Data Flow Construction and Quality Evaluation of Electronic Source Data in Clinical Trials: Pilot Study Based on Hospital Electronic Medical Records in China.

Background: The traditional clinical trial data collection process requires a clinical research coordinator who is authorized by the investigators to read from the hospital's electronic medical record. Using electronic source data opens a new path to extract patients' data from electronic health records (EHRs) and transfer them directly to an electronic data capture (EDC) system; this method is often referred to as eSource. eSource technology in a clinical trial data flow can improve data quality without compromising timeliness. At the same time, improved data collection efficiency reduces clinical trial costs. Objective: This study aims to explore how to extract clinical trial-related data from hospital EHR systems, transform the data into a format required by the EDC system, and transfer it into sponsors' environments, and to evaluate the transferred data sets to validate the availability, completeness, and accuracy of building an eSource dataflow. Methods: A prospective clinical trial study registered on the Drug Clinical Trial Registration and Information Disclosure Platform was selected, and the following data modules were extracted from the structured data of 4 case report forms: demographics, vital signs, local laboratory data, and concomitant medications. The extracted data was mapped and transformed, deidentified, and transferred to the sponsor's environment. Data validation was performed based on availability, completeness, and accuracy. Results: In a secure and controlled data environment, clinical trial data was successfully transferred from a hospital EHR to the sponsor's environment with 100% transcriptional accuracy, but the availability and completeness of the data could be improved. Conclusions: Data availability was low due to some required fields in the EDC system not being available directly in the EHR. Some data is also still in an unstructured or paper-based format. The top-level design of the eSource technology and the construction of hospital electronic data standards should help lay a foundation for a full electronic data flow from EHRs to EDC systems in the future.

Mild phototherapy mediated by IR780-Gd-OPN nanomicelles suppresses atherosclerotic plaque progression through the activation of the HSP27-regulated NF-κB pathway.

Reducing plaque lipid content and enhancing plaque stability without causing extensive apoptosis of foam cells are ideal requirements for developing a safe and effective treatment of atherosclerosis. In this study, we synthesized IR780-Gd-OPN nanomicelles by conjugating osteopontin (OPN) and loading a gadolinium-macrocyclic ligand (Gd-DOTA) onto near-infrared dye IR780-polyethylene glycol polymer. The nanomicelles were employed for mild phototherapy of atherosclerotic plaques and dual-mode imaging with near-infrared fluorescence and magnetic resonance. In vitro results reveal that the mild phototherapy mediated by IR780-Gd-OPN nanomicelles not only activates heat shock protein (HSP) 27 to protect foam cells against apoptosis but also inhibits the nuclear factor kappa-B (NF-κB) pathway to regulate lipid metabolism and macrophage polarization, thereby diminishing the inflammatory response. In vivo results further validate that mild phototherapy effectively reduces plaque lipid content and size while simultaneously enhancing plaque stability by regulating the ratio of M1 and M2-type macrophages. In summary, this study presents a promising approach for developing a safe and highly efficient method for the precise therapeutic visualization of atherosclerosis. STATEMENT OF SIGNIFICANCE: The rupture of unstable atherosclerotic plaques is a major cause of high mortality rates in cardiovascular diseases. Therefore, the ideal outcome of atherosclerosis treatment is to reduce plaque size while enhancing plaque stability. To address this challenge, we designed IR780-Gd-OPN nanomicelles for mild phototherapy of atherosclerosis. This treatment can effectively reduce plaque size while significantly improving plaque stability by increasing collagen fiber content and elevating the ratio of M2/M1 macrophages, which is mainly attributed to the inhibition of the NF-κB signaling pathway by mild phototherapy-activated HSP27. In summary, our proposed mild phototherapy strategy provides a promising approach for safe and effective treatment of atherosclerosis.

Reducing Clinical Trial Monitoring Resources and Costs With Remote Monitoring: Retrospective Study Comparing On-Site Versus Hybrid Monitoring.

