Prospective assessment of a nasopharyngeal carcinoma risk score in a population undergoing screening.

Despite evidence suggesting the utility of Epstein-Barr virus (EBV) markers to stratify individuals with respect to nasopharyngeal carcinoma (NPC) risk in NPC high-risk regions, no validated NPC risk prediction model exists. We aimed to validate an EBV-based NPC risk score in an endemic population undergoing screening for NPC. This prospective study was embedded within an ongoing NPC screening trial in southern China initiated in 2008, with 51 235 adult participants. We assessed the score's discriminatory ability (area under the receiver-operator-characteristics curve, AUC). A new model incorporating the EBV score, sex and family history was developed using logistic regression and internally validated using cross-validation. AUCs were compared. We also calculated absolute NPC risk combining the risk score with population incidence and competing mortality data. A total of 151 NPC cases were detected in 2008 to 2016. The EBV-based score was highly discriminating, with AUC = 0.95 (95% CI = 0.93-0.97). For 90% specificity, the score had 87.4% sensitivity (95% CI = 81.0-92.3%). As specificity increased from 90% to 99%, the positive predictive value increased from 2.4% (95% CI = 1.9-3.0%) to 12.5% (9.9-15.5%). Correspondingly, the number of positive tests per detected NPC case decreased from 272 (95% CI = 255-290) to 50 (41-59). Combining the score with other risk factors (sex, first-degree family history of NPC) did not improve AUC. Men aged 55 to 59 years with the highest risk profile had the highest 5-year absolute NPC risk of 6.5%. We externally validated the discriminatory accuracy of a previously developed EBV score in a high-risk population. Adding nonviral risk factors did not improve NPC prediction.

Estimation of cancer burden in Guangdong Province, China in 2009.

BACKGROUND: Surveying regional cancer incidence and mortality provides significant data that can assist in making health policy for local areas; however, the province- and region-based cancer burden in China is seldom reported. In this study, we estimated cancer incidence and mortality in Guangdong Province, China and presented basic information for making policies related to health resource allocation and disease control. METHODS: A log-linear model was used to calculate the sex-, age-, and registry-specific ratios of incidence to mortality (I/M) based on cancer registry data from Guangzhou, Zhongshan, and Sihui between 2004 and 2008. The cancer incidences in 2009 were then estimated according to representative I/M ratios and the mortality records from eight death surveillance sites in Guangdong Province. The cancer incidences in each city were estimated by the corresponding sex- and age-specific incidences from cancer registries or death surveillance sites in each area. Finally, the total and region-based cancer incidences and mortalities for the entire population of Guangdong Province were summarized. RESULTS: The estimated I/M ratios in Guangzhou (3.658), Zhongshan (2.153), and Sihui (1.527) were significantly different (P < 0.001), with an average I/M ratio of 2.446. Significant differences in the estimated I/M ratios were observed between distinct age groups and the three cancer registries. The estimated I/M ratio in females was significantly higher than that in males (2.864 vs. 2.027, P < 0.001). It was estimated that there were 163,376 new cancer cases (99,689 males and 63,687 females) in 2009; it was further estimated that 115,049 people (75,054 males and 39,995 females) died from cancer in Guangdong Province in 2009. The estimated crude and age-standardized rate of incidences (ASRI) in Guangdong Province were 231.34 and 246.87 per 100,000 males, respectively, and 156.98 and 163.57 per 100,000 females, respectively. The estimated crude and age-standardized rate of mortalities (ASRM) in Guangdong Province were 174.17 and 187.46 per 100,000 males, respectively, and 98.59 and 102.00 per 100,000 females, respectively. In comparison with the western area and the northern mountain area, higher ASRI and ASRM were recorded in the Pearl River Delta area and the eastern area in both males and females. CONCLUSIONS: Cancer imposes a heavy disease burden, and cancer patterns are unevenly distributed throughout Guangdong Province. More health resources should be allocated to cancer control, especially in the western and northern mountain areas.

Nasopharyngeal carcinoma incidence and mortality in China in 2010.

