Incidence and Mortality of Sarcomas in Shanghai, China, During 2002-2014.

Background: Sarcomas are a heterogeneous group of rare but deadly malignant tumors. The aim of this study was to comprehensively describe the incidence and mortality of sarcomas in Shanghai during 2002-2014. Method: Data were from Shanghai Cancer Registry. All new cases diagnosed with sarcomas and all death records where the cause of death listed as sarcomas were included. The characteristics of sarcomas incidence and mortality were analyzed. Age-standardized rates (ASRs) were adjusted by the world standard population. The trends were assessed by Joinpoint analysis. Results: A total of 9,440 incident cases were identified. The ASR was 3.4/105 for all sarcomas combined. Incidence of sarcomas overall was similar in females (3.5/105) as in males (3.4/105). Except for sarcomas "Not Otherwise Specified" (NOS), the most common histological subtype was gastrointestinal stromal sarcoma (GISS) (14.8%), which was followed by fibrosarcoma (7.2%), lipoblastoma (6.7%), leiomyosarcomas (6.5%), and osteosarcoma (5.3%). Among those incident cases, 87.9% were located in soft tissue sarcomas (STS) and 12.1% in bone and joint (bone sarcomas). The ASRs for STS and bone sarcomas were 2.8/105 and 0.6/105, respectively. Incidence rates for all STS combined rose exponentially with age, while bone sarcomas had the highest incidence at age 0-19. There were 4,279 deaths during 2002-2014 with the ASR of 1.3/105. Age-adjusted mortality due to sarcomas was slightly higher in males (1.5/105) than females (1.2/105). Except for sarcomas NOS, leiomyosarcomas was the most common subtype, comprising 9.9% of deaths due to sarcomas, followed by lipoblastoma (6.4%) and osteosarcoma (6.3%). The ASRs of mortality for STS and bone sarcomas were 1.0/105 and 0.2/105, respectively. For both males and females, the age-standardized incidence for STS and bone sarcomas did not change meaningfully over the study period. In contrast, age-standardized STS mortality in females increased by 2.3% per year (95% CI: 0.3, 4.4%), but was unchanged in males. No meaningful trends in bone sarcomas mortality were observed for either males or females. Conclusion: This population-based study was the first report of epidemiology of sarcomas in Shanghai according to anatomic site and histologic type. The diversity and rarity of sarcomas suggested more detailed data are warranted.

The incidence and mortality of lung cancer in 2016 and their trends from 2002 to 2016 in Shanghai / 肿瘤

Objective:To investigate the lung cancer incidence and mortality in 2016 and their trends from 2002 to 2016 in shanghai. Methods:The data of incidence and death on lung cancer in shanghai from 2002 to 2016 were obtained from the Shanghai Municipal Center for Disease Control and Prevention population-based cancer registry and Vital Statistics System.Lung Cancer incidence and mortality stratified by age of diagnosis or death,gender and age-group were analyzed.The number of cases and deaths,proportion,crude rates,age-specific rates,age-standardized rates,corresponding truncated age-standardized rates(35-64 years)and cumulative rates were calculated.Segi's 1960 world standard population was used for calculating age-standardized rates of incidence and mortality as well as truncated age-standardized rates.Trends in age-standardized rates of incidence and death for lung cancer in Shanghai from 2002-2016 were estimated by Joinpoint analysis and characterized by the annual percent change(APC). Results:The new lung cancer cases and deaths were 14 395 and 9 170 in Shanghai in 2016.The crude rate of incidence was 99.41/105,and the age-standardized rate of incidence was 39.76/105.New cases of lung cancer accounted for 19.34％of all malignant tumors in shanghai,ranking the first in the incidence spectrum of malignant tumors.The crude rate of mortality was 63.33/105,and the age-standardized rate was 21.57/105.Deaths of lung cancer accounted for 24.78％of all malignant tumor deaths in shanghai,ranking the first in the mortality spectrum of malignant tumors.The age-standardized rates of incidence and mortality for males were higher than those for females.The age-specific numbers and rates of incidence and mortality increased with age.The age-specific number and rate of incidence reached the peak at the age group of 60-64 years and 80-84 years respectively,and those of mortality peaked at the age group of 80-84 years and older than 85 years respectively.The incidence of lung cancer increased from 33.70/105 in 2002 to 39.76/1 05 in 2016 in Shanghai.Joinpoint analyses showed that the age-standardized rate of lung cancer incidence remained stable from 2002 to 2010(APC=-0.79,t=-1.46,P=0.175)but showed a significant upward trend with an average annual increase rate of 5.12％from 2010 to 2016(APC=5.12,t=6.97,P＜0.001).The standardized mortality showed a downward trend with an average annual decrease rate of 0.87％from 2002 to 2016(APC=-0.87,t=-2.87,P=0.013). Conclusion:The incidence of lung cancer in Shanghai during 2002-2016 presented an upward trend while the mortality of lung cancer showed a gradual downward trend.There are differences in the incidence and mortality of lung cancer among different gender and age groups.

