Effect of intra-operative chemotherapy with 5-fluorouracil and leucovorin on the survival of patients with colorectal cancer after radical surgery: a retrospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#The effect of intra-operative chemotherapy (IOC) on the long-term survival of patients with colorectal cancer (CRC) remains unclear. In this study, we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection.@*METHODS@#1820 patients were recruited, and 1263 received IOC and 557 did not. Clinical and demographic data were collected, including overall survival (OS), clinicopathological features, and treatment strategies. Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models. A regression model was developed to analyze the independent effects of IOC.@*RESULTS@#Proportional hazard regression analysis showed that IOC (hazard ratio [HR]=0.53, 95% confidence intervals [CI] [0.43, 0.65], P  < 0.001) was a protective factor for the survival of patients. The mean overall survival time in IOC group was 82.50 (95% CI [80.52, 84.49]) months, and 71.21 (95% CI [67.92, 74.50]) months in non-IOC group. The OS in IOC-treated patients were significantly higher than non-IOC-treated patients ( P  < 0.001, log-rank test). Further analysis revealed that IOC decreased the risk of death in patients with CRC in a non-adjusted model (HR=0.53, 95% CI [0.43, 0.65], P  < 0.001), model 2 (adjusted for age and gender, HR=0.52, 95% CI [0.43, 0.64], P  < 0.001), and model 3 (adjusted for all factors, 95% CI 0.71 [0.55, 0.90], P  = 0.006). The subgroup analysis showed that the HR for the effect of IOC on survival was lower in patients with stage II (HR = 0.46, 95% CI [0.31, 0.67]) or III disease (HR=0.59, 95% CI [0.45, 0.76]), regardless of pre-operative radiotherapy (HR=0.55, 95% CI [0.45, 0.68]) or pre-operative chemotherapy (HR=0.54, 95% CI [0.44, 0.66]).@*CONCLUSIONS@#IOC is an independent factor that influences the survival of CRC patients. It improved the OS of patients with stages II and III CRC after radical surgery.@*TRIAL REGISTRATION@#chictr.org.cn, ChiCTR 2100043775.

Incidence and mortality of bladder cancer in China, 2014 / 中华肿瘤杂志

Objective@#To estimate the incidence and mortality of bladder cancer in China based on the cancer registration data in 2014, collected by the National Central Cancer Registry (NCCR).@*Methods@#There were 449 cancer registries submitted bladder cancer new cases and deaths occurred in 2014 to NCCR. After evaluating the data quality, 339 registries′ data were finally accepted for analysis. According to the national population data of 2014, the nationwide incidence and mortality of bladder cancer were estimated by stratification in the area (urban or rural), gender, and age. Chinese population census in 2000 and Segi′s population were used for age-standardized incidence/mortality rates.@*Results@#All 339 cancer registries covered a total of 288 243 347 populations (144 061 915 in urban and 144 181 432 in rural areas). The percentage of morphologically verified cases and death certificate-only cases were 74.86% and 1.45%, respectively. The mortality to incidence ratio was 0.41. The estimates of new bladder cancer cases were 78 100 in China in 2014, with a crude incidence rate of 5.71/100 000. The age-standardized incidence rates by China standard population (ASR China) and world standard population (ASR world) of bladder cancer were 3.61/100 000 and 3.56/100 000, respectively. Cumulative incidence rate of bladder cancer in China was 0.41%. The crude and ASR China incidence rates in urban areas were 6.88/100 000 and 4.07/100 000, respectively, whereas those were 4.29/100, 000 and 2.96/100 000 in rural areas. The estimates of bladder cancer deaths caused by bladder cancer were about 32 100 in China in 2014, with a crude mortality rate of 2.35/100 000. The ASR China and ASR world mortality rates were both 1.30/100 000 with a cumulative mortality rate (0-74 years old) of 0.12%. The crude and ASR China mortality rates were 2.79/100 000 and 1.41/100 000 in urban areas, respectively, whereas those were 1.81/100 000 and 1.14/100 000 in rural areas.@*Conclusions@#The incidence and mortality pattern of bladder cancer were different in urban and rural areas. The incidence and mortality were higher in urban areas than that in rural areas, and higher for male than for female. We should focus on strengthening the prevention and control of bladder cancer in key population, especially men in urban areas.