Nasopharyngeal carcinoma (NPC) is common in South China. Although regional epidemiological data on NPC in China is available, national epidemiological data have been unavailable up to now. The goal of this study was to analyze the NPC incidence and mortality data in some domestic cancer registries, estimate these rates in China in 2010, and provide scientific information that can be harnessed for NPC control and prevention. To accomplish this goal, NPC incidence and mortality data for 2010 were collected from 145 Chinese cancer registries from which data were included in the 2013 National Cancer Registry Annual Report. Such indices as its incident and death numbers, crude rates, age-standardized rates and truncated rates were calculated and analyzed. The incidence and mortality in China and constituent areas were estimated according to the national population in 2010. An estimated 41,503 new cases and 20,058 deaths were attributed to NPC in China in 2010, accounting for 1.34% of all new cancer cases and 1.03% of all cancer-related deaths that year in China. Crude incidence and mortality were 3.16/100,000 and 1.53/100,000, respectively. World age-standardized incidence and mortality were 2.44/100,000 and 1.18/100,000, respectively. Incidence and mortality were higher among males than among females and slightly higher in urban areas than in rural areas. Among seven Chinese administrative regions, NPC incidence and mortality were obviously higher in South China than in other regions and lowest in North China. The male and female age-specific incidence and mortality both rose quickly from age 25-29 years, but peaked at different ages and varied by location. These results demonstrated that NPC incidence and mortality in China especially in South China were at high levels in the world, and suggested that control and prevention efforts should be enhanced.

Incidence and mortality of liver cancer in China, 2010.

Liver cancer is a common malignant tumor in China and a major health concern. We aimed to estimate the liver cancer incidence and mortality in China in 2010 using liver cancer data from some Chinese cancer registries and provide reference for liver cancer prevention and treatment. We collected and evaluated the incidence and mortality data of liver cancer in 2010 from 145 cancer registries, which were included in the 2013 Chinese Cancer Registry Annual Report, calculated crude, standardized, and truncated incidences and mortalities, and estimated new liver cancer cases and deaths from liver cancer throughout China and in different regions in 2010 from Chinese practical population. The estimates of new liver cancer cases and deaths were 358,840 and 312,432, respectively, in China in 2010. The crude incidence, age-standardized rate by Chinese standard population (ASR China), and age-standardized rate by world standard population (ASR world) were 27.29/100,000, 21.35/100,000, and 20.87/100,000, respectively; the crude, ASR China, and ASR world mortalities were 23.76/100,000, 18.43/100,000, and 18.04/100,000, respectively. The incidence and mortality were the highest in western regions, higher in rural areas than in urban areas, and higher in males than in females. The age-specific incidence and mortality of liver cancer showed a rapid increase from age 30 and peaked at age 80-84 or 85+. Our results indicated that the 2010 incidence and mortality of liver cancer in China, especially in undeveloped rural areas and western regions, were among high levels worldwide. The strategy for liver cancer prevention and treatment should be strengthened.

Two Epstein-Barr virus-related serologic antibody tests in nasopharyngeal carcinoma screening: results from the initial phase of a cluster randomized controlled trial in Southern China.

A nasopharyngeal carcinoma (NPC) mass screening trial using a combination of immunoglobulin A antibodies to Epstein-Barr virus capsid antigen and nuclear antigen-1 by enzyme-linked immunosorbent assay in addition to indirect mirror examination in the nasopharynx and/or lymphatic palpation (IMLP) was conducted in southern China. Cantonese aged 30-59 years residing in 2 cities randomly selected by cluster sampling, Sihui and Zhongshan, were invited to participate in this screening from May 2008 through May 2010. Participants were offered fiberoptic endoscopy examination and/or pathologic biopsy if their serologic tests reached our predefined level of high risk or if results from the physical examination indicated possible cancer (i.e., were IMLP positive). A total of 28,688 individuals were voluntarily screened in the initial round. The overall NPC detection rate was 0.14% (41/28,688) with an early diagnosis rate of 68.3% (28/41) during the first year of follow-up. Thirty-eight of 41 cases (92.7%) were detected among the high-risk group, and 7 of 41 cases (17.1%) were detected among the IMLP-positive group. The 2 Epstein-Barr virus serologic tests by enzyme-linked immunosorbent assay could be a feasible alternative for NPC screening in endemic areas. Further follow-up is needed to examine whether screening has an effect on decreasing mortality from NPC in these areas.

[Epidemiology of uterine corpus cancer in some cancer registering areas of China from 2003 - 2007].