BACKGROUND: Clinical research associates (CRAs) monitor the progress of a trial, verify the data collected, and ensure that the trial is carried out and reported in accordance with the trial protocol, standard operating procedures, and relevant laws and regulations. In response to monitoring challenges during the COVID-19 pandemic, Peking University Cancer Hospital launched a remote monitoring system and established a monitoring model, combining on-site and remote monitoring of clinical trials. Considering the increasing digitization of clinical trials, it is important to determine the optimal monitoring model for the general benefit of centers conducting clinical trials worldwide. OBJECTIVE: We sought to summarize our practical experience of a hybrid model of remote and on-site monitoring of clinical trials and provide guidance for clinical trial monitoring management. METHODS: We evaluated 201 trials conducted by our hospital that used on-site monitoring alone or a hybrid monitoring model, of which 91 trials used on-site monitoring alone (arm A) and 110 used a hybrid model of remote and on-site monitoring (arm B). We reviewed trial monitoring reports from June 20, 2021, to June 20, 2022, and used a customized questionnaire to collect and compare the following information: monitoring cost of trials in the 2 models as a sum of the CRAs' transportation (eg, taxi fare and air fare), accommodation, and meal costs; differences in monitoring frequency; the number of monitored documents; and monitoring duration. RESULTS: From June 20, 2021, to June 20, 2022, a total of 320 CRAs representing 201 sponsors used the remote monitoring system for source data review and the verification of data from 3299 patients in 320 trials. Arm A trials were monitored 728 times and arm B trials were monitored 849 times. The hybrid model in arm B had 52.9% (449/849) remote visits and 48.1% (409/849) on-site visits. The number of patients' visits that could be reviewed in the hybrid monitoring model increased by 34% (4.70/13.80; P=.004) compared with that in the traditional model, whereas the duration of monitoring decreased by 13.8% (3.96/28.61; P=.03) and the total cost of monitoring decreased by 46.2% (CNY ¥188.74/408.80; P<.001). These differences were shown by nonparametric testing to be statistically significant (P<.05). CONCLUSIONS: The hybrid monitoring model can ensure timely detection of monitoring issues, improve monitoring efficiency, and reduce the cost of clinical trials and should therefore be applied more broadly in future clinical studies.

Perioperative or postoperative adjuvant oxaliplatin with S-1 versus adjuvant oxaliplatin with capecitabine in patients with locally advanced gastric or gastro-oesophageal junction adenocarcinoma undergoing D2 gastrectomy (RESOLVE): an open-label, superiority and non-inferiority, phase 3 randomised controlled trial.

