Population-based survival for childhood cancer patients diagnosed during 2002-2005 in Shanghai, China.

BACKGROUND: There have been no population-based studies on cancer survival among children aged 0-14 years in China. In this study, we aimed to characterize the cancer survival among children in Shanghai. PROCEDURE: Childhood cancer cases registered by the Shanghai Cancer Registry between 2002 and 2005 and enrolled in the Shanghai Childhood Survival Study were included in this study. We used Kaplan-Meier product-limit method for survival analysis and Cox proportional hazards models for investigating the effects of various prognostic factors. RESULTS: The median follow-up time was 5.4 years (range 0-8.9 years). The 5-year observed survival for all childhood cancers combined was 55.7% (95% CI: 51.7-59.6%). For leukemia, lymphoma, and central nervous system tumors, the three most common types of childhood cancer, 5-year survival rates were 52.2%, 58.8%, and 41.2%, respectively. Higher 5-year survival rates were observed for epithelial cancer (88.9%), malignant renal tumors (86.7%), germ cell and other gonadal tumors (78.4%), and retinoblastoma (75.0%). Cancers with poor prognosis included sympathetic nervous system tumors (57.9%), soft tissue sarcoma (54.1%), bone tumors (52.6%), and liver cancer (33.3%). There were no significant differences between survival rates by gender and age groups. Compared with those reported in the USA and Europe, the survival rates for all cancers combined and the three most common types in Shanghai were lower. CONCLUSIONS: The survival rate for children aged 0-14 diagnosed with cancer in Shanghai during 2002-2005 was at the medium level. There was a substantial survival difference from childhood cancers between Shanghai and specific developed countries.

Improved risk scoring systems for colorectal cancer screening in Shanghai, China.

BACKGROUND: An optimal risk-scoring system enables more targeted offers for colonoscopy in colorectal cancer (CRC) screening. This analysis aims to develop and validate scoring systems using parametric and non-parametric methods for average-risk populations. METHODS: Screening data of 807,695 subjects and 2806 detected cases in the first-round CRC screening program in Shanghai were used to develop risk-predictive models and scoring systems using logistic-regression (LR) and artificial-neural-network (ANN) methods. Performance of established scoring systems was evaluated using area under the receiver operating characteristic curve (AUC), calibration, sensitivity, specificity, number of high-risk individuals and potential detection rates of CRC. RESULTS: Age, sex, CRC in first-degree relatives, chronic diarrhoea, mucus or bloody stool, history of any cancer and faecal-immunochemical-test (FIT) results were identified as predictors for the presence of CRC. The AUC of LR-based system was 0.642 when using risk factors only in derivation set, and increased to 0.774 by further incorporating one-sample FIT results, and to 0.808 by including two-sample FIT results, while those for ANN-based systems were 0.639, 0.763 and 0.805, respectively. Better calibrations were observed for the LR-based systems than the ANN-based ones. Compared with the currently used initial tests, parallel use of FIT with LR-based systems resulted in improved specificities, less demands for colonoscopy and higher detection rates of CRC, while parallel use of FIT with ANN-based systems had higher sensitivities; incorporating FIT in the scoring systems further increased specificities, decreased colonoscopy demands and improved detection rates of CRC. CONCLUSIONS: Our results indicate the potentials of LR-based scoring systems incorporating one- or two-sample FIT results for CRC mass screening. External validation is warranted for scaling-up implementation in the Chinese population.

Interaction of two functional genetic variants LOXL1 rs1048661 and VEGFA rs3025039 on the risk of age-related macular degeneration in Chinese women.