OBJECTIVE: To analyze corpus uteri epidemiology in selected cancer registering areas of China during 2003 - 2007, and to provide scientific information for its prevention and control in China. METHODS: The incident and mortality data of corpus uteri cancer in 32 cancer registering areas of China with better quality during 2003 - 2007, which were selected according to the criteria of and provided by National Center for Cancer Registration, were analyzed. RESULTS: There were 8850 new cases and 1559 death cases of corpus uteri cancer, which accounted for 2.96% (8 850/299 306) of all female new cancer cases and 0.94% (1 559/166 305) of all female cancer death cases, respectively. Corpus uteri cancer was the 9th most common cancer for all new female cancer cases which world age adjusted incidence rates was 5.04/105, and 19th most common cancer for all female cancer death cases which world age adjusted mortality rate was 0.83/105 in 32 selected cancer registering areas of China during 2003 - 2007. Zhongshan city, Guangzhou city in Guangdong province and Beijing were the areas with the highest incidence rates in which were 14.51/105, 8.51/105 and 6.69/105, respectively. Zhongshan city in Guangdong province, Dafeng city in Jiangsu province and Feicheng city in Shandong province were the areas with the highest mortality rates, in which were 4.03/105, 3.19/105 and 1.65/105 respectively during 2003 - 2007. There were increasing trends for its incidence rates in above 32 areas during 2003 - 2007, its world age adjusted incidence rates increased from 3.94/105 in 2003 to 5.56/105 in 2007 (P = 0.026), while its urban world age adjusted incidence rates increased from 4.57/105 in 2003 to 6.18/105 in 2007 (P = 0.038), and rural rates increased from 1.74/105 in 2003 to 3.01/105 in 2007 (P = 0.013), and the results showed that urban areas obviously higher than rural areas (P < 0.01). Although there was a slow increasing trend for its world age adjusted mortality rates in above 32 areas during 2003 - 2007 which increased from 0.64/105 in 2003 to 0.87/105 in 2007 (P = 0.214), and from 0.66/105 in 2003 to 0.88/105 in 2007 in urban areas (P = 0.340), and from 0.57/105 in 2003 to 0.83/105 in 2007 in rural areas (P = 0.070), while increasing trends without statistical significance.But mortality rates in urban areas were obviously higher than those of rural areas (P < 0.01). CONCLUSIONS: Although the world standardized incidence and mortality rates of corpus uteri cancer were at low level worldwide, there were increasing trends for its incidence rates during 2003 - 2007 in the 32 selected cancer registering areas of China. Moreover, its incidence and mortality rates were at high level worldwide in some areas such as Zhongshan city of Guangdong province and Dafeng city of Jiangsu province during the period, in which suggested that its prevention and control should be enhanced.

Nasopharyngeal carcinoma incidence and mortality in China, 2013.

BACKGROUND: We estimated the incidence and mortality of nasopharyngeal carcinoma (NPC) in China in 2010 according to the data of 145 domestic population-based cancer registries in 2014, and no such reports since then. Hence, to further and better understand its epidemiology in China and to provide more precise scientific information for its control and prevention in China, we analyzed the NPC incidence and mortality of 255 domestic population-based cancer registries, and estimated the national rates in 2013 again. METHODS: NPC incidence and mortality data of 255 domestic cancer registries in 2013, accepted by the 2016 National Cancer Registry Annual Report, were collected and collated, and the indices of NPC such as the numbers of new cases and deaths, crude rates, age-standardized rates, and truncated rates of incidence and mortality were calculated and analyzed. The incidence and mortality in China and its constituent areas were estimated according to the national population in 2013. RESULTS: An estimated 42,100 new cases and 21,320 deaths were attributed to NPC in China in 2013, accounting for 1.14% of all new cancer cases and 0.96% of all cancer-related deaths that year in China. Crude incidence and mortality of NPC were 3.09/100,000 and 1.57/100,000, respectively. World age-standardized incidence and mortality were 2.17/100,000 and 1.08/100,000, respectively. The incidence and mortality of males were obviously higher than those of females and slightly higher in urban areas than in rural areas. Among seven Chinese administrative regions, NPC incidence and mortality were obviously higher in South China than in other regions and lowest in North China. Top 3 incidence and mortality provinces and registering areas all located in South China. The age-specific incidence and mortality rose quickly from age 25-29 and 35 to 39 years, respectively, peaked at different ages and varied by location. CONCLUSIONS: These results demonstrated that NPC incidence and mortality in China in 2013 were also at high levels worldwide, which suggested that its control and prevention should be enhanced.

Auto-Coding of Cancer Registry Data in China.