BACKGROUND: The optimal perioperative chemotherapeutic regimen for locally advanced gastric cancer remains undefined. We evaluated the efficacy and safety of perioperative and postoperative S-1 and oxaliplatin (SOX) compared with postoperative capecitabine and oxaliplatin (CapOx) in patients with locally advanced gastric cancer undergoing D2 gastrectomy. METHODS: We did this open-label, phase 3, superiority and non-inferiority, randomised trial at 27 hospitals in China. We recruited antitumour treatment-naive patients aged 18 years or older with historically confirmed cT4a N+ M0 or cT4b Nany M0 gastric or gastro-oesophageal junction adenocarcinoma, with Karnofsky performance score of 70 or more. Patients undergoing D2 gastrectomy were randomly assigned (1:1:1) via an interactive web response system, stratified by participating centres and Lauren classification, to receive adjuvant CapOx (eight postoperative cycles of intravenous oxaliplatin 130 mg/m2 on day one of each 21 day cycle plus oral capecitabine 1000 mg/m2 twice a day), adjuvant SOX (eight postoperative cycles of intravenous oxaliplatin 130 mg/m2 on day one of each 21 day cycle plus oral S-1 40-60 mg twice a day), or perioperative SOX (intravenous oxaliplatin 130 mg/m2 on day one of each 21 day plus oral S-1 40-60 mg twice a day for three cycles preoperatively and five cycles postoperatively followed by three cycles of S-1 monotherapy). The primary endpoint, assessed in the modified intention-to-treat population, 3-year disease-free survival to assess the superiority of perioperative-SOX compared with adjuvant-SOX and the non-inferiority (hazard ratio non-inferiority margin of 1·33) of adjuvant-SOX compared with adjuvant-CapOx. Safety analysis were done in patients who received at least one dose of the assigned treatment. This study is registered with ClinicalTrials.gov, NCT01534546. FINDINGS: Between Aug 15, 2012, and Feb 28, 2017, 1094 patients were screened and 1022 (93%) were included in the modified intention-to-treat population, of whom 345 (34%) patients were assigned to the adjuvant-CapOx, 340 (33%) patients to the adjuvant-SOX group, and 337 (33%) patients to the perioperative-SOX group. 3-year disease-free survival was 51·1% (95% CI 45·5-56·3) in the adjuvant-CapOx group, 56·5% (51·0-61·7) in the adjuvant-SOX group, and 59·4% (53·8-64·6) in the perioperative-SOX group. The hazard ratio (HR) was 0·77 (95% CI 0·61-0·97; Wald p=0·028) for the perioperative-SOX group compared with the adjuvant-CapOx group and 0·86 (0·68-1·07; Wald p=0·17) for the adjuvant-SOX group compared with the adjuvant-CapOx group. The most common grade 3-4 adverse events was neutropenia (32 [12%] of 258 patients in the adjuvant-CapOx group, 21 [8%] of 249 patients in the adjuvant-SOX group, and 30 [10%] of 310 patients in the perioperative-SOX group). Serious adverse events were reported in seven (3%) of 258 patients in adjuvant-CapOx group, two of which were related to treatment; eight (3%) of 249 patients in adjuvant-SOX group, two of which were related to treatment; and seven (2%) of 310 patients in perioperative-SOX group, four of which were related to treatment. No treatment-related deaths were reported. INTERPRETATION: Perioperative-SOX showed a clinically meaningful improvement compared with adjuvant-CapOx in patients with locally advanced gastric cancer who had D2 gastrectomy; adjuvant-SOX was non-inferior to adjuvant-CapOx in these patients. Perioperative-SOX could be considered a new treatment option for patients with locally advanced gastric cancer. FUNDING: National Key Research and Development Program of China, Beijing Scholars Program 2018-2024, Peking University Clinical Scientist Program, Taiho, Sanofi-Aventis, and Hengrui Pharmaceutical. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Burden of lung cancer attributable to ambient fine particles and potential benefits from air quality improvements in Beijing, China: A population-based study.

OBJECTIVE: We aimed to establish a representative exposure response function between PM2.5 and lung cancer to evaluate the impact on lung cancer burden and the benefits gained in association with the environmental policy change in Beijing, China. METHODS: Based on population-based cancer registration data during 2001-2016, using a spatiotemporal Poisson regression model, long-term concentrations of PM2.5 were linked to sex-age adjusted incidence rates of total lung cancer and its pathological subtypes. We calculated the health and monetary benefits associated with air quality improvement using the cost of illness method. RESULTS: In the constructed regression model, a 10 µg/m3 increment of PM2.5 was associated with increases of 6.0% (95% confidence interval [95% CI]: 4.3%, 7.7%), 14.8% (10.3%, 19.4%), and 6.5% (3.3%, 9.8%) in the incidence of total lung cancer, squamous cell carcinoma, and adenocarcinoma, respectively. The estimated associations indicate that long-term exposure to PM2.5 contributed 1947 to 3059 incident cases of lung cancer per year among the residents in Beijing during the study period. Clean air actions saved 4978 (95% CI: 2711, 7417) lung cancer cases, which brought a savings of 218 (118, 324) million RMB (~31 [17, 46] million US dollars) in direct inpatient medical expenditures. If air quality had met national standards of long-term PM2.5 (35 µg/m3) in 2014-2016, 10,003 (95% CI: 9325, 10,650) lung cancer cases could have been prevented and direct inpatient medical expenditures of 438 (409, 466) million RMB (~63 [58, 67] million US dollars) could have been saved. CONCLUSIONS: This study enriches epidemiological study, confirming the association between exposure to PM2.5 and lung cancer or its subtypes, and provides novel evidence for the notable reduction in lung cancer burden and medical expenditure savings that were achieved through air quality improvements in Beijing from 2014 to 2016.

