Evaluating efficacy of screening for upper gastrointestinal cancer in China:a study protocol for a randomized controlled trial

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）.

Cancer incidence and mortality in China in 2013：an analysis based on urbanization level

Objective： To explore the cancer patterns in areas with different urbanization rates（URR） in China with data from 255 population-based cancer registries in 2013, collected by the National Central Cancer Registry（NCCR）.Methods： There were 347 cancer registries submitted cancer incidence and deaths occurred in 2013 to NCCR.All those data were checked and evaluated based on the NCCR criteria of data quality, and qualified data from 255 registries were used for this analysis. According to the proportion of non-agricultural population, we divided cities/counties into 3 levels： high level, with URR equal to 70% and higher; median level, with URR between 30%and 70%; and low level, with URR equal to 30% and less. Cancer incidences and mortalities were calculated,stratified by gender and age groups in different areas. The national population of Fifth Census in 2000 and Segi＇s population were applied for age-standardized rates.Results： Qualified 255 cancer registries covered 226,494,490 populations. The percentage of cases morphologically verified（MV%） and death certificate-only cases（DCO%） were 68.04% and 1.74%, respectively,and the mortality to incidence rate ratio（M/I） was 0.62. A total of 644,487 new cancer cases and 399,275 cancer deaths from the 255 cancer registries were submitted to NCCR in 2013. The incidence rate was 284.55/100,000（314.06/100,000 in males, 254.19/100,000 in females）, and the age-standardized incidence rates by Chinese standard population（ASIRC） and by world standard population（ASIRW） were 190.10/100,000 and 186.24/100,000 with the cumulative incidence rate（0–74 age years old） of 21.60%. The cancer mortality was 176.28/100,000（219.03/100,000 in males, 132.30/100,000 in females）, and the age-standardized mortality rates by Chinese standard population（ASMRC） and by world standard population（ASMRW） were 110.91/100,000 and 109.92/100,000, and the cumulative mortality rate（0–74 age years old） was 12.43%. Low urbanization areas were high in crude cancer incidence and mortality rates, middle urbanization areas came next to it followed by high urbanization areas. After adjusted by age, there was a U-shaped association between age-standardized incidence（ASIRC and ASIRW） and the urbanized ratio with the middle urbanization areas having the lowest ASIRC and ASIRW. Unlike with the agestandardized incidence, the sort order of age-standardized mortality（ASMRC and ASMRW） among three urbanization areas was reversed completely from the crude mortality. Lung cancer was the most common cancer in all areas of 255 cancer registries, followed by stomach cancer, liver cancer, colorectal cancer and esophageal cancer with new cases of 130,700, 76,200, 63,800, 60,900 and 50,200 respectively. Lung cancer was also the leading cause of cancer death in all areas of 255 cancer registries for both males and females with the number of deaths of 72,200 and 34,100, respectively. Other cancer types with high mortality in males were liver cancer, stomach cancer,esophageal cancer and colorectal cancer. In females, stomach cancer was the second cause of cancer death, followed by liver cancer, colorectal cancer and breast cancer.Conclusions： Along with the development of socioeconomics associated with urbanization, as well as the agingpopulation, the incidence and mortality keep increasing in China. Cancer burden and patterns are different in each urbanization level. Cancer control strategies should be implemented referring to local urbanization status.