Report of breast cancer incidence and mortality in China registry regions, 2008-2012 / 中华肿瘤杂志

Objective@#The registration data of local cancer registries from 2008 to 2012 were collected by National Central Cancer Registry to estimate the incidence and mortality of female breast cancer in China.@*Methods@#Data from 135 registries were qualified and selected in the final analysis, and each registry at least has submitted data from 2010 to 2012. Cancer incidence and mortality analyses were stratified by area (urban/rural, eastern/middle/western areas) and age group. The age composition of standard population of Chinese census in 2000 and Segi′s population were used for age-standardized incidence and mortality in China and worldwide, respectively.@*Results@#A total of 135 registries were recruited in the analysis, covering 629 333 910 person-years (382 669 450 in urban and 246 664 460 in rural). About 13, 258 cases of female breast cancer were diagnosed and 32 205 cases were dead between 2008 and 2012. Female breast cancer incidence was 42.67/100, 000 and age-standardized rate calculated by worldwide standard population was 28.87/100, 000. The crude incidence of urban area was 51.85/100, 000, higher than 28.29/100, 000 of rural area, and the crude incidence of eastern area was 46.35/100, 000, higher than 36.38/100, 000 of middle area and 27.60/100, 000 of western area. The age-specific incidence increased with age and reached the peak at age 55-59 (96.36/100, 000), and declined at age 60. The age-standardized incidence rate by Chinese standard population increased 30.56% from 2003 to 2012. The increase rate of rural area was 72.32%, faster than 23.48% of urban area. Female breast cancer mortality was 10.36/100, 000 and the age-standardized rate calculated by worldwide standard population was 6.61/100, 000. The crude mortality of urban area was 11.64/100, 000, higher than 8.36/100, 000 of rural area, and the crude mortality of eastern area was 10.81/100, 000, higher than 7.38/100, 000 of middle area and 9.90/100, 000 of western area. The age-specific incidence increased with age and reached the peak at age above 85 (61.25/100, 000). Age-standardized incidence rate by Chinese standard population remained stable during the period of 2003-2012 (6.23%). The mortality rate mainly increased in rural area (54.94%), while decreased 2.32% in urban area over the 10 years.@*Conclusions@#Although the incidence and mortality of breast cancer in China are comparatively low worldwide, in China the incidence and mortality of female breast cancer have rose to the first and sixth place respectively among all the female cancers. The disease burden of breast cancer is very different between urban and rural area. Therefore, the targeted measure and strategy of control and prevention according to the area difference are needed.

Optimizing the role of general practitioners in organized colorectal cancer screening / 中华全科医师杂志

Organized,population-based colorectal cancer (CRC) screening has been implemented in various cities of China in order to control its rising threat.General practitioners (GPs) play a crucial role as central coordinators among potential screening participants,service providers and program organizers.However,rates of participation and adherence to CRC screening program remain low,whilst its program performance indicators are increasingly receiving more attention.In this review,we summarize the latest literature focusing on strategies to optimize the role of GPs in different stages of organized CRC screening programs,which could substantially enhance screening efficiency and cost-effectiveness of population-based screening programs.