Secular trends in incidence of lung cancer by histological type in Beijing, China, 2000-2016.

OBJECTIVE: The objective of this study was to characterize secular trends in the sex-specific, age-standardized incidence of lung cancer by histological type in Beijing, China, from 2000 to 2016 based on data from a population-based cancer registry. METHODS: Data on the incidence of cancer from 2000 to 2016 were obtained from the Beijing Cancer Registry. We examined trends in the sex-specific, age-standardized incidence of lung cancer by histological type using a Joinpoint regression model. RESULTS: A total of 117,409 cases of lung cancer were diagnosed from 2000 to 2016. Overall, 73,062 (62.23%) patients were males. The most common histological type among both sexes was adenocarcinoma; however, the proportion of adenocarcinoma differed significantly between males and females (45.36% vs. 77.14%, respectively, P<0.0001). The age-standardized incidence of total lung cancer increased from 2000 to 2010 with an annual percent change (APC) of 2.2% [95% confidence interval (95% CI), 1.5% to 2.9%] and stabilized thereafter. Among males, the incidence of total lung cancer peaked in 2008 and then decreased slightly, with an APC of -1.1% (95% CI, -2.1% to -0.1%). Among females, the incidence increased continuously during the study period, with an APC of 1.4% (95% CI, 0.9% to 1.9%). The incidence of squamous cell carcinoma decreased significantly in recent years among both sexes, with APCs of -2.6% (95% CI, -4.5% to -0.6%) from 2007 to 2016 for males and -5.4% (95% CI, -7.2% to -3.6%) from 2004 to 2016 for females. In contrast, the incidence of adenocarcinoma increased continuously throughout the study period, by APCs of 4.0% (95% CI, 2.6% to 5.4%) for males and 6.2% (95% CI, 4.8% to 7.6%) for females. The incidence of small cell carcinoma peaked in 2007 and stabilized thereafter among males, whereas it peaked in 2012 and then decreased with an APC of -14.7% (95% CI, -25.3% to -2.6%) among females. The incidence of large cell carcinoma and other specified malignant neoplasm did not change much, whereas the incidence of unspecified type decreased among both sexes during the study period. CONCLUSIONS: Although the incidence of squamous cell carcinoma decreased significantly among both sexes in recent years in Beijing, China, adenocarcinoma increased continuously throughout the study period among both sexes. Knowledge of differences in trends is useful for surveillance and control of lung cancer. However, the reason for the increase in adenocarcinoma remains unclear and warrants investigation.

Incidence and mortality of stomach cancer in China, 2014.

OBJECTIVE: In this study, we aimed to estimate the updated incidence and mortality rate of stomach cancer based on the cancer registration data in 2014, collected by the National Central Cancer Registry of China (NCCRC). METHODS: In 2017, 339 registries' data were qualified based on the criteria of data quality control of the NCCRC. Cases of stomach cancer were retrieved from the national database. We estimated numbers of stomach cancer cases and deaths in China using age-specific rates and corresponding national population stratified by area, sex, age-group (0, 1-4, 5-9, 10-14, …, 85+). Chinese standard population in 2000 and Segi's world population were applied for age-standardized incidence and mortality rates. RESULTS: In 2014, 410,400 new stomach cancer cases and 293,800 cancer-associated deaths were estimated to have occurred in China. The crude incidence rate of stomach cancer was 30.00/100,000, age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 19.62/100,000 and 19.51/100,000, respectively. The crude mortality rate of stomach cancer was 21.48/100,000, age-standardized mortality rates by Chinese (ASMRC) and by world standard population (ASMRW) were 13.44/100,000 and 13.30/100,000, respectively. Incidence and mortality rates in rural areas were both higher than that in urban areas. Stomach cancer has a strong relationship with gender and age. The disease has occurred more frequently among men than women with a male to female ratio of 2.4 for ASIRC. After age group of 40-44 years, incidence rates are substantially higher in men than in women, same pattern was seen for age-specific mortality rates. CONCLUSIONS: There is still a heavy burden of stomach cancer in China. The incidence and mortality patterns of stomach cancer show substantial gender and regional disparities. Great effort is needed to provide more accessible health services, sufficient financial resources, and adequate cancer-care infrastructure for the Chinese population, especially for people living in rural areas.