Annual report on status of cancer in China, 2011

Objective： The National Central Cancer Registry （NCCR） collected population-based cancer registration data in 20l 1 from all cancer registries. National cancer incidence and mortality were compiled and cancer incident new cases and cancer deaths were estimated. Methods： In 2014, there were 234 cancer registries submitted cancer incidence and deaths occurred in 2011. All datasets were checked and evaluated based on the criteria of data quality from NCCR. Total 177 registries＇ data were qualified and compiled for cancer statistics in 2011. The pooled data were stratified by area （urban/rural）, gender, age group （0, 1-4, 5-9, 10-14...85＋） and cancer type. Cancer incident cases and deaths were estimated using age-specific rates and national population in 2011. All incidence and death rates are age-standardized to the 2000 Chinese standard population and Segi＇s population expressed per 100,000 persons. Results： All 177 cancer registries （77 in urban and 100 in rural areas） covered 175,310,169 populations （98,341,507 in urban and 76,968,662 in rural areas）. The morphology verified cases （MV%） accounting for 70.14% and 2.44% of incident cases were identified through death certifications only （DCO%） with mortality to incidence ratio of 0.63. The estimates of new cancer incident cases and cancer deaths were 3,372,175 and 2,113,048 in 2011, respectively. The incidence rate was 250.28/100,000 （males 277.77/100,000, females 221.37/100,000）, and the age-standardized incidence rates by Chinese standard population （ASIRC） and by world standard population （ASIRW） were 186.34/100,000 and 182.76/100,000 with the cumulative incidence rate （0-74 years old） of 21.20%. The cancer incidence and ASIRC in urban areas were 261.38/100,000 and 189.89/100,000 compared to 238.60/100,000 and 182.10/100,000 in rural areas, respectively. The cancer mortality was 156.83/100,000 （194.88/100,000 in males and 116.81/100,000 in females）, the age-standardized mortality rates by Chinese standard population （ASMRC） and by world standard population （ASMRW） were 112.88/100,000 and 111.82/100,000, and the cumulative mortality rate （0-74 years old） was 12.69%. The cancer mortality and ASMRC were 154.37/100,000 and 108.20/100,000 in urban areas, and 159.42/100,000 and 117.97/100,000 in rural areas, respectively. Cancers of lung, female breast, stomach, liver, colon and rectum, esophageal, cervix, uterus, prostate and ovary were the most common cancers, accounting for about 75% of all cancer new cases. Lung cancer, liver cancer, stomach cancer, esophageal cancer, colorectal cancer, female breast cancer, pancreatic cancer, brain tumor, cervical cancer and leukemia were the leading causes of cancer death, accounting for about 80% of all cancer deaths. The cancer incidence, mortality and spectrum showed difference between urban and rural areas, males and females. Conclusions： The coverage of cancer registration population had a greater increase than that in the last year. The data quality and representativeness are gradually improved. As the basic work of cancer prevention and control, cancer registry is playing an irreplaceable role. The disease burden of cancer is increasing, and the health department has to take effective measures to contain the increased cancer burden in China.

The incidence and mortality of major cancers in China,2012

Background:The National Central Cancer Registry(NCCR) collected population-based cancer registration data in 2012 from local registries and estimated the cancer incidence and mortality in China.Methods:In the middle of 2015,261 cancer registries submitted reports on new cancer cases and deaths occurred in 2012.Qualified data from 193 registries were used for analysis after evaluation.Crude rates,number of cases,and age-standardized rates stratified by area(urban/rural),sex,age group,and cancer type were calculated according to the national population in 2012.Results:The covered population were 198,060,406 from 193 qualified cancer registries(74 urban and 119 rural registries).The major indicators of quality control,percentage of cases morphologically verified(MV%),death certificateonly cases(DCO%),and the mortality to incidence(M/l) ratio,were 69.13%,2.38%,and 0,62,respectively.It was estimated that there were 3,586,200 new cancer cases and 2,186,600 cancer deaths in 2012 in China with an incidence of 264.85/100,000[age-standardized rate of incidence by the Chinese standard population(ASRIC) of 191.89/100,000]and a mortality of 161.49/100,000[age-standardized rate of mortality by the Chinese standard population(ASRMC)of 112.34/100,000].The ten most common cancer sites were the lung,stomach,liver,colorectum,esophagus,female breast,thyroid,cervix,brain,and pancreas,accounting for approximately 77.4% of all new cancer cases.The ten leading causes of cancer death were lung cancer,liver cancer,gastric cancer,esophageal cancer,colorectal cancer,pancreatic cancer,female breast cancer,brain tumor,leukemia,and lymphoma,accounting for 84.5% of all cancer deaths.Conclusions:Continuous cancer registry data provides basic information in cancer control programs.The cancer burden in China is gradually increasing,both in urban and rural areas,in males and females.Efficient cancer prevention and control,such as health education,tobacco control,and cancer screening,should be paid attention by the health sector and the whole society of China.

