its use is increasing recently. Compared with the conventional laparoscopy-assisted distal gastrectomy （LADG）, totally laparoscopic distal gastrectomy （TLDG） involves intracorporeal reconstruction, which can avoid the additional incision, resulting in pain reduction and early recovery. This study aimed to compare the short-term postoperative outcomes of TLDG vs. LADG in gastric cancer in a high-volume center.Methods： A retrospective cohort study was conducted on 1,322 patients who underwent laparoscopic distal gastrectomy from June 2012 to June 2017 at the National Cancer Center, Korea. LAD G was performed in the early period before July 2015, and TLDG was applied in the later period. Postoperative short-term outcomes were compared in terms of complication and clinical course between the two groups. Pain score was measured by rating the pain intensity from 0 to 10 points on postoperative day （POD） 1 and 3. Results： A total of 667 patients underwent LADG and 655 patients underwent TLDG. Clinieopathologic characteristics were not different in both groups. Intraoperative estimated blood loss （EBL） was significantly lower in the TLDG group （P〈0.001）. Postoperative pain scores were significantly lower in the TLDG group than in the LADG group on POD 1 （5.1±1.5 vs. 4.8±1.4, P=0.015）. First flatus passage after operation was significantly earlier in the TLDG group （3.4±0.8 d vs. 3.2±0.6 d, P〈0.001）. There were no differences in postoperative complications and hospital stay between the two groups. Conclusions： Based on the reported short-term postoperative outcomes, TLDG is safe and feasible as well as LADG. Moreover, compared with LADG, TLDG can reduce intraoperative EBL and postoperative pain and enhance the bowel motility in gastric cancer surgery.
基金the National Natural Science Foundation of China,No.81772642Beijing Municipal Science and Technology Commission,No.Z161100000116045Capital’s Funds for Health Improvement and Research,No.CFH 2018-2-4022
文摘BACKGROUND The necessity of additional gastrectomy for early gastric cancer (EGC) patients who do not meet curative criteria after endoscopic submucosal dissection (ESD) is controversial. AIM To examine the clinicopathologic characteristics of patients who underwent additional laparoscopic gastrectomy after ESD and to determine the appropriate strategy for treating those after noncurative ESD. METHODS We retrospectively studied 45 patients with EGC who underwent additional laparoscopic gastrectomy after noncurative ESD from January 2013 to January 2019 at the Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the patients’ clinicopathological data and identified the predictors of residual cancer (RC) and lymph node metastasis (LNM). RESULTS Surgical specimens showed RC in ten (22.2%) patients and LNM in five (11.1%).Multivariate analysis revealed that positive horizontal margin [odds ratio (OR)=13.393, 95% confidence interval (CI): 1.435-125, P=0.023] and neural invasion (OR=14.714, 95%CI: 1.087-199, P=0.043) were independent risk factors for RC. Undifferentiated type was an independent risk factor for LNM (OR=12.000, 95%CI: 1.197-120, P=0.035). Tumors in all patients with LNM showed submucosal invasion more than 500 μm. Postoperative complications after additional laparoscopic gastrectomy occurred in five (11.1%) patients, and no deaths occurred among patients with complications. CONCLUSION Gastrectomy is necessary not only for patients who have a positive margin after ESD, but also for cases with neural invasion, undifferentiated type, and submucosal invasion more than 500 μm. Laparoscopic gastrectomy is a safe, minimally invasive, and feasible procedure for additional surgery after noncurative ESD. However, further studies are needed to apply these results to clinical practice.