Cancer incidence in Beijing, 2014.

OBJECTIVE: To analyze cancer incidence data in Beijing in 2014 and temporal trends for selected common cancers during 2005 and 2014. METHODS: A total of 144 secondary and tertiary hospitals reported newly diagnosed cancer cases to Beijing Cancer Registry, which covers 13 million residents in Beijing. The cancer incidence rate was calculated in strata by cancer type, sex, age group and area. The population composition of China in 1982 and Segi's population structure were used to calculate age-standardized rates. Extensive procedures were used to assure the quality of the data. RESULTS: The overall data quality indicators of the percentage of morphology verification (MV) (%), the percentage of death certificate-only (DCO) (%) and the mortality to incidence ratio (M/I) were 72.15%, 0.94% and 0.54 respectively. A total of 45,300 new cancer cases were diagnosed in Beijing in 2014. The incidence rate was 341.92/100,000 (343.50/100,000 in males, 340.33/100,000 in females), and the age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 143.48/100,000 and 182.99/100,000, respectively. The cumulative incidence rate for cancer before 75 years was 20.61%. Cancers of lung, colorectum, liver, stomach and prostate were the top five common cancer types for males, while cancers of breast, lung, thyroid, colorectum and uterus were the top five common cancer types for females. The different patterns were also observed between rural and urban areas. Regarding temporal trends, the incidence of thyroid cancer has the fastest growth between 2005 and 2014. The incidence of liver cancer decreased, and stomach and esophageal cancer also decreased significantly for males in the last decade. Incidence rate for lung cancer was relatively stable during that period of time. CONCLUSIONS: With more than 45,000 new cases in Beijing in 2014, cancer remains an important public health problem. Actions should be taken to diminish total cancer incidence in Beijing.

Phase 3 Randomized Low-Dose Paclitaxel Chemoradiotherapy Study for Locally Advanced Non-Small Cell Lung Cancer.

INTRODUCTION: Concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced non-small cell lung cancer (LA-NSCLC) but is associated with poor chest tumor control. Here, we report results of a randomized phase 3 study comparing two CCRT regimens in improving chest tumor control by low-dose paclitaxel chemoradiation for LA-NSCLC. METHODS: Due to the logistics of local referral pattern, the study was designed to enroll patients with stage III LA-NSCLC who had completed 2-4 cycles of full-dose chemotherapy. One hundred thirty four were randomized to either Arm 1 [paclitaxel at 15 mg/m2, three times per week (Monday, Wednesday, and Friday) for 6 weeks, n = 74] or Arm 2 (weekly paclitaxel at 45 mg/m2 for 6 weeks, n = 60). Chest radiotherapy was 60-70 Gy in standard fractionation. Response rate was the primary endpoint, with recurrence-free survival (RFS) as the secondary endpoint. RESULTS: From March 2006 to February 2013, 71 patients completed Arm 1 treatment and 59 completed Arm 2 treatment. The response rate for Arm 1 was significantly higher (83.1%) than Arm 2 (54.2%) (p=0.001). RFS was superior in Arm 1: median 14.6 vs. 9.4 months, p = 0.005, Hazard ratio (HR) 1.87 [95% confidence interval (CI) 1.20, 2.90]. Overall survival was not significantly different: median 32.6 months in Arm 1 vs. 31.3 months in Arm 2, p = 0.91, HR 0.97 (95% CI 0.55, 1.70). Toxicity was significantly lower in Arm 1 for Grade 3 and 4 leukopenia/neutropenia (p < 0.001). CONCLUSION: Pulsed low-dose paclitaxel CCRT resulted in significantly better RFS and tumor response rate, and less hematologic toxicities than weekly CCRT for LA-NSCLC.