National cancer incidence and mortality in China, 2012

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.

Annual report on status of cancer in China,2010

Objective：Population-based cancer registration data in 2010 were collected,evaluated and analyzed by the National Central Cancer Registry （NCCR） of China.Cancer incident new cases and cancer deaths were estimated.Methods：There wvere 219 cancer registries submitted cancer incidence and death data in 2010.All data were checked and evaluated on basis of the criteria of data quality from NCCR.Total 145 registries＇ data were qualified and accepted for cancer statistics in 2010.Pooled data were stratified by urban/rural,area,sex,age group and cancer site.Cancer incident cases and deaths were estimated using age-specific rates and national population.The top ten common cancers in different groups,proportion and cumulative rate were also calculated.Chinese census in 2000 and Segi＇s population were used for age-standardized incidence/ mortality rates.Results：All 145 cancer registries （63 in urban and 82 in rural） covered a total of 158,403,248 population （92,433,739 in urban and 65,969,509 in rural areas）.The estimates of new cancer incident cases and cancer deaths were 3,093,039 and 1,956,622 in 2010,respectively.The morphology verified cases （MV％） accounted for 67.11％ and 2.99％ of incident cases were identified through death certifications only （DCO％） with mortality to incidence ratio （M/I） of 0.61.The crude incidence rate was 235.23/100,000 （268.65/100,000 in males,200.21/100,000 in females）,age-standardized incidence rates by Chinese standard population （ASIRC,2000） and by world standard population （ASIRW） were 184.58/100,000 and 181.49/100,000 with the cumulative incidence rate （0-74 years old） of 21.l 1％.The cancer incidence and ASIRC were 256.41/100,000 and 187.53/100,000 in urban areas whereas in rural areas,they were 213.71/100,000 and 181.10/100,000,respectively.The crude cancer mortality in China was 148.81/100,000 （186.37/100,000 in males and 109.42/100,000 in females）,age-standardized incidence rates by Chinese standard population （ASMRC,2000） and by world standard population （ASMRW） were 113.92/100,000 and 112.86/100,000,and the cumulative incidence rate （0-74 years old） was 12.78％.The cancer mortality and ASMRC were 156.14/100,000 and 109.21/100,000 in urban areas,whereas in rural areas,they were 141.35/100,000 and 119.00/100,000 respectively.Lung cancer,gastric cancer,colorectal cancer,liver cancer,esophageal cancer,pancreas cancer,encephaloma,lymphoma,female breast cancer and cervical cancer,were the most common cancers,accounting for 75％ of all cancer cases in urban and rural areas.Lung cancer,gastric cancer,liver cancer,esophageal cancer,colorectal cancer,pancreatic cancer,breast cancer,encephaloma,leukemia and lymphoma accounted for 80％ of all cancer deaths.Conclusions：The coverage of cancer registration population had a rapid increase and could reflect cancer burden in each area and population.As the basis of cancer control program,cancer registry plays an irreplaceable role in cancer epidemic surveillance,evaluation of cancer control programs and making anticancer strategy.China is facing serious cancer burden and prevention and control should be enhanced.

