Cancer statistics in China, 2016 / 中华肿瘤杂志

Objective: Data for 2016 from cancer registries were used to estimate cancer incidence and mortality in China in 2016. Methods: According to the quality control process of the National Central Cancer Registry, the data from 683 cancer registries submitted by each province were evaluated, and the data of 487 cancer registries were qualified and included in the final analysis. Age-specific incidence and mortality rates were calculated by area (urban/rural), sex, age and cancer site, combined with national population data to estimate cancer incidence and mortality in China in 2016. Chinese population census in 2000 and Segi's population were used for age-standardized incidence and mortality rates. Results: Total population covered by 487 cancer registries was 381 565 422 (192 628 370 in urban and 188 937 052 in rural areas). The percentages of morphologically verified (MV%) and death certificate-only cases (DCO%) accounted for 68.31% and 1.40%, respectively, and the mortality to incidence ratio was 0.61. It was estimated about 4 064 000 new cases occurred in China in 2016, with the crude incidence rate being 293.91/100 000 (the rates of males and females were 315.52/100 000 and 271.23/100 000), age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 190.76/100 000 and 186.46/100 000, with the cumulative incidence rate (0-74 years old) being 21.42%. The crude incidence and ASIRC were 314.74/100 000 and 196.38/100 000 in urban areas, whereas in rural areas, they were 265.90/100 000 and 182.21/100 000, respectively. It was estimated about 2 413 500 cancer deaths occurred in China in 2016, the crude mortality rate was 174.55/100 000 (216.16/100 000 in males and 130.88/100 000 in females), the age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 106.00/100 000 and 105.19/100 000, and the cumulative mortality rate (0-74 years old) was 11.85%. The crude mortality and ASMRC were 180.31/100 000 and 104.44/100 000 in urban areas, whereas in rural areas, they were 166.81/100 000 and 108.01/100 000, respectively. The most common cancer cases include lung, colorectal, stomach, liver and female breast cancers. The top five cancers accounted for about 57.27% of all cancer cases. The most common cancer deaths included lung, liver, stomach, colorectal and esophageal cancers. The top five cancers accounted for about 69.25% of all cancer deaths. Conclusions: The burden of cancer shows a continuous increasing trend in China. Regional and gender differences in cancer burden are obvious. The cancer patterns still show the coexistence of cancer patterns in developed countries and developing countries. The situation of cancer prevention and control is still serious in China.

Progress in cancer epidemiology research in China in 2019 / 中华疾病控制杂志

@#Cancer is the leading cause of death in China． In recent years，Chinese government has advocated tremendous efforts in advancing research on cancer prevention and control，and has made great advancement． In this review，we briefly summarized the current research progress on cancer epidemiology in China，including the aspects of cancer burden，cancer－related risk factors and its intervention，screening and early detection，implementation plan of cancer prevention and control ( 2019－2022) ，in order to provide technical support and theoretical evidence in implementing effective cancer prevention and control in China in the future．

The history, present and prospect of cancer prevention and control in China / 中华疾病控制杂志

Cancer is a major chronic disease that seriously harms human health. Cancer prevention and control has become one of the priorities of health strategy for governments around the world. We have gradually explored the way of cancer prevention and control in China and produced many research achievements with Chinese characteristics since the 1950s, which has a major impact in cancer prevention and control in the world. This paper systematically reviewed the major historical events of cancer prevention and control in China since the foundation of the People’s Republic of China, and introduced the current situation of cancer prevention and control in modern era, and pointed out the prospect of future work.