Analysis of the patterns of female breast cancer incidence in Shanghai, 2003-2012 / 中华预防医学杂志

Objective@#To analyze the patterns of female breast cancer and their incidence in Shanghai during 2003-2012, and to compare them with international data.@*Methods@#The data of female breast cancer cases diagnosed between 2003 and 2012 were collected from the Shanghai Cancer Registry. The record of cancer cases included the patient's name, gender, date of birth, permanent and residential address, diagnosis site or name, histological type, date of first diagnosis, diagnostic basis and diagnostic stage, etc. Data source of cancer incidence of World, Developed Countries, Developing Countries, East Asia and China in 2012 sourced from GLOBOCAN 2012 database of the WHO International Agency for Research on Cancer (IARC); and the data of USA during 2008-2012 was collected from SEER 18 database from Surveillance, Epidemiology, and End Results Program of the National Cancer Institute (NCI). Incidence indicators of Shanghai female breast cancer were calculated, including the average cases, median age, average age, proportion, crude rate, age-specific rate and age-standardized rate.@*Results@#During 2003-2012, 41 991 new cases of female breast cancer were diagnosed in Shanghai, with an average of 4 199 cases per year, accounting for 17.23% among total new female cancer cases, ranking first in female cancer incidence in Shanghai during 2003-2012, with a crude incidence rate of 60.90 per 100 000 and an age-standardized incidence rate of 33.90 per 100 000. During 2008-2012, an average 4 528 new cases of female breast cancer was diagnosed per year in Shanghai, with 16.97% among total female cancer cases. The median age was 56 years old and the mean age was 57.73 years old. The crude rate was 64.23 per 100 000 and the age-standardized rate was 35.00 per 100 0000, which was higher than those of China (22.1 per 100 000), Eastern Areas (27.0 per 100 000) and Developing Counties (31.3 per 100 000), and lower than that of World (43.1 per 100 000), and Yellow Race Population of USA (68.77 per 100 000). During 2003-2007, on average, 3 869 new cases of female breast cancer were diagnosed per year in Shanghai, accounting for 17.54% of total female cancer cases. The median age was 53 years old and the mean age was 56.44 years old. The crude rate was 57.42 per 100 000 and the age-standardized rate was 32.69 per 100 000. There was a continuing peak stage spanned 25 years old from 50 to 74 years old, during 2008-2012. Compared with those of 2003-2007, the beginning age group of the continuing peak stage was delayed for 5 years old and the ending age group was delayed for 10 years old.@*Conclusion@#The age-standardized incidence rate in Shanghai was higher than those of China, Eastern Areas and Developing Counties, and lower than that of World, and that of Yellow Race Population of USA; Compared with 2003-2007, the crude rate and age-standardized rate increased, the median age, mean age and the beginning and ending age group of the continuing peak stage were delayed.

The patterns of head and neck cancer incidence in Shanghai from 2003 to 2012 / 中国癌症杂志

Background and purpose:Head and neck cancer is common worldwide. This article aimed to describe the patterns of incidence of head and neck cancer and their changes in Shanghai from 2003 to 2012, in order to provide reference for prevention programs, research and control strategies on cancer.Methods:The data of lip, oral cavity and pharynx cancer cases were collected by the Shanghai Cancer Registry. The distributions of Shanghai lip, oral cavity and pharynx cancer incidences from 2003 to 2012 were described. The patterns were described according to gender, age, basis of diagnosis, histological type, diagnostic stage in detail. We compared incidences of recent 5 years (from 2008 to 2012) with those of previous 5 years (from 2003 to 2007).Results:On average from 2003 to 2012, 1105 new cases of head and neck cancer were diagnosed in Shanghai each year, with 2.08% among the total cancer cases. The crude rate was 8.01 per 100000 and the age-standardized rate was 4.45 per 100000. Nasopharyngeal cancer was the major subtype of the head and neck cancer, with 50.81% among the total head and neck cases. The crude and age-standardized rates among males were higher than those among females. The histologically verified percentage was 85.77%. The squamous carcinoma was the major histological type, with 57.58% among the total cases. The age-stan-dardized rate of nasopharyngeal cancer was in decline.Conclusion:The incidence of head and neck cancer was low in Shanghai during the past 10 years. Male cases were more than female cases. The major histological type was squamous carcinoma. Half of new cases were nasopharyngeal cancer which appeared to affect patients at a relatively young age. Patients with nasopharyngeal cancer were diagnosed at relatively advanced stages.