The updated incidences and mortalities of major cancers in China, 2011

Introduction: The National Central Cancer Registry(NCCR) of China collected population-based cancer registration data from all cancer registries in China. This study aimed to compile national cancer incidences and mortalities in 2011 and estimate cancer incident new cases and cancer deaths.Methods: In 2014, there were 234 cancer registries that submitted records of new cancer cases and cancer deaths that occurred in 2011 to the NCCR. All datasets were evaluated based on the criteria of data quality of the NCCR. The data of 177 registries was of suicient quality and was compiled to evaluate cancer statistics in 2011. The pooled data were stratiied by area, sex, age group, and cancer type. Cancer incident cases and deaths were estimated using age-standardized rates(ASR) and the Chinese population. All incidences and mortalities were age-standardized to the 2000 Chinese standard population and Segi's population.Results: The estimates of new cancer incident cases and cancer deaths were 3,372,175 and 2,113,048 in 2011, respectively. The crude incidence was 250.28/1,00,000(277.77/1,00,000 for males and 221.37/1,00,000 for females). The ASRs of incidence by the Chinese standard population(ASRIC) and by the world standard population(ASRIW) were 186.34/1,00,000 and 182.76/1,00,000, respectively, with a cumulative incidence(0–74 years old) of 21.20%. Cancers of the lung, female breast, stomach, liver, colorectum, esophagus, cervix, uterus, prostate, and ovary were the most common cancers, accounting for approximately 75% of all new cancer cases. Lung, liver, gastric, esophageal, colorectal, female breast, pancreatic, brain, and cervical cancers and leukemia were the leading causes of cancer death, accounting for approximately 80% of all cancer deaths. Cancer incidence, mortality, and spectrum were all diferent between urban and rural areas and between males and females.Conclusions: The population covered by the cancer registries greatly increased from 2010 to 2011. The data quality and representativeness of cancer registries have gradually improved. Cancer registries have an irreplaceable role in research on cancer prevention and control. The disease burden of cancer is increasing, and the health department must implement efective measures to contain the increased cancer burden in China.

Estimates of cancer incidence and mortality in China,2013

Introduction: Population-based cancer registration data are collected by the National Central Cancer Registry in China every year. Cancer incident cases and cancer deaths in 2013 were analyzed.Methods: Through the procedure of quality control, reported data from 255 registries were accepted to establish the national database for cancer estimates. Incidences and mortalities were calculated with stratification by area(urban/rural), sex(male/female), age group(0,1-4,5-9,10-14... 80-84, and 85-year-old and above), and cancer site.The structure of Segi's population was used for the calculation of age-standardized rates(ASR).Top 10 most common cancers and leading causes of cancer deaths were listed.Results: In 2013,3,682,200 new cancer cases and 2,229,300 cancer deaths were estimated in China based on the pooled data from 255 cancer registries, covering 16.65% of the national population. The incidence was270.59/100,000, with an ASR of 186.15/100,000; the mortality was 166.83/100,000, with an ASR of 108.94/100,000.The top 10 most common cancer sites were the lung, stomach, liver, colorectum, female breast, esophagus, thyroid, cervix, brain, and pancreas. The ten leading causes of cancer deaths were lung cancer, liver cancer, gastric cancer, esophageal cancer, colorectal cancer, pancreatic cancer, female breast cancer, brain tumor, leukemia, and lymphoma.Conclusions: Cancer leaves serious disease burden in China with high incidence and mortality. Lung cancer was the most common cancer and the leading cause of cancer death in China. Efficient control strategy is needed, especially for major cancers.

Liver cancer incidence and mortality in China: Temporal trends and projections to 2030

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.

Breast cancer incidence and mortality in women in China: temporal trends and projections to 2030

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.

Incidence and mortality of stomach cancer in China,2014

Objective： In this study,we aimed to estimate the updated incidence and mortality rate of stomach cancer based on the cancer registration data in 2014,collected by the National Central Cancer Registry of China（NCCRC）.Methods： In 2017,339 registries＇ data were qualified based on the criteria of data quality control of the NCCRC.Cases of stomach cancer were retrieved from the national database.We estimated numbers of stomach cancer cases and deaths in China using age-specific rates and corresponding national population stratified by area,sex,agegroup（0,1–4,5–9,10–14,…,85＋）.Chinese standard population in 2000 and Segi＇s world population were applied for age-standardized incidence and mortality rates.Results： In 2014,410,400 new stomach cancer cases and 293,800 cancer-associated deaths were estimated to have occurred in China.The crude incidence rate of stomach cancer was 30.00/100,000,age-standardized incidence rates by Chinese standard population（ASIRC） and by world standard population（ASIRW） were 19.62/100,000 and19.51/100,000,respectively.The crude mortality rate of stomach cancer was 21.48/100,000,age-standardized mortality rates by Chinese（ASMRC） and by world standard population（ASMRW） were 13.44/100,000 and13.30/100,000,respectively.Incidence and mortality rates in rural areas were both higher than that in urban areas.Stomach cancer has a strong relationship with gender and age.The disease has occurred more frequently among men than women with a male to female ratio of 2.4 for ASIRC.After age group of 40-44 years,incidence rates are substantially higher in men than in women,same pattern was seen for age-specific mortality rates.Conclusions： There is still a heavy burden of stomach cancer in China.The incidence and mortality patterns of stomach cancer show substantial gender and regional disparities.Great effort is needed to provide more accessible health services,sufficient financial resources,and adequate cancer-care infrastructure for the Chinese population,especially for people living in rural areas.