Long-term outcomes of endoscopic argon plasma coagulation (APC) therapy for early esophageal cancer and precancerous lesions / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the long-term outcomes of endoscopic argon plasma coagulation (APC) therapy for early esophageal cancer and precancerous lesions.</p><p><b>METHODS</b>One-hundred and seventy-one cases with early esophageal cancer (intramucosal carcinoma) and precancerous lesions were treated by APC from 1994 to 2005, and all the cases were followed up. One-hundred and sixty-eight (98.2%) cases were follow-up by endoscopic examination for several times. On average, each patient was endoscopically examined 2.8 times. The follow-up rate was 100%.</p><p><b>RESULTS</b>The precancerous lesion group had 160 patients. They were followed up for 5 years. 11 patients died of causes unrelated to cancer. The lesions developed into esophageal squamous cell carcinoma in five patients ( 2 died and 3 underwent esophagectomy). The remaining 144 cases survived without cancer. In this group, the esophageal cancer incidence rate is only 3.1% (5/160). The early cancer (i.e. intramucosal cancer) group had 11 patients. During the 5-year follow-up period, two patients died of causes unrelated to cancer,six patients had recurrence (4 patients died and 2 patients underwent esophagectomy), and only 3 patients survived without cancer. Therefore, the 5-year survival rate was only 27.3% (3/11).</p><p><b>CONCLUSIONS</b>The APC therapy for precancerous lesions of the esophagus is effective and successful. Indications should be carefully considered when treating early esophageal cancer such as intramucosal carcinoma by APC therapy.</p>

Analysis of mortality and years of life lost of malignant tumors among inhabitants in rural area of Feicheng city from 2000 to 2010 / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the mortality trends and disease burden of malignant tumors in rural area of Feicheng city from 2000 to 2010, and to provide basic information for the prevention and treatment of malignant tumors in this area.</p><p><b>METHODS</b>The data of cancer mortality from 2000 to 2010 from Feicheng Cancer Registry database were checked. Mortality rate, standardized mortality rate, potential years of life Iost (PYLL), standardized potential years of life lost (SPYLL), average years of life lost (AYLL) and other indexes were calculated and analyzed. The trend of the standardized rates transformed by the natural logarithm over time was assessed by Prais-Winsten regression method in which the errors was assumed to follow a first-order autoregressive process. STATA 12.0 was used to analyze the data.</p><p><b>RESULTS</b>In average, the crude mortality rate was 199.67 per 100 000 (264.69 per 100 000 in males and 137.24 per 100 000 in females), and the standardized mortality rate was 157.00 per 100 000 (200.49 per 100 000 in males and 101.31 per 100 000 in females). There were no significant changes in the trends of all standardized rates. For males, the mortality rates of lung and colorectal cancers increased significantly, and for females, the rates of lung and breast cancers had increased trend while the rate of esophageal cancer showed a downward trend. There were no statistically significant changes in other main malignant tumors. During 2000 to 2010, the PYLL of malignant tumors in Feicheng was 183 685.0 person-years, and PYLL rate was 23.3 per 1000. The SPYLL was 153 091.0 person-years, SPYLL rate was 19.4 per 1000, and AYLL was 14.8 years.</p><p><b>CONCLUSIONS</b>There are no obvious changes in the trends of standardized mortality rates in rural area of Feicheng over the past 11 years. For males, the mortality of lung cancer and colorectal cancer is increasing, and for females, the rates of lung and breast cancers have an increasing trend while the rate of esophageal cancer shows a decreasing trend. The prevention and control of digestive malignant tumors, lung cancer and breast cancer are getting seriously important and should be the focal point in this issue.</p>

Cost-benefit analysis of screening for esophageal and gastric cardiac cancer / 癌症

In 2005, a program named "Early Detection and Early Treatment of Esophageal and Cardiac Cancer" (EDETEC) was initiated in China. A total of 8279 residents aged 40-69 years old were recruited into the EDETEC program in Linzhou of Henan Province between 2005 and 2008. Howerer, the cost-benefit of the EDETEC program is not very clear yet. We conducted herein a cost-benefit analysis of screening for esophageal and cardiac cancer. The assessed costs of the EDETEC program included screening costs for each subject, as well as direct and indirect treatment costs for esophageal and cardiac severe dysplasia and cancer detected by screening. The assessed benefits of this program included the saved treatment costs, both direct and indirect, on esophageal and cardiac cancer, as well as the value of prolonged life due to screening, as determined by the human capital approach. The results showed the screening cost of finding esophageal and cardiac severe dysplasia or cancer ranged from RMB 2707 to RMB 4512, and the total cost on screening and treatment was RMB 13 115-14 920. The cost benefit was RMB 58 944-155 110 (the saved treatment cost, RMB 17 730, plus the value of prolonged life, RMB 41 214-137 380). The ratio of benefit-to-cost (BCR) was 3.95-11.83. Our results suggest that EDETEC has a high benefit-to-cost ratio in China and could be instituted into high risk areas of China.