Incidence trend of malignant tumors in children in Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the incidence trend of malignant tumors in children aged <15 years in Shanghai.</p><p><b>METHODS</b>The <15 years old children diagnosed with cancer in Shanghai between 2009 and 2011 were included in this study. The types of malignant tumors were classified according to International Classification of Childhood Cancer, Version 3 (ICCC-3). The gender and age specific incidences of malignant tumors were analyzed. Software Joinpoint was used to calculate the annual percentage of childhood cancer cases.</p><p><b>RESULTS</b>A total of 460 cases of childhood cancer were diagnosed in Shanghai during 2009-2011, accounting for 0.3% of total cancer cases. The crude incidence was 129.0 per million and the age standardized rate (ASR) was 129.6 per million. The ASR was higher in boys (142.1 per million) than in girls (116.4 per million). The boy to girl ratio was 1.2(95%CI: 1.0-1.5). The incidence was highest in age group <5 years (165.1 per million). The incidences in age groups 5-9 years and 10-14 years were 101.2 per million and 113.9 per million, respectively. Leukemia was the most common cancer in children (n=165, 35.9%, ASR: 47.0 per million), followed by central nervous system tumors (n=91, 19.8%, ASR: 25.6 per million) and lymphomas (n=45, 9.8%, ASR: 12.6 per million). The age and gender specific incidence of malignant tumors and the type specific incidence of malignant tumors in children in Shanghai had no significant changes during the study period.</p><p><b>CONCLUSIONS</b>The incidence of malignant tumors was higher in boys than in girls in Shanghai. Leukemia, central nervous system tumors and lymphomas were the three most common cancers in children. The overall incidence of malignant tumors in children in Shanghai had no significant changes during 2002-2011.</p>

Survival analysis of patients with gastric cancer in Shanghai / 中国癌症杂志

Background and purpose:Incidence and mortality of gastric cancer have increased gradually in China. Population-based cancer survival rate can relfect improvements in cancer diagnosis and treatment, as well as provide evidence for gastric cancer prevention and control.Methods:Data from gastric cancer incidence and follow-up between 2002 and 2006 were collected by the Shanghai Cancer Registry. Life table and EdererⅡ were used to calculate observed survival (OS) and relative survival (RS).Results:A total number of 28 243 gastric cancer cases were documented between 2002 and 2006 in Shanghai. The 5-year OS and RS of gastric cancer were 32.15% and 45.81%, respectively. Survival rates of gastric cancer varied by age, residence, diagnostic stage, and tumor histological type, but not by gender. Patients aged 35-44 years who were diagnosed at stageⅠ or with tubular adenocarcinoma, had the highest survival rates. Moreover, patients in rural areas had higher 5-year OS than those in urban areas. During the period 2002-2006,both 5-year OS and RS of gastric cancer increased dramatically, as compared with 1972-1976. Conclusion:Survival rates of gastric cancer varied by age, residence, diagnostic stage, and tumor histological type. The 5-year OS and RS signiifcantly increased in Shanghai over the past three decades, but are still far below developed countries. Early diagnosis of gastric cancer would be an effective strategy to improve survival and prognosis of patients with gastric cancer.