Trend of cancer mortality in Hebei province, 1973-2013 / 中华流行病学杂志

Objective To analyze the data of malignant tumor mortality and change in disease burden in Hebei province from 1973 to 2013.Methods Cancer mortality rate,age-standardized mortality rate and the years of life lost due to premature mortality (YLLs) were calculated by using the data from three rounds of all death causes survey and database of cancer registry in Hebei during 1973-2013.Results From 1973 to 2013,a linear upward of malignant tumor mortality was observed,with a 51.57％ increase.The mortality rate during 1973-1975 was 98.52/100 000 and it was 149.33/100 000 during 2011-2013.During 1973-1975,the YLLs was 17.0/1 000 in males and 12.8/1 000 in females.While during 2011-2013,the YLLs was 23.2/1 000 in males and 15.9/1 000 in females.During 1973-1975,esophagus cancer,stomach cancer and liver cancer were top three leading causes of deaths.During 2011-2013,lung cancer,stomach cancer and liver cancer were main leading causes of deaths.During the past 40 years,the deaths of esophagus cancer and cervix cancer decreased dramatically,but the deaths of lung cancer and breast cancer increased sharply.Conclusions The disease burden caused by malignant tumor is becoming more serious in Hebei.It is necessary to strengthen the primary prevention and screening of malignant tumor.

Trend of cancer mortality in Hebei province, 1973-2013 / 中华流行病学杂志

Objective To analyze the data of malignant tumor mortality and change in disease burden in Hebei province from 1973 to 2013.Methods Cancer mortality rate,age-standardized mortality rate and the years of life lost due to premature mortality (YLLs) were calculated by using the data from three rounds of all death causes survey and database of cancer registry in Hebei during 1973-2013.Results From 1973 to 2013,a linear upward of malignant tumor mortality was observed,with a 51.57％ increase.The mortality rate during 1973-1975 was 98.52/100 000 and it was 149.33/100 000 during 2011-2013.During 1973-1975,the YLLs was 17.0/1 000 in males and 12.8/1 000 in females.While during 2011-2013,the YLLs was 23.2/1 000 in males and 15.9/1 000 in females.During 1973-1975,esophagus cancer,stomach cancer and liver cancer were top three leading causes of deaths.During 2011-2013,lung cancer,stomach cancer and liver cancer were main leading causes of deaths.During the past 40 years,the deaths of esophagus cancer and cervix cancer decreased dramatically,but the deaths of lung cancer and breast cancer increased sharply.Conclusions The disease burden caused by malignant tumor is becoming more serious in Hebei.It is necessary to strengthen the primary prevention and screening of malignant tumor.

Estimated of esophageal cancer incidence and mortality in China, 2013 / 中华肿瘤杂志

Objective@#The National Central Cancer Registry (NCCR) collected esophageal data of local cancer registries in 2013 to estimate the incidence and mortality in China.@*Methods@#Data submitted from 347 registries were evaluated and 255 registries' data are qualified by NCCR. Data of incidence and mortality were stratified with areas (urban/rural), gender and age group. Chinese population census in 2000 and Segi's population were used for age-standardized incidence/mortality.@*Results@#All of 255 cancer registries covered a total of 226 494 490 population (111 595 772 in urban areas and 114 898 718 in rural areas). The morphology verified cases (MV%) of esophageal cancer accounted for 75.51% and 1.64% of incident cases were identified through death certifications only (DCO%) with mortality to incidence ratio of 0.75. The estimates of new esophageal cancer cases and deaths were 277 thousand and 206 thousand in China, respectively. The crude incidence rate of esophageal cancer in Chinese cancer registration areas was 20.35/105 (28.15/105 in male, 12.15/105 in female), age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population were 13.64/105 and 13.82/105 with the cumulative incidence rate (0-74 age years old) of 1.77%. The esophageal cancer incidence and ASIRC were 13.38/105 and 8.74/105 in urban areas whereas in rural areas, they were 28.44/105 and 19.56/105, respectively. In rural areas, the crude incidence rate of esophageal cancer was 2.13 times higher than that in urban areas, and after age-standardized it remained 2.24 times higher. The esophageal cancer mortality in Chinese cancer registration areas was 15.17/105 (20.86/105 in male and 9.20/105 in female), age-standardized mortality by Chinese standard population (ASMRC) and by world standard population were 9.95/105 and 9.98/105, with the cumulative mortality rate (0-74 age years old) of 1.20%. The esophageal cancer mortality and ASMRC were 10.12/105 and 6.46/105 in urban areas, whereas in rural areas, they were 21.05/105 and 14.16/105, respectively. In rural areas, the esophageal cancer mortality and ASMRC were 2.08 and 2.19 times higher than those in urban areas. Esophageal cancer was the sixth common cancer and the fourth leading causes of cancer death, accounting for about 7.52% of all cancer cases and 9.26% of all cancer deaths.@*Conclusions@#Esophageal cancer is one of the most common cancers in China. Screening and early detection are important to reduce the incidence and mortality.