Analysis of the esophageal cancer mortality in 2004 - 2005 and its trends during last 30 years in China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To describe the mortality of esophageal cancer (EC) in China during 2004 - 2005, and its trends over past 30 years.</p><p><b>METHODS</b>The Third National Retrospective Sampling Survey of Death Causes in 2004 - 2005 was covered 142 660 482 person years (72 970 241 person years in male, 69 690 241 person years in female; 47 899 806 person years in urban, 94 760 676 person years in rural). All death records of EC cases were selected. Crude, age-adjusted mortality, the proportion to all cancer deaths, and age-standardized death rate by Chinese standard population (CASR) and world standard population (WASR) were calculated. The statistic indexes of mortality were compared with those of previous retrospective death surveys in 1973 - 1975 and 1990 - 1992.</p><p><b>RESULTS</b>During 2004 - 2005, the crude death rate of EC was 15.21/100 000 (21 694/142 660 482), CASR was 9.98/100 000, EC death accounted for 11.19% (21 694/193 841) and ranked fourth of all cancer death causes. The CASR of male (14.32/100 000, 15 067 cases) was higher than that of female (5.75/100 000, 6627 cases). In rural areas, there were 16 437 deaths caused by EC with CASR of 12.01/100 000, it was higher than in urban areas (CASR was 6.48/100 000, 5257 deaths). There were little different of EC mortality among Eastern, Central and Western areas in China. EC crude death rate in Eastern was the highest with rate of 16.67/100 000 (8761/52 556 694) and the lowest rate was 12.92/100 000 (5209/40 322 563) in Western area. EC crude death rate was increased by age increasing and reached the peak with mortality of 180.55/100 000 (1984/1 098 885) at age group of 80-. The CASR of EC was reduced by 41.64% compared with the first survey (CASR was 17.10/100 000) in 1973 - 1975, and reduced by 33.56% compared with the second survey (CASR was 15.02/100 000) in 1990 - 1992.</p><p><b>CONCLUSION</b>Although the EC mortality has dropped obviously in the past three decades, it is still the main cancer burden, especially in rural areas. EC prevention and control should be focused on the rural high risk areas in China in future.</p>

Ovary cancer mortality in China 2004 - 2005: results from the Third National Retrospective Sampling Survey of Death Causes / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analyze the distribution characteristics and trend of ovary cancer mortality based on results of the Third National Retrospective Sampling Survey of Death Causes.</p><p><b>METHODS</b>Data of National Retrospective Sampling Survey for the years of 2004 - 2005 from 158 counties/cities/districts was used for the settings. A total of 69,690,241 person-year for female between 2004 and 2005 including 23,598,822 person-year in urban and 46,091,419 person-year in rural were respectively included in the study. Furthermore, the areas of east, middle, and west were divided into the subsets. And also the areas of urban and rural areas were divided into the subsets. The crude death rate and age-specific death rate and the age-standardized death rate by Chinese population of 1982 (CASR) and by world population of 1960 (WASR) were calculated. The historical comparison with the sampling survey of 1990 - 1992 (second time) was conducted, and the global comparison with some selected countries was performed.</p><p><b>RESULTS</b>The crude death rate for ovary cancer was 1.45/100 000 (1008/69 690 241) between 2004 and 2005, which was ranked the 12th and accounted for 1.45% (1008/69 667) of all sites of cancers. The CASR was 0.97/100 000 and the WASR was 1.26/100 000. The crude death rate of ovary cancer were 2.67/100 000 (630/23 598 822) and 0.82/100 000 (378/46 091 419) in urban and rural areas respectively, with the CASR of 1.62/100 000 and 0.59/100 000 in urban and rural areas respectively. Compared with the data from the second time (0.06/100 000 for crude death rate, 0.53/100 000 for CASR and 0.75% for proportion), the crude death rate increased by 141.07% and the CASR increased by 83.02%. The proportion of mortality was increased by 92.92%, which ranked from the 17th to the 12th. In the urban areas, the CASR of ovary cancer increased by 31.71% (1.23/100 000 vs 1.62/100 000), while by 118.52% in rural areas (0.27/100 000 vs 0.59/100 000) with an increasing trend more remarkable in rural than in urban.</p><p><b>CONCLUSION</b>Ovary cancer is not the leading site of cancer death-cause in China, its morality is higher in urban than in rural. It is necessary to pay more attention to ovary cancer in China.</p>