Survival analysis of liver cancer between 2002 and 2006 in Shanghai / 中国癌症杂志

Background and purpose:China is a high incidence area of liver cancer. The latest monitoring data in Shanghai show that liver cancer is one of the most common cancers with very high disease burden. This study aimed to describe and analyze the population-based survival rates of patients with liver cancer in Shanghai.Methods:Data of liver cancer cases diagnosed between 2002 and 2006, including follow-up information and death report, were collected from Shanghai Cancer Registry. Life table and Ederer Ⅱ were used to calculate observed survival (OS) and relative survival (RS). The related demographic characteristics and status were also analyzed to relfect the survival situations of the liver cancer survivors in major areas of Shanghai.Results:In this study, 20 702 liver cancer cases were included in analysis. Five-year OS rate for liver cancer was 11.72%, whereas RS rate was 15.45%. The OS of male liver cancer patients was higher than that of female patients. Patients whose age ranged from 0-34 years had the highest survival rates than patients from other age groups. The survival of patients with hepatocellular carcinoma was higher than that of patients with other histologic types of liver cancer. Signiifcant difference in survival had also been found among patients with various stages of liver cancer. The survival rate of patients with stageⅠliver cancer was much higher than that of patients with stageⅢ andⅣ liver cancers. There was no signiifcant difference in the survival of liver cancer patients between urban and rural residents. Over the past 3 decades, the 5-year OS increased dramatically in Shanghai. Conclusion:The survival of patients with liver cancer in Shanghai is improved signiifcantly. The prognosis is poor compared with other common malignant tumors. It is necessary to strengthen the risk factors and high-risk population control and intervention in the future.

Colorectal cancer survival analysis in major areas in shanghai China / 中国癌症杂志

Background and purpose:The incidence and mortality of colorectal cancer increased gradually in China, cancer survival rate plays an important role in guiding cancer prevention and treatment.Methods:Data of colorectal cancer cases diagnosed during 2002-2006, follow-up information and death report were from Shanghai Cancer Registry, Life Table and EdererⅡ were used to calculate observed survival (OS) and relative survival (RS), the related demographic characteristics and status were also analyzed to relfect the survival situations of the colorectal cancer survivors in major areas in Shanghai.Results:In this study, 16 682 colon cancer cases and 11 906 rectum cancer cases were included in analysis, 5-year OS rates for colon cancer and rectum cancer were 48.84% and 51.65%, RS rates were 70.50% and 71.31%. Signiifcant difference in survival had been found among the various diagnostic stages, the survival rate in stageⅠ was much higher than those in stageⅢ and stageⅣ. The survival of colorectal cancer patients with different gender, age, tumor histological and residential areas were also found with differences, female was higher than male, age ranged from >44-54 years had the highest survival rates than other age groups. The survival of epithelial tumors was higher than other histologic types in colon cancer, and the survival of non-epithelial tumors was higher than other histologic types in rectum cancer. Over the past 3 decades, the 5-year OS increased dramatically in Shanghai. Conclusion:The level of survival of colorectal cancer in Shanghai is similar with it in developed counties. Colorectal cancer survival rate with different population characteristics may provide suggestions and evidence for further improvement of early screening, diagnosis and treatment.

Long-term survival analysis of different breast cancer molecular subtypes: Shanghai Breast Cancer Survival Study / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the survival of breast cancer molecular subtypes and to examine the effect of therapy on the long-term prognosis of different subtypes.</p><p><b>METHODS</b>This study included 3 586 breast cancer patients with estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) information in Shanghai Breast Cancer Survival Study, a population-based prospective cohort study established in 2002. Molecular subtypes, based on immunohistochemistry were categorized as follows: Luminal A, Luminal B, HER2, and triple-negative subtype. Characteristics and clinical data were collected through questionnaires and medical records at baseline survey and sequential follow-up surveys. Survival rates of different molecular subtypes were analyzed and compared with Log-rank tests. Multiple Cox regression models were used to evaluate the effect of therapy on long-term prognosis of different molecular subtypes.</p><p><b>RESULTS</b>Among the 3 586 cases, Luminal A, Luminal B, HER2 and triple-negative breast cancer subtypes accounted for 54.5%, 16.6%, 13.9%, and 14.9%, respectively. With a median follow-up of 10.3 years (ranging 0.6 to 12.8 years), the 10-year overall survival (OS) rates for the four subtypes were 82.7% (95% CI: 80.9% to 84.4%), 77.7% (95% CI: 74.1% to 80.8%), 76.3% (95% CI: 72.3% to 79.8%), and 74.8% (95% CI: 70.9% to 78.3%), respectively. The 10-year disease to free survival (DFS) rates were 79.0% (95% CI: 76.7% to 81.0%), 76.0% (95% CI: 71.9% to 79.5%), 73.6% (95% CI: 68.9% to 77.7%), and 74.5% (95% CI: 69.4% to 78.9%), respectively. Significant difference in survival among four subtypes was observed (Log-rank test, P<0.01). Multivariate Cox regression indicated that hormonal therapy can significantly reduce the long-term risk of total mortality and recurrence breast cancer specific mortality among Luminal A subtype patients. Adjuvant chemotherapy could improve the long-term prognosis of triple-negative breast cancer. No benefit from radiotherapy was observed for four subtypes of breast cancer in terms of long-term prognosis.</p><p><b>CONCLUSIONS</b>Molecular subtypes based on ER/PR/HER2 could provide important information to predict breast cancer prognosis. The hormonal status was an important basis for individualized therapy and precision medicine.</p>