Incidence, distribution of histological subtypes and primary sites of soft tissue sarcoma in China

Objective: Soft tissue sarcomas(STSs) are rare malignancies deriving from mesenchyme.In this study, we reported the epidemiology of STS in China using population-based cancer registry data.Methods: In 2017, qualified data from 339 cancer registries were included in the national database.All STS cases were retrieved based on the morphological and topographical codes of International Classification of Diseases for Oncology, and were categorized into different histological subtypes and primary sites accordingly.Nationwide new STS cases were estimated using incidence rate of STS and the national population, and were reported for gastrointestinal stromal tumor(GIST) and STSs other than GIST separately by sex and region.Distribution of histological subtypes and primary sites of STS were calculated, as well as primary sites of GIST.Results: Approximately 39,900 new STS cases occurred nationwide in China in 2014, accounting for 1.05% of overall cancer incidence.The crude incidence rate was 2.91/100,000 and generally increased with age.An overall female predilection was found.GIST was the most common histological subtype, followed by nerve sheath tumor and malignant peripheral nerve sheath tumor,leiomyosarcoma, liposarcoma, and fibrosarcoma.About 67.5% of GIST occurred in stomach while 1.4% were recorded outside the gastrointestinal tract.Connective, subcutaneous and other soft tissues were the most common primary site, of which extremities were the major subsite.Conclusions: The burden of STS is not serious in China relatively.However, due to their histological and topographical complexity, STSs should not be unnoticed, and more basic and clinical studies should focus on STSs.

The influence of stage at diagnosis and molecular subtype on breast cancer patient survival: a hospital.based multi.center study

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.

Pancreatic cancer incidence and mortality patterns in China, 2011

Objective： The National Central Cancer Registry （NCCR） collected population-based cancer registration data in 2011 from all cancer registries in China. The incidence and mortality rates for pancreatic cancer were compiled and pancreatic cancer incident new cases and deaths were estimated. Methods： A total of 234 cancer registries submitted cancer data to NCCR. Data from 177 cancer registries were qualified and compiled for cancer statistics in 2011. Pancreatic cancer cases were extracted and analyzed from the national database. The pooled data were stratified by area （urban/rural）, gender and age group （0, 1-4, 5-9, 10-14...85＋）. Pancreatic cancer incident cases and deaths were estimated using age-specific rates and national population in 2010. The national census in 2000 and Segi＇s population were used for age- standardized rates. Results： All 177 cancer registries （77 in urban and I00 in rural areas） covered 175,310,169 populations （98,341,507 in urban and 76,968,662 in rural areas）. The morphology verified pancreatic cancer cases （MV%） accounting for 40.52% and 4.33% of pancreatic cancer incident cases were identified through death certifications only （DCO%） with mortality to incidence ratio （M/I） of 0.91. The estimated number of newly diagnosed pancreatic cancer cases and deaths were 80,344 and 72,723 in 2011, respectively. The crude incidence rate was 5.96/100,000 （males 6.57/100,000, females 5.32/100,000）. The age-standardized incidence rates by Chinese standard population （ASIRC） and by world standard population （ASIRW） were 4.27/100,000 and 4.23/100,000 respectively, ranking 10th among all cancers. Pancreatic cancer incidence rate and ASIRC were 7.03/100,000 and 4.94/100,000 in urban areas whereas they were 4.84/100,000 and 3.56/100,000 in rural areas. The incidence rate of pancreatic cancer of 33 cancer registries increased from 3.24/I00,000 in 2003 to 3.59/100,000 in 2011 with an annual percentage change （APC） of 1.44. The pancreatic cancer mortality rate was 5.40/100,000 （males 5.88/100,000, females 4.89/100,000）, ranking 6th among all cancers. The age-standardized mortality rates by Chinese standard population （ASMRC） and by world standard population （ASMRW） were 3.81/100 000 and 3.79/100 000. The pancreatic cancer mortality and ASMRC were 6.47/100,000 and 4.48/100,000 in urban areas, and 4.27/100,000 and 3.08/100,000 in rural areas, respectively. The mortality rates of pancreatic cancer showed an approximately 1.14-fold increase, from 2.85/100,000 in 2003 to 3.26/100,000 in 2011, with an APC of 1.68. Conclusions： The burden of pancreatic cancer is increasing in China. Identification of high-risk population and adequate treatment and prevention are important.