The significance, difficulty and strategy of coding cancer data according to international coding standards are discussed, and the concept, methods and realization of cancer data automatic coding in cancer registries in China are introduced in the paper. Coding cancer data automatically with software could not only reduce the time, manpower and workload, while improving the accuracy and efficiency of cancer data coding, but also enhance the validity of cancer registration and the value of cancer registry data, which is of great significance.

[History of cancer registration in china].

The first cancer registry office was established in 1959 in China. In 1969, most provinces, autonomous regions and independently administered municipal districts had their own cancer prevention offices. In the 1970s, many cancer high incidence areas began their work on cancer registration. Thirty-eight cancer registry offices had been set up by the 1980s. In 1990 the China Cancer Registration Collaboration Regulations were made and in 2003, the Plan of Cancer Prevention and Control was issued by the Ministry of health of China. Cancer registration was emphasized as the main feature of cancer prevention and control. In 2004, the China Cancer Registration Handbook was published and at the same time, the China Institute of Health Information and the Cancer Registration and Monitoring Board were established and regulations of the board had been passed. Until now there are 195 cancer registry offices in China (80 in cities and 113 in rural areas) covering about 190 million people which accounts for 13% of the Chinese population.

Cancer registration in the Peoples Republic of China.

The current situation of cancer registration in China was systematically reviewed. So far, cancer registration in China has been making a great progress in the following aspects: the number of cancer registries and covered population have increased dramatically; a registration network has been established and completed gradually; regulations and rules improved remarkably; more attention is being paid by every level of government; a lot of registration software has been created and financial support ensured. However, we are still facing some problems and challenges, such as no stable groups of registrars, shortage of training opportunities, poor data quality, insufficient utilization and lack of multidisciplinary mechanisms, so that the cancer registration system still needs to be enhanced and improved. Along with the development of economy, science and information technology, methods and patterns of cancer registration is changing. It is to be expected that cancer registration will be automatic, nationwide and integrated with community healthcare in the near future.

Histopathological classification of nasopharyngeal carcinoma.

This article reviews all related research and reports on nasopharyngeal cancer (NPC) histopathological classifications worldwide. Despite continuous advance of Chinese and international NPC histopathological classification research, it was difficult to unify previous with current China classifications, and the China with World Health Organization (WHO) classifications. For example, non-keratinizing and undifferentiated carcinoma of the WHO NPC classification does not coincide with poorly-differentiated squamous cell carcinoma of the previous China classification. In addition, the incidence rates of different NPC pathological types show obvious regional discrepancies. It suggested that for facilitating Chinese and international NPC research and exchange, NPC histopathological classifications worldwide should be effectively unified.

[Trend of changes on incidence and pathological proportions of nasopharyngeal carcinoma in Zhongshan city, Guangdong province, during 1970 - 2007].

OBJECTIVE: To understand the nasopharyngeal carcinoma (NPC) incidence and pathological changes in Zhongshan city, during 1970 - 2007. METHODS: Data on NPC in Zhongshan during 1970 - 2007 was from the Zhongshan Cancer Registry system. Indices as incident numbers, crude incidence rates, age-adjusted incidence rates, incident pathological proportion and trend etc. were calculated and analyzed. RESULTS: The NPC world-adjusted incidence rates on males and females were relatively stable as 27.54/10(5) and 11.28/10(5) respectively. Non-keratinizing carcinoma accounted for 84.57 percent of all the new NPC cases while Keratinizing carcinoma only accounted for 5.81 percent. The proportion of pathological types of cancers had not been obviously changed in Zhongshan during 1970 - 2007. CONCLUSION: Although relatively stable on the trends of NPC incidence in Zhongshan during 1970 - 2007, it was still higher than data from the world or the nation.

Epidemiological trends of nasopharyngeal carcinoma in China.

Research papers and data concerning NPC epidemiology in China available worldwide were reviewed. It was found that although the results of three national all death-causes sampling surveys in China showed mortality rates in most sampling areas and all as overall to be declining continuously and remarkably, figures for 1987-2000 in some selected areas of China released by the World Health Organization were relatively stable, and the NPC incidence and mortality rates reported by Zhongshan and Sihui cities of Guangdong Province in China had shown ascending or stable trends, respectively. Differences with regard to change in NPC incidence and mortality rates over time may be caused by variation in the data quality from divergent sources, but the exact reasons clearly warrant further analysis.