Population-based cancer incidence analysis in Beijing, 2008-2012.

OBJECTIVE: To analyze the incidence of cancer during 2008-2012 in Beijing, China, and compare the cancer spectrum with that during 1998-1999. METHODS: Data from the Beijing Cancer Registry (BCR), which covered 12 million residents and 16 administrative regions in Beijing, were checked and evaluated on basis of the criteria of data quality from the National Central Cancer Registry (NCCR) of China. Incidences were calculated stratified by cancer type, sex, areas (urban/rural), and age. The Chinese census population in 1982 and the world Segi's population were used for calculating the age-standardized incidences. RESULTS: A total of 177,101 new cancer cases were diagnosed in Beijing between 2008 and 2012. The crude incidence rate (CR) of all cancers was 282.64/100,000 (290.71/100,000 in males and 274.45/100,000 in females). The age-standardized rates by Chinese standard population (ASR-China) and by world standard population (ASR-world) were 124.46/100,000 and 161.18/100,000, respectively. Female breast cancer was the most common cancer, followed by lung cancer, colorectal cancer, liver cancer, and stomach cancer, with the CR of 59.87/100,000, 59.21/100,000, 32.49/100,000, 19.81/100,000 and 17.96/100,000, respectively. In urban areas, female breast cancer (68.50/100,000) was still the most common cancer, followed by lung cancer (61.23/100,000), colorectal cancer (37.23/100,000), prostate cancer (20.49/100,000) and stomach cancer (20.07/100,000). In rural areas, lung cancer (55.94/100,000) was the most common cancer, followed by female breast cancer (45.87/100,000), colorectal cancer (24.77/100,000), liver cancer (20.68/100,000) and stomach cancer (14.52/100,000). Great changes of the cancer spectrum were found from the period of 1998-1999 to the period of 2011-2012 in Beijing. CONCLUSIONS: The cancer burden in Beijing was heavier than the national average level. Cancer prevention and control strategies, especially for lung, colorectal, prostate and female thyroid cancers, should be enhanced.

Factors associated with menopausal symptoms among middle-aged registered nurses in Beijing.

OBJECTIVE: To determine factors related to menopause symptoms among middle-aged registered nurses in Beijing. METHODS: Self-administered questionnaires that included closed-ended questions on many factors possibly related to menopausal symptoms were distributed to 2100 registered nurses aged 40-55 at 20 hospitals in Beijing, China. RESULTS: Menopausal status was most associated with menopausal symptoms (p < 0.01), including hot flashes and sweating, paresthesiae, insomnia, arthralgia/myalgia, palpitations, skin formication and an unsatisfactory sexual life. The odds ratios (ORs) were highest for hot flashes and sweating. Upsetting events in the past year and being pessimistic were significantly inversely correlated with almost all the symptoms analyzed. Hot flashes and sweating (p < 0.01), paresthesiae (p < 0.01), unsatisfactory sexual life (p < 0.01), irritability (p < 0.05), depression or suspicion (p < 0.05) and dizziness (p < 0.05) were negatively correlated with the frequency of sexual activity. CONCLUSION: Many factors may influence symptoms of the menopause. We found that menopausal status was most strongly associated with most menopausal symptoms, especially hot flashes and sweating. Psychosocial factors also played an important role. A higher frequency of sexual activity negatively correlated with most menopausal symptoms.

[Analysis of lymphoma incidence in Beijing, 1998-2010].