中国预期寿命与癌症发病率和死亡率的相互影响:基于人群的聚类分析

背景与目的在发达国家和发展中国家中,癌症和预期寿命之间的相关性均得到了良好的确立。中国幅员辽阔,人口结构和医疗保健有着显著的地理差异,这为分析预期寿命与癌症发病率和死亡率之间复杂的相关性提供了难得的机会。方法提取全国肿瘤登记中心2013年共255个单位(城市或县)的癌症数据。单位水平的预期寿命数据从国家疾病预防控制中心获得。采用线性回归分析方法分析癌症粗发病率和死亡率与预期寿命的相关性。在另一项分析中,预期寿命被定级为低(<76岁)、中(76–80岁)或高(>80岁)。结果总体而言,癌症发病和死亡率均与男性和女性的预期寿命呈正相关(R分别为0.37和0.50,P<0.001)。这种相关性在下列癌症中显著:男性的肺癌、结直肠癌、前列腺癌、膀胱癌、胰腺癌与淋巴瘤(R:0.36–0.58,P <0.001);女性的肺癌、乳腺癌、结直肠癌、甲状腺癌、子宫癌与卵巢癌(R:0.18–0.51,P<0.001)。我们未观察到上消化道癌症与预期寿命相关。预期寿命为低、中、高水平的肿瘤登记点个数分别为110、101和44个。在预期寿命水平高的地区观察到的癌症年龄标准化发病率(192.83/100,000)最高。在预期寿命最低的地区年龄标准化死亡率(118.44/100,000)最高。胃癌、肝癌和食管癌是低、中预期寿命地区的主要癌症类型。相比之下,预期寿命高的地区结直肠癌、女性乳腺癌和男性前列腺癌的发病率和死亡率高。结论在中国,预期寿命越长总体癌症发病率和死亡率越高。不同预期寿命水平地区的癌症模式不同。在制订预防和治疗癌症策略时必须考虑预期寿命水平的影响。

Colorectal cancer burden and trends:Comparison between China and major burden countries in the world

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.

Association of cancer prevention awareness with esophageal cancer screening participation rates: Results from a population-based cancer screening program in rural China

Objective: : China have implemented population-based esophageal cancer(EC) screening programs, however,the participant rates were relatively low. This study was conducted to examine the association between cancer prevention knowledge and EC screening participation rates(PRs).Methods: : Data in the analyses were obtained from a population-based cancer screening program in four provinces in China since 2007. In the course of 2007-2016, participants who were evaluated as high risk for EC and subsequently recommended for endoscopy examination were included in the final analysis. One-way analysis of variance test, Chi-square test and logistic regression analysis were applied.Results: : A total of 28,543 individuals assessed as high-risk population for EC were included in this study, with13,036 males(45.67%) and 15,507 females(54.33%). The prevalence rates of current smoking and alcohol drinking were higher in males(58.25% and 44.22%, respectively) than in females(5.35% and 4.05%, respectively).Participants of females, and those who had older age, lower income, as well as higher education level and cancer prevention knowledge level were more likely to undergo endoscopy. Multivariable analysis showed that higher cancer prevention knowledge was associated with higher PR for endoscopic screening [adjusted odd ratio(aORQ4/Q1) =1.511, 95% confidence interval(95% CI): 1.398-1.632] among our study subjects. This association between cancer prevention knowledge and compliance with endoscopic screening also tends to be strong within subgroups of males, females, aged below 60 years, aged 60 years and above, and lower level of education(illiterate individuals and those with junior high education or less).Conclusions: : Our results displayed a positive relationship between cancer prevention knowledge and PRs for endoscopic screening, implying cancer prevention awareness being an independent influence factor for compliance with EC screening. Promoting public campaigns about comprehensive knowledge of cancer prevention seemed to be a reasonable and effective strategy to improve population PRs for EC screening.

