Plant-based dietary patterns and risk of esophageal cancer:A prospective cohort study spanning 17 years

Objective: Plant-based diets have multiple health benefits for cancers;however, little is known about the association between plant-based dietary patterns and esophageal cancer(EC).This study presents an investigation of the prospective associations among three predefined indices of plant-based dietary patterns and the risk of EC.Methods: We performed endoscopic screening for 15,709 participants aged 40-69 years from two high-risk areas of China from January 2005 to December 2009 and followed the cohort until December 31, 2022. The overall plant-based diet index(PDI), healthful plant-based diet index(h PDI), and unhealthful plant-based diet index(u PDI), were calculated using survey responses to assess dietary patterns. We applied Cox proportional hazard regression to estimate the multivariable hazard ratios(HRs) and 95% confidence intervals(95% CIs) of EC across 3plant-based diet indices and further stratified the analysis by subgroups.Results: The final study sample included 15,184 participants in the cohort. During a follow-up of 219,365person-years, 176 patients with EC were identified. When the highest quartile was compared with the lowest quartile, the pooled multivariable-adjusted HR of EC was 0.50(95% CI, 0.32-0.77) for h PDI. In addition, the HR per 10-point increase in the h PDI score was 0.42(95% CI, 0.27-0.66) for ECs. Conversely, u PDI was positively associated with the risk of EC, and the HR was 1.80(95% CI, 1.16-2.82). The HR per 10-point increase in the u PDI score was 1.90(95% CI, 1.26-2.88) for ECs. The associations between these scores and the risk of EC were consistent in most subgroups. These results remained robust in sensitivity analyses.Conclusions: A healthy plant-based dietary pattern was associated with a reduced risk of EC. Emphasizing the healthiness and quality of plant-based diets may be important for preventing the development of EC.

Lead-time bias in esophageal cancer screening in high-risk areas in China

Objective:To investigate what extent lead-time bias is likely to affect endoscopic screening effectiveness for esophageal cancer in the high-risk area in China.Methods:A screening model based on the epidemiological cancer registry data,yielding a population-level incidence and mortality rates,was carried out to simulate study participants in the high-risk area in China,and investigate the effect of lead-time bias on endoscopic screening with control for length bias.Results:Of 100,000 participants,6,150(6.15%)were diagnosed with esophageal squamous dysplasia during the 20-year follow-up period.The estimated lead time ranged from 1.67 to 5.78 years,with a median time of 4.62 years[interquartile range(IQR):4.07-5.11 years]in the high-risk area in China.Lead-time bias exaggerated screening effectiveness severely,causing more than a 10%overestimation in 5-year cause-specific survival rate and around a 43%reduction in cause-specific hazard ratio.The magnitude of lead-time bias on endoscopic screening for esophageal cancer varied depending on the screening strategies,in which an inverted U-shaped and U-shaped effects were observed in the 5-year cause-specific survival rate and cause-specific hazard ratio respectively concerning a range of ages for primary screening.Conclusions:Lead-time bias,usually causing an overestimation of screening effectiveness,is an elementary and fundamental issue in cancer screening.Quantification and correction of lead-time bias are essential when evaluating the effectiveness of endoscopic screening in the high-risk area in China.

Hepatocellular carcinoma and intrahepatic cholangiocarcinoma incidence between 2006 and 2015 in China: estimates based on data from 188 population-based cancer registries

Background:Hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC)are the most common subtypes of primary liver cancer,but nationwide incidence of both liver cancer subtypes have never been reported in China.We aimed to estimate the most recent incidence of HCC and ICC and temporal trends in China based on the most updated data from high qualified population-based cancer registries(covering 13.1%of the national population),in comparison to those in the United States at the same period.Methods:We used data from 188 Chinese population-based cancer registries covering 180.6 million population of China to estimate the nationwide incidence of HCC and ICC in 2015.And 22 population-based cancer registries’data were used to estimate the trends of HCC and ICC incidence from 2006 to 2015.Multiple imputation by chained equations method was used to impute liver cancer cases with unknown subtype(50.8%).We used data from 18 population-based registries from the Surveillance,Epidemiology,and End Results program to analyze incidence of HCC and ICC in the United States.Results:In China,an estimated 301,500 and 61,900 newly diagnosed HCC and ICC occurred in 2015.The overall age-standardized rates(ASRs)of HCC incidence decreased by 3.9%per year.For ICC incidence,the overall ASR was relatively stable,but increased in the population of over 65 years old.Subgroup analysis by age showed that the ASR of HCC incidence had the sharpest decline in population who were less than 14 years old and received neonatally hepatitis B virus(HBV)vaccination.In the United States,though the incidence of HCC and ICC were lower than those in China,the overall HCC and ICC incidence increased by 3.3%and 9.2%per year.Conclusions:China still faces with a heavy burden of liver cancer incidence.Our results may further support the beneficial effect of Hepatitis B vaccination on reduction of HCC incidence.Both healthy lifestyle promotion and infection control are needed for future liver cancer control and prevention for China and the United States.

Incidence and survival of neuroendocrine neoplasms in China with comparison to the United States

Background:Neuroendocrine neoplasms(NENs)are rare tumors characterized by variable biology and delayed diagnosis.However,the nationwide epidemiology of NENs has never been reported in China.We aimed to estimate the incidence and survival statistics of NENs in China,in comparison to those in the United States during the same period.Methods:Based on the data from 246 population-based cancer registries covering 272.5 million people of China,we calculated age-specific incidence on NENs in 2017 and multiplied by corresponding national population to estimate the nationwide incidence in China.The data of 22 population-based cancer registries were used to estimate the trends of NENs incidence from 2000 to 2017 through the Joinpoint regression model.We used the cohort approach to analyze the 5-year age-standardized relative survival by sex,age group,and urban-rural area between 2008 and 2013,based on data from 176 high-quality cancer registries.We used data from the Surveillance,Epidemiology,and End Results(SEER)18 program to estimate the comparable incidence and survival of NENs in the United States.Results:The overall age-standardized rate(ASR)of NENs incidence was lower in China(1.14 per 100,000)than in the United States(6.26 per 100,000).The most common primary sites were lungs,pancreas,stomach,and rectum in China.The ASRs of NENs incidence increased by 9.8%and 3.6%per year in China and the United States,respectively.The overall 5-year relative survival in China(36.2%)was lower than in the United States(63.9%).The 5-year relative survival was higher for female patients than male patients,and was higher in urban areas than in rural areas.Conclusions:The disparities in burden of NENs persist across sex,area,age group,and site in China and the United States.These findings may provide a scientific basis on prevention and control of NENs in the two countries.