OBJECTIVE: To analyze the incidence trends and characteristics of lymphoma in Beijing, 1998-2010. METHODS: Total of 9 763 new cases diagnosed as lymphoma in 1998-2010 were extracted from the population-based database of Beijing Cancer Registry, covering population of 151 601 066 person-years. Incidence, age-adjusted incidence, cumulative incidence, truncated incidence and annual percentage change (APC) were calculated. The gender-specific, age-specific and pathology-specific incidence trends were analyzed. RESULT: The incidence rate of lymphoma was 6.48/100 000 (9 763/150 720 187) during the period of 1998-2010, increased from 3.78/100 000 (410/10 850 626) in 1998 to 8.88/100 000 (1 111/12 518 114) in 2010 with an increasing rate of 136.17% (APC = 5.21%, P < 0.05). The incidence rate of Hodgkin lymphoma increased from 0.25/100 000 (27/10 850 626) in 1998 to 0.47/100 000 (59/12 518 114) in 2010 with an increasing rate of 88.00% (APC = 4.33%, P < 0.05). The incidence rate of non-Hodgkin lymphoma was increased from 2.89/100 000 (314/10 850 626) in 1998 to 5.93/100 000 (742/12 518 114) in 2010 with an increasing rate of 105.19% (APC = 4.19%, P < 0.05) . During the period of 1998-2010, the incidence of lymphoma was 7.78/100 000 (7 125/91 621 898) in urban areas and 4.47/100 000 (2 638/59 098 289) in rural areas, 7.40/100 000 (5 632/76 121 672) in males and 5.54/100 000 (4 131/74 598 518) in females. CONCLUSION: The incidence of lymphoma keeps increasing in 1998-2010, and the incidence was higher in males than females, urban areas than rural areas. The incidence patterns of Hodgkin lymphoma and non-Hodgkin lymphoma were different.

Characteristics and trends in incidence of childhood cancer in Beijing, China, 2000-2009.

OBJECTIVE: To investigate the characteristics and incidence trends of childhood cancer in Beijing, China, from 2000 to 2009. METHODS: A total of 1,274 cases with childhood cancer in Beijing from 2000 to 2009 were included in the study. All rates were age-standardized using the direct method to the world standard population and expressed per million person-years. Incidence trends were characterized by calculating annual percent change (APC) using Joinpoint Regression Program. RESULTS: The crude incidence rate was 106.47 per million [age-standardized rate (ASR) 113.34] between 2000 and 2009 in Beijing with the most common diagnoses, leukemia (N=505, 39.64%, ASR 45.20), followed by central nervous system (CNS) tumors (N=228, 17.90%, ASR 19.28) and lymphoma (N=91, 7.14%, ASR 6.97). The incidence for all childhood cancers combined has increased during the study period, with an APC of 5.84% [95% confidence interval (95% CI): 1.0-10.9] after adjusted by world population. The ASR of all combined cancers in boys showed a slight, but no significant increase, with an APC of 5.33% (95% CI: -0.6-11.6); for girls, the trends increased significantly, with an APC of 6.54% (95% CI: 1.5-11.8). CONCLUSIONS: The incidence rate of childhood cancer in Beijing was higher than the average level of China and lower than that of western countries. The incidence trends of childhood cancer, especially leukemia among girls showed a significantly increase from 2000 to 2009. While among boys, no substantially change was seen during the observed time period. Some sex-specific trends by subcategories and trends of major cancers in different age groups by cancer site merit further investigation.

[Relationship between female breast cancer incidence and the socioeconomic status in Beijing].