Analysis of colorectal cancer incidence and mortality rates during the last 40 years in Hebei Province / 中国癌症杂志

Background and purpose: Colorectal cancer is one of the most common gastrointestinal cancers. There were about 1.36 million new cases of colorectal cancer, which was the third highest incidence of malignant tu-mors of the world in 2012. It was the fourth leading cause of cancer death and became a serious threat to human health. The aim of the study was to estimate the colorectal cancer burden in Hebei Province with the data of cancer registries areas and analyze the trend of colorectal cancer mortality rates with three of the Hebei Province death retrospective surveys. Methods: Nine cancer registries in Hebei Province submitted cancer registry data from 2010 to 2012 to the Hebei Provincial Cancer Registry Center. The pooled data were stratified by gender and age (0, 1-4, 5-9, 10-14…80+). Proportions and incidence/mortality rates for colorectal cancer were calculated. Incidence and mortality rates were age-standardized to Chinese population census in 2000 and world Segi's population standard. Colorectal cancer mortal-ity data during the periods 1973-1975, 1990-1992 and 2004-2005 were extracted from the death retrospective surveys and analyzed. Mortality and incidence rate data from Cixian County from 1988 to 2012 and Shexian County from 2000 to 2012 were obtained in each county and analyzed using Joinpoint regression model. Results: The estimated number of newly diagnosed colorectal cancer cases and deaths from 2010 to 2012 in cancer registry areas of Hebei Provinc were 2303 and 1229, respectively. The crude incidence rate of colorectal cancer was 16.48/100000 (male 18.12/100000 and female 14.77/100000). The age-standardized incidence rate by Chinese population census (ASRC) in 2000 was 13.74/100000. The colorectal cancer mortality rate was 8.79/100000 (male 10.23/100000 and female 7.31/100000). The age-standardized mortality rate by Chinese population census (ASRC) in 2000 was 7.59/100000. The mortality rates of colorectal cancer displayed a significant increasing trend in Hebei Province from 1973-1975 to 2010-2012, with an increased rate of 28.03%. In Cixian County, the annual percentage change (APC) of colorectal cancer incidence rate was 3.55, while the APC of colorectal cancer mortality rate was 1.64 for males from 1988 to 2012. In Shexian County, the APC of colorectal cancer incidence rates were 4.68 and 9.17 for males and females from 2000 to 2012, respectively;the APC of colorectal cancer mortality was 5.61 for males in Shexian County. Conclusion: The incidence and mortality rates of colorectal cancer showed an increasing trend in Hebei Province over the past 40 years. It is an important task that colorectal cancer screening is strengthened to reduce morbidity and mortality of the colorectal cancer in Hebei Province.

Incidence and mortality of cancers appeared in the Hebei provincial cancer registry system in 2011 / 中华流行病学杂志

Objective To analyze the cancer incidence and mortality in Hebei cancer registry available areas in 2011.Methods Data were collected from 8 population-based cancer registries systems in Hebei province.Incidence and mortality rates stratified by areas (urban/rural),sex,age group and cancer site were analyzed.10 common cancers in different groups,proportions and cumulative rates were calculated.The Chinese population census in the year 2000 and Segi's populations were used for age-standardized incidence/mortality rates.Results In all the 8 cancer registries that covering a total of 4 573 293 population (2 139 779 in urban and 2 433 514 in rural areas),data was used for the analysis.The total new cancer incidence cases and deaths were 11 269 and 7 477,respectively.All the morphologically verified cancer cases (MV％) accounted for 75.26％ while 3.85％ of the incident cases were identified only through death certification records (DCO％).The mortality to incidence ratio appeared as 0.66.The crude incidence appeared in the Hebei cancer registration areas was 246.41/105 (264.55/105 in males and 227.75/105 in females).The age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) appeared as 207.13/105 and 206.61/105 respectively,with the cumulative incidence rates as (0-74 age years old) 23.57％.The cancer incidence and ASIRC were 242.64/105 and 200.19/105 in urban areas,whereas 249.72/105 and 214.11/105,respectively in rural areas.The crude mortality in Hebei cancer registration areas was 163.49/105(196.54/105 in male,129.51/105 in female),with age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) as 144.48/105 and 147.69/105.The cumulative mortality rate (0-74 age years old) was 14.71％.The cancer mortality (167.91/105) in rural areas seemed higher than the mortality (158.47/105) in urban areas.The most common sites of cancers were:stomach,lung,esophagus,breast,liver and colorectal,which accounted for 71.66％ of all the cancer cases.Lung cancer,stomach cancer,esophagus cancer,liver cancer and colorectal cancer were the major causes responsible for the cancer deaths in the areas with data of cancer registration,which accounted for 74.79％ of all the cancer deaths.Conclusion The coverage of Hebei cancer registration population could reflect the cancer burden in various areas and populations.The most commonly seen cancers were stomach,lung,esophagus,breast,liver,and colorectal,in Hebei province.In order to reduce the burden of cancers,prevention and control measures should be strengthened.