Annual cost of illness of stomach and esophageal cancer patientsin urban and rural areas in China： A multi-center study

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.

Epidemiology and trend analysis on malignant mesothelioma in China

Objective： Population-based cancer registration data were used to analyze the epidemiology and trend of malignant mesothelioma in China, and the result would provide basic data for its prevention and control. Methods： Malignant mesothelioma data in 2013 were retrieved from the database of National Cancer Registry. Malignant mesothelioma incidence and mortality were estimated using age-specific rate by urban/rural and gender according to the national population in 2013. Malignant mesothelioma data from 22 cancer registries were used for trend analysis during 2000-2013. Results： It is estimated that there were 2,041 new malignant mesothelioma cases and 1,659 malignant mesothelioma deaths occurred in 2013. The crude incidence rate in China were 1.50/106 （males 1.67/106, females 1.32/106）, age-standardized incidence rates by Chinese standard population （ASIRC） and by world standard population （ASIRW） were 1.03/106 and 1.02/106, respectively. The crude mortality rate in China was 1.22/106 （males 1.67/106, females 1.32/106）, age-standardized mortality rates by Chinese standard population （ASMRC） and by world standard population （ASMRW） were 0.83/106 and 0.81/106, respectively. There was an increasing trend of incidence rate for malignant mesothelioma in registration areas of China during 2000-2013 with annual percentage change （APC） of 2.5% [95% confidence interval （95% CI）： 0.6%--4.5%]. After age standardization, no significant differences were observed. No matter for crude mortality rates or age-standardized mortality rates, no significant differences were observed during 2000-2013. Conclusions： Malignant mesothelioma is the major occupational and environmental neoplasm associated with asbestos exposure. The increasing incidence trend suggests that more attention should be paid on this disease.

Incidence and mortality of primary bone cancers in China, 2014

Objective: In this study, we aimed to estimate the updated incidence and mortality of primary bone cancers based on population-based cancer registration data in 2014, collected by the National Central Cancer Registry of China(NCCRC).Methods: In 2017, 339 registries' data were qualified based on data quality criteria set down by the NCCRC.Cases of primary bone cancers were retrieved from the national database. We estimated numbers of primary bone cancer cases and deaths in China using age-specific rates and corresponding national population stratified by area,sex, age-group(0, 1-4, 5-9, 10-14, …, 85+). Chinese standard population in 2000 and Segi's World population were applied for the calculation of age-standardized incidence and mortality rates.Results: In 2014, 24,000 primary bone cancer cases and 17,200 deaths attributable to primary bone cancers were estimated to have occurred in China. The crude incidence rate of primary bone cancers was 1.76/100,000, with agestandardized incidence rate by Chinese standard population(ASIRC) and by World standard population(ASIRW)being 1.35/100,000 and 1.32/100,000, respectively. The crude mortality rate of primary bone cancers was1.26/100,000, with age-standardized mortality rate by Chinese standard population(ASMRC) and by World standard population(ASMRW) being 0.88/100,000 and 0.86/100,000, respectively. Age-specific incidence curve was bimodally distributed with age, with the first peak occurring in the second decade of the life and the second peak in the elderly. Males had higher crude and age-standardized rates for both incidence and mortality compared with females. Both crude and age-standardized incidence rates were higher in rural areas than in urban areas, so were the crude and age-standardized mortality rates.Conclusions: This population-based study presents the most recently available estimates on primary bone cancers in China, revealing that the males are 1.34 times as much as females suffering from primary bone cancers and the adolescents in puberty and the elderly are predominantly affected groups by these cancers. High-quality cancer registration data are a prerequisite for undertaking further study for gaining insight into the causes and risk factors for primary bone cancers in China.