OBJECTIVE: To explore the relationship between female breast cancer incidence and the socioeconomic status in Beijing. METHODS: The data of female breast cancer patients of Beijing residents diagnosed between 2001 and 2010 were sorted from the population-based surveillance database of Beijing Cancer Registry.28, 184 cases were included, covering 58, 427, 396 female person-years. Incidence rates, rates adjusted by world population in each year, mean and median age at diagnosis and the peak age group were calculated. JoinPoint software was applied to calculate the incidence trend and the annual percentage of changing (APC). Using the data from the Beijing Statistical Yearbook in 1991-2000, we calculated the gross output value of industry, the average wage of Beijing residents, the food expenditure level and the average wage in different districts in Beijing. The relationship between female breast cancer incidence, the average age (mean, median and the peak age groups) at diagnosis and the socioeconomic status in the last 10 years was also calculated. RESULTS: From 2001 to 2010, the incidence rate of female breast cancer in Beijing rose from 32.03/100 000 to 58.10/100 000, a total increase of 81.39% over the last 10 years and the annual percentage change was 5.76%, after adjusted by world population (APC = 5.76%, P < 0.05). The relationships between female breast cancer incidence from 2001-2010 and the gross output value of industry, the average wage of Beijing residents, the food expenditure level in 1991-2000 were significant (P < 0.05). The Pearson correlation coefficients were 0.928, 0.957, and 0.982, respectively. In terms of the data in different districts in Beijing, the relationships between the average age (mean, median and the peak age group) in 2001-2010 and the average wage of Beijing residence in 1991-2000 were also significant with a correlation coefficient of 0.806,0.785 and 0.754, respectively (P < 0.05). CONCLUSIONS: The increase of female breast cancer incidence rate in Beijing is positively correlated with the socioeconomic status, especially with the food expenditure level of Beijing residents over the last 10 years. The higher the economic development, the peak age of onset of female breast cancer is more postponed.

[Time trends and pathological characteristics of thyroid cancer in urban Beijing, 1995 - 2010].

OBJECTIVE: To describe the incidence trends and to access the histological changing patterns of thyroid cancer in urban areas of Beijing. METHODS: Total of 4883 new cases diagnosed as thyroid cancer in 1995-2010 in urban areas of Beijing were extracted from the population-based data base of Beijing cancer registry, among which 1185 were males and 3698 were females with a coverage population of 56 143 454 person-years and 54 430 655 person-years, respectively. Incidence, age adjusted incidence, annual percentage change (APC) and gender specific incidence change of different histology patterns during last 16 years were calculate. RESULTS: There were 4883 cases diagnosed as thyroid cancer during 1995 - 2010 with the sex ratio of 1:3 (1185 males and 3698 females). Incidence rate of thyroid cancer in urban areas of Beijing increased dramatically from 1.55/100 000 (97/6 245 016) in 1995 to 9.90/100 000 (768/7 758 759) in 2010 with an increase rate of 538.71%. After adjusted by world population, the standardized incidence rate increased from 1.27/100 000 in 1995 to 6.96/100 000 in 2010 with a 12.12% annual percentage change (APC = 12.12%, P < 0.05). Among males, incidence rate increased from 0.85/100 000 (27/3 185 669) to 4.58/100 000 (179/3 912 458) with an increase rate of 438.82%. After adjusted by world population, the standardized incidence rate of males increased from 0.68/100 000 in 1995 to 3.19/100 000 in 2010 with an 11.09% annual percentage change (APC = 11.09%, P < 0.05). Among females, the incidence rate increased from 2.29/100 000 (70/3 059 347) to 15.31/100 000 (589/3 846 301) with an increase rate of 568.56%. After adjusted by world population, the standardized incidence rate of females increased from 1.89/100 000 in 1995 to 10.82/100 000 in 2010 with a 12.48% annual percentage change (APC = 12.48%, P < 0.05). Incidence rate ranked 18th and 12th in 1995 among males and females, respectively; while it ranked 14th and 5th in 2010 respectively. Among 4883 cases, 4594 cases were confirmed histologically as primary tumor accounting for 94.08% of total cases. Papillary carcinoma was the most common subtype accounting for 77.31% (3775/4883) of total cases. Among all the pathological types of thyroid cancer, the proportion of papillary carcinoma has risen from 51.55% (50/97) in 1995 to 87.63% (673/768) in 2010. However, the proportion of the follicular carcinoma decreased from 5.15% (5/97) to 1.69% (13/768). CONCLUSION: Incidence of thyroid cancer in urban areas of Beijing keeps increasing which is mainly due to the rising of papillary carcinoma. Risk factors of papillary thyroid cancer should be focused on when strategies for thyroid cancer prevention and control are conducted.