A prospective study of the origin of esophageal squamous cell carcinoma in the esophageal mucosa:result from a high risk area of esophageal cancer in China during a 15-year follow up (1987 - 2002) / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study was to observe the association between the occurrence of esophageal cancer lesions and esophageal mucosa fold (white ridges), and further identify where is the initial origin of esophageal cancer lesions in the esophagus mucosa.</p><p><b>METHODS</b>This was a cohort study which recruited 551 subjects underwent endoscopic examination in a high risk area of esophageal cancer in Linxian, Henan Province in 1987. 339 subjects with esophageal white ridges, and with red area or erosion lesion at the surface of the white ridges, was studied as exposure group. Other 212 subjects whose esophagus had no white ridges and pathological diagnosis was negative, was studied as control group. The endpoint was occurrence of pathologically confirmed esophageal cancer. After a 15-year follow-up, the results were compared between two groups.</p><p><b>RESULTS</b>Among the 551 subjects, there were 339 cases with esophageal mucosal white ridges in the exposure group. During the period of 15 year follow-up, the incidence of esophageal cancer was 11.8% (9/76) in 76 case with simple mucosal white ridges, 33.5% (88/263) in 263 subjects with white ridges and red area, or erosions on the surface of white ridge. While only 8.0% of subjects (17/212) developed esophageal cancer after the 15-year follow up in the control group. There was a significant difference between the two groups (P < 0.001).</p><p><b>CONCLUSION</b>Esophageal mucosal white ridge, especially white ridge with red area or erosions is closely associated with subsequent esophageal cancer occurrence in the esophageal cancer high risk area in China. It is suggested that esophageal mucosa with white ridge may be the initial origin of esophageal cancer. Further investigations focused on this spot are required.</p>

Natural progression of early esophageal squamous cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The survival time of untreated advanced esophageal squamous cell carcinoma is about 8 - 9 months. The objective of this study was to observe the natural progression of untreated early esophageal squamous cell carcinoma for 20 years.</p><p><b>METHODS</b>4800 subjects from a high risk area of esophageal cancer in Lin-zhou city, Henan province, were examined by endoscopy from 1985 to 1990. Among them, 132 cases were diagnosed as early esophageal cancer. Based on the criteria, the lesions were endoscopically diagnosed as superficial mucosal lesions and histopathologically confirmed by biopsy as carcinoma in situ, intramucosal carcinoma or squamous cell carcinoma. 48 of the 132 patients, who refused treatment, were followed up to the end of 2005. There were 43 death and 5 alive. 40 patients were re-examined for 1 - 4 times by endoscopy during the following up.</p><p><b>RESULTS</b>A total of 48 patients have been followed up for 20 years. 38 (79.2%) cases died of esophageal squamous cell carcinoma, 5 (10.4%) died of non-cancer diseases and 5 (10.4%) were surviving. 37 patients had survived for over 5 years. The 5-, 10-, 15- and 20-years survival rates were 77.1%, 39.6%, 25.0% and 10.4%, respectively.</p><p><b>CONCLUSION</b>The natural history of esophageal squamous cell carcinoma takes a long time to progress from early to advanced stage. It is very helpful for early diagnosis and selection of opportunity for treatment. The leading time bias by natural history of this disease should be considered when evaluate therapeutic effect on early stage esophageal cancer.</p>