Lung cancer in young patients aged from 15 to 44 years:incidence trend, current status and survival analysis from 2002 to 2005 / 肿瘤

Objective:To analyze the incidence trend, current status and survival period of young patients with lung cancer aged from 15 to 44 years in Shanghai between 2002 to 2005. Methods:All the data were collected from the database of registration and ma-nagement system of diagnosed cancer cases in Shanghai city organized by Shanghai Municipal Center for Disease Control & Prevention. The incidence trend was analyzed by using APC(annual percent change)model. The survival period and median survival time were calculated by using SPSS 12.0 software and life table method. The univariate and multivariate analyses were analyzed by using Kaplan-Meier and COX regression model, respectively.Results:A total of 972 young patients with lung cancer who aged from 15 to 44 years were diagnosed in Shanghai between 2002 and 2005, accounting for 3.09% of the whole percentage of adenocarcinoma in young patients was higher than that in whole lung cancer population at the same period, while the TNM stage was not significantly different between male and female young patients. Multivariate analysis demonstrated that gender, pathological classification and TNM stage were independent prognostic factors for young patients with lung cancer. Conclusion:The lung cancer had different characteristics in young patients compared with that in whole lung cancer population in Shanghai city. It was necessary to further investigate the biologic behavior of lung cancer in young patients.

The understanding of cancer pain by medical doctors and its therapeutic status in Shanghai-a survey in 2007 / 肿瘤

Objective:To investigate the understanding of cancer pain by medical doctors and its therapeutic status in Shanghai. Methods:We recruited 1 982 medical physicians from 106 secondary and tertiary hospitals in Shanghai city from January to March in 2007. The understanding and the therapeutic status of cancer pain were investigated by conducting a questionnaire survey and the results were statistically analyzed.Rusults:There were 52.3% physicians who believed that they understand the treatment protocol of the Three-step Analgesic Ladder regimen. The rate increased by 21.6 percentage point compared with the results in 1999. The understanding degree of oncologists was significantly better than non-oncologists. There were 16.8% physicians giving the correct answers on the three main principles of the dosage titration in analgesic management. The correct rate of oncologists was significantly higher than that of non-oncologists. Opium with strong analgesic effect had become the first choice for severe cancer pain, and the use of pethidine (Dolantin) for severe cancer pain decreased significantly.The pain was significantly relieved in 74.8% patients. The pain-relieving rate increased by 25.4 percentage point compared with the results in 1999. There were 81.1% medical doctors confirming the effect of pain treatment and among them oncologists were more optimistic to therapeutic outcome than others. There were 93.3% physicians who agreed that it was necessary to carry out the standardized training of cancer pain treatment and the requirement of non-oncologists were much emergent. The over-strict controls by the hospitals and the regulations were the main obstacles for using analgesic drugs.Conclusion:The understanding of medical doctors and the diagnostic and therapeutic levels of cancer pain were improved significantly compared with those in 1999. But more training of cancer pain treatment are still required to publicize the standardized therapy and overcome the obstacles of using analgesic drug.