Trends in the survival of patients with nasopharyngeal carcinoma between 1976 and 2005 in Sihui, China: a population-based study

Both the incidence a nd mortality of nasopharyngeal carcinoma(NPC) have decreased in Hong Kong and Taiwan but not in China's Mainland. The goal of this study was to analyze trends in NPC patient survival between 1976 and 2005 in Sihui, an area of China's Mainland with a population at high risk for NPC. A total of 1,761 patients diagnosed with NPC between 1976 and 2005 according to the records of Sihui Cancer Registry were followed to the end of 2006. We determined their observed and relative survival rates and used Cox proportional hazards regression analysis to predict prognosis. Our results showed that the 5-year and 10-year observed survival rates of NPC patients in Sihui were 50.5% and 36.9% , respectively, and the median survival time was 5.1 years. The 5-year observed survival rate of NPC patients diagnosed after 2000 was 69.8%, significantly higher than that of patients diagnosed between 1976 and 1985 (42.5% ; P<0.001, relative risk=0.28). Similarly, the 5-year relative survival rate was 84.8% between 2000 and 2005 but 51.8% between 1976 and 1985. Besides date of diagnosis, other prognostic factors included patient sex and age and NPC clinical stage and histologic type. The relative risks of death from NPC were 0.76 [95% confidence interval (CI): 0.65-0.90] for female comparing to male and 1.28 (95% CI: 1.00-1.64) for WHO type I comparing to WHO types II and III. For the eldest age group and the latest clinical stage group, the relative risks were 2.22 (95% CI: 1.73-2.84) and 3.41 (95% CI: 2.34-4.49), respectively. Our results indicate that the survival of NPC patients in Sihui has significantly increased in recent years and this increase is not influenced by patient's sex, age, histologic type, and clinical stage. A reduction in mortality rate is expected in coming years.

Role of community-based active case finding in screening tuberculosis in Yunnan province of China

Background:The barriers to access diagnosis and receive treatment,in addition to insufficient case identification and reporting,lead to tuberculosis(TB)spreads in communities,especially among hard-to-reach populations.This study evaluated a community-based active case finding(ACF)strategy for the detection of tuberculosis cases among high-risk groups and general population in China between 2013 and 2015.Methods:This retrospective cohort study conducted an ACF in ten communities of Dongchuan County,located in northeast Yunnan Province between 2013 and 2015;and compared to 136 communities that had passive case finding(PCF).The algorithm for ACF was:1)screen for TB symptoms among community enrolled residents by home visits,2)those with positive symptoms along with defined high-risk groups underwent chest X-ray(CXR),followed by sputum microscopy confirmation.TB incidence proportion and the number needed to screen(NNS)to detect one case were calculated to evaluate the ACF strategy compared to PCF,chi-square test was applied to compare the incidence proportion of TB cases'demography and the characteristics for detected cases under different strategies.Thereafter,the incidence rate ratio(IRR)and multiple Fisher's exact test were applied to compare the incidence proportion between general population and high-risk groups.Patient and diagnostic delays for ACF and PCF were compared by Wilcoxon rank sum test.Results:A total of 97521 enrolled residents were visited with the ACF cumulatively,12.3%were defined as highrisk groups or had TB symptoms.Sixty-six new TB patients were detected by ACF.There was no significant difference between the cumulative TB incidence proportion for ACF(67.7/100000 population)and the prevalence for PCF(62.6/100000 population)during 2013 to 2015,though the incidence proportion in ACF communities decreased after three rounds active screening,concurrent with the remained stable prevalence in PCF communities.The cumulative NNS were 34,39 and 29 in HIV/AIDS infected individuals,people with positive TB symptoms and history of previous TB,respectively,compared to 1478 in the general population.The median patient delay under ACF was 1 day(Interquartile range,IQR:0-27)compared to PCF with 30 days(IQR:14-61).Conclusions:This study confirmed that massive ACF was not effective in general population in a moderate TB prevalence setting.The priority should be the definition and targeting of high-risk groups in the community before the screening process is launched.The shorter time interval of ACF between TB symptoms onset and linkage to healthcare service may decrease the risk of TB community transmission.Furthermore,integrated ACF strategy in the National Project of Basic Public Health Service may have long term public health impact.