Diagnosis and long-term results of surgical resection of early cardiac adenocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize therapeutic experience and the long-term results of early cardiac adenocarcinoma with surgical resection.</p><p><b>METHODS</b>Ninety cases were diagnosed with early cardiac adenocarcinoma during endoscopic screening in high incidence rate area of esophageal cancer from 1972 to 1997. All of the patients accepted surgical treatment. Cardiectomy included partial stomach and esophagus was performed through left thoracotomy in all patients. Esophagogastrostomy was carried out in the infra-aortic region and thoracoabdominal lymphatic dissection was performed in all cases.</p><p><b>RESULTS</b>The resection rate was 100%. One patient died in one month after the operation. Postoperative complications occurred in 4 cases (4.4%). Pathological examination of cancer specimens showed that 46 cases (51.1%) were intramucosal carcinoma without lymphatic metastasis and 44 cases (48.9%) were submucous infiltrating carcinoma with lymphatic metastasis in 5 (11.4%). The patients were followed-up to 2002, and the overall 5, 10, 15, 20 and 25 year survival rates were 91.9%, 83.6%, 69.6%, 49.8% and 16.6%, respectively.</p><p><b>CONCLUSIONS</b>Early diagnosis and early treatment may be the best approach for promoting the survival of the cardiac cancer. Surgical resection of early cardiac carcinoma provides excellent long-term survival.</p>

A prospective study on the relationship between nutrition intervention and incidence of malignant tumors in Lin County, China / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the tendency in the incidence of malignant tumors in nutrition-intervened population of Lin County.</p><p><b>METHODS</b>Subjects who had been enrolled in the General Population Trial, Lin County Nutrition Intervention Trial were followed up and the data of malignant tumors were collected with collaboration of National Cancer Institute/National Institute of Health. Incidences of malignant tumors during and after nutrition intervention were calculated and compared.</p><p><b>RESULTS</b>Esophageal cancer, cardiac cancer, and stomach cancer were constantly the three leading cancers, accounting for 84.06% and 83.74% of the malignant tumors in men and women, respectively. The incidences of lung cancer and liver cancer in men showed increasing tendencies, while similar tendencies were found in those of stomach cancer, colorectal cancer, and liver cancer in women. With the prolonging of the follow-up, the incidences of upper digestive tract cancers declined (except stomach cancer in women).</p><p><b>CONCLUSIONS</b>The upper digestive tract cancers remain the leading malignant tumors, although their incidences may decline with longer-term follow-up. Prevention and control of tumors in Lin County should still be focused on the esophageal cancer, cardiac cancer, and stomach cancer, as well as lung cancer and liver cancer.</p>

Evaluation of efficacy and influence factors of transarterial interventional therapy in patients with liver metastasis from malignancy of alimentary tract / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and prognostic factors of transarterial interventional therapy (TAIT) in patient with liver metastasis from malignancy of the alimentary tract.</p><p><b>METHODS</b>266 patients with unresectable liver metastases from malignancy of the alimentary tract received totally 754 sessions of transarterial interventional therapy. Cox regression was used in the proportional hazard analysis.</p><p><b>RESULTS</b>The overall response rate of TAIT was 45.4%, The median survival time (MS) was 14.3 months in this series. The 0.5-, 1-, 2-, 3-, 5-year cumulative survival rate (CSR) was 83.1%, 56.8%, 17.7%, 9.3% and 1.5% , respectively. No severe adverse reaction was observed except nausea, vomiting and mild fever as well as pain in the hepatic area. It was found that portal vein tumor thrombosis (PVTT), the blood supply of tumor, metastasis from esophageal carcinoma, the number of metastasis, multi-lobe involvement, resection nature of primary tumor were independent factors affecting survival.</p><p><b>CONCLUSION</b>Transarterial interventional therapy is effective for treatment of liver metastasis from malignancy of the alimentary tract. Portal vein tumor thrombosis, metastasis from esophageal carcinoma, multiple metastatic lesions, multi-lobe involvement are poor prognostic factors, while complete resection of the primary tumor and rich blood supply of metastatic lesion are good independent prognostic factors.</p>