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Objective@#To acknowledge the availability and rates of annual transition of outcomes during the progression and regression stages of colorectal cancer (CRC) and related diseases, by pooling global follow-up studies on the natural history of CRC.@*Methods@#Till March, 2017, data was collected through systematic literature review over multiple databases, including PubMed, Embase, Cochrane and Chinese Biology Medicine (CBM) disc. Information regarding the characteristics, classification system of health states, related outcomes and incidence rates on CRC or high-risk adenoma for the surveillance cohorts of the studies, were extracted and summarized. Both Meta and sensitivity analyses were performed on those outcomes if they appeared in more than 3 studies, using the random effects model. Annual transition rate with 95%CI was used to estimate each of the outcomes, Quality of the studies was assessed, using the Newcastle-Ottawa Scale.@*Results@#A total of 29 cohort studies were included, with the mean follow-up period as 5.7 years. All studies except one, focused on adenoma-carcinoma pathway and reported the outcome parameters of adenomas by different risk, and some reported the findings on different sizes (n=6) of adenomas. These cohorts were divided into three groups (normal status, with low-risk or high-risk adenoma) according to the status of baseline endoscopic pathologic findings. Their available outcome parameters, corresponding number of involved articles, aggregated sample size and pooled annual transition rates were presented. Six parameters were obtained in the normal cohorts, including those from normal to low-risk adenoma (16 articles, 58 235, 0.030: 0.024-0.037), to high-risk adenoma (17 articles, 62 089, 0.003: 0.002-0.004), to diminutive adenoma (<5 mm, 4 articles, 1 277, 0.021: 0.013-0.029), to small adenoma (6-9 mm, 4 articles, 1 277, 0.006: 0.001-0.010), to large adenoma (≥10 mm, 7 articles, 3 531, 0.002: 0.000-0.003) and to CRC (19 articles, 104 836, 0.000 3: 0.000 2-0.000 5). Three parameters were obtained in low-risk adenoma in cohorts with polypectomy findings, including recurrence (9 articles, 4 788, 0.109: 0.062-0.157) from low-risk adenoma after polypectomy to high-risk adenoma (10 articles, 5 736, 0.009: 0.004-0.013) and to CRC (12 articles, 11 347, 0.000 6: 0.000 4-0.000 8). Three parameters were obtained on high-risk adenoma from cohorts with polypectomy findings, including recurrence (12 articles, 7 030, 0.038: 0.028-0.048) from high-risk adenoma after polypectomy to low-risk adenoma (8 articles, 2 489, 0.133: 0.081-0.185) and CRC (14 articles, 14 899, 0.002: 0.001-0.003). Except for normal to low-risk adenomas, results from the sensitivity analysis for the other parameters showed stable. Of the included studies, two presented incidence rates of CRC in different clinical stages and the another two were focusing on the parameters related to serrated pathway.@*Conclusions@#Globally, follow-up studies reported data on natural history of colorectal cancer is of paucity. Compared to the "adenoma-carcinoma" pathway, transition parameters of the serrated lesion pathway are more limited. This Meta-analysis provided convincing evidence for optimizing the strategies regarding follow-up program on the disease, using the baseline endoscopic findings from global CRC Screening Program. These results also offered strong data-related support for Chinese population- specific interventional model on colorectal cancer.
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Objective@#To clarify the research status of economic burden of stomach cancer in China from 1996 to 2015.@*Methods@#Based on three electronic literature databases (China Knowledge Resource Integrated Database, Wanfang Database and PubMed), a total of 2 873, 1 244 and 84 articles published during 1996 to 2015 were found, respectively, using keywords of"cancer","neoplasms","malignant tumor","tumor","economic burden","health expenditure","cost","cost of illness", and"China". According to the inclusion and exclusion criteria, 30 literatures were included in the final analysis. Then the basic information and study subjects, indicators and main results of economic burden were abstracted and analyzed. All the expenditure data were discounted to the values in 2013 by using China's percapita consumer price index.@*Results@#Totally, 30 articles were included, covering 14 provinces and of which 16 were published during 2011-2015. One article was based on population-level and the remaining studies were all based on individual-level. The number of individual-level articles that reported direct medical, non-medical and indirectly economic burden was 29, 1 and 2, respectively. The main indicators of direct medical expenditure were expenditure per patient (22), per clinical visit (9) and per diem (11), respectively. The median expenditure per patient was 7 387-28 743 RMB (CNY), with average annual growth rate (AAGR) of 1.7% (1996-2013). The median expenditure per clinical visit was 18 504-41 871 RMB (2003-2013), with AAGR of 5.5%. The median expenditure per diem was 313-1 445 RMB (1996-2012), with AAGR of 3.7%. Difference was found among provinces.@*Conclusions@#The evidence for economic burden of stomach cancer was still limited over the past two decades and mainly focused on individual and regional levels. An increase and differences in provinces were observed in direct medical expenditure. Evaluation on direct non-medical and indirect medical expenditure needs to be addressed.