BACKGROUND: Cumulative evidence indicates that LOXL1 and VEGF-a play important roles in extracellular matrix formation and angiogenesis, respectively. The disorder of extracellular matrix and angiogenesis are the key factors of pathogenesis of age-related macular degeneration (AMD). We hypothesized that rs1048661 (T>G) in the LOXL1 gene and rs3025039 (C>T) in the VEGFA gene might be associated with risk of AMD. METHODS: A total of 533 unrelated Chinese subjects, 286 cases (247 with early AMD and 39 with late neovascular AMD) and 247 controls, were included in the study. The gene sequences of LOXL1 rs1048661 and VEGFA rs3025039 were amplified by polymerase chain reaction and genotyped. Interaction between rs1048661 and rs3025039 on AMD risk was also assessed. RESULTS: LOXL1 rs1048661 but not VEGFA rs3025039 was associated with a significantly increased risk of AMD. The adjusted odds ratio was 1.6 (95% CI, 1.1-2.5) for rs1048661 TT + GT genotype compared with GG homozygotes in the dominant model analysis. Moreover, there was a significant gene-gene interaction between these two polymorphic loci. In VEGFA rs3025039 CC + CT genotype which indicated sufficient expression of VEGF-a, LOXL1 rs1048661 had odds ratios of 1.7 (95% CI, 1.1-2.7) for early AMD and 3.6 (95% CI, 1.1-12.3) for late neovascular AMD in the dominant model analysis. However, LOXL1 rs1048661 did not confer the risk of AMD in subjects harboring VEGFA rs3025039 TT genotype which indicated decreased expression of VEGF-a. CONCLUSIONS: Our findings suggest that LOXL1 rs1048661 (T>G) may be involved in the risk of AMD. In addition, LOXL1 rs1048661 and VEGFA rs3025039 interacted to confer the development of AMD, especially for late-stage neovascular AMD. Our data need to be further validated.

[Recent incidences and trends of childhood malignant solid tumors in Shanghai, 2002-2010].

OBJECTIVE: To examine the recent incidences and trends of childhood malignant solid tumors in Shanghai. METHOD: Data from the population-based Shanghai Cancer Registry and related retrospective survey were used to analyze the patterns of incidence and trends of malignant solid tumors diagnosed between 2002 and 2010 in children aged 0-14 years. The distributions of incidences were described according to gender, age and cancer types which were classified according to International Classification of Childhood Cancer (ICCC). Annual age-standardized rates (ASRs) were adjusted by the world standard population. Approximate confidence intervals for standardized rate ratios (SRR) based Poisson distribution test-based methods were used to assess changes in incidence over the period 2002 - 2006 and 2007 - 2010. RESULT: (1)A total of 868 cases of childhood malignant solid tumors were diagnosed in Shanghai during 2002 - 2010, accounting for 65.8% of all childhood cancers. The ASR of 2002 - 2010 was 80.2 per million for all solid tumors. (2) The ASR was higher in boys (86.3 per million) than in girls (73.8 per million) with SRR 1.2 (95%CI 1.0 - 1.3). Incidence rate was the highest in the first five years of life with 93.4 per million. The age-specific incidence rates in 5 - 9 and 10 - 14 age groups were 65.2 and 79.3 per million, respectively. (3) CNS tumors, lymphomas, germ cell tumors, neuroblastoma, and soft tissue sarcomas were the top 5 most common solid tumors in children, with the incidence rate of 23.8, 11.0, 7.8, 7.7 and 6.8 per million, respectively. The patterns of subgroups varied in different age groups. Blastomas, such as neuroblastoma, retinoblastoma, were more common in the children aged 0 - 4 years, whereas epithelial carcinomas and bone tumors developed more frequently in elder children aged 10 - 14 years. (4) Compared with the ASR in 2002 - 2006, the ASR for both genders in 2007 - 2010 had no substantial changes (78.7 per million in 2002 - 2006 and 82.9 per million in 2007 - 2010). However, among boys, the incidence rate in 2007 - 2010 was significantly higher than that in 2002 - 2006 with SRR 1.2 (95%CI: 1.0 - 1.4). For specific subgroups of cancer, there were no substantial changes. Some cautions should be taken when interpreting results involving a small number of cases per year and those with wide 95% confidence intervals. CONCLUSION: The incidence rate of pediatric malignant solid tumors among males was higher than females during 2002 - 2010, and it differed among different age groups with the highest in the first five years of life. CNS tumor was the most common type of solid tumors in children. This was a unique characteristics comparing with adult reflected in disease spectrum and age of onset. The patterns of incidence and its trends for childhood malignant solid tumors in Shanghai could provide a basis for etiologic research and preventive interventions. The findings also suggest an urgent need for longer population-based surveillance to verify the pattern and changing trends.

[Estimates and prediction of prostate cancer incidence, mortality and prevalence in China, 2008].

OBJECTIVE: To estimate the incidence, mortality and 5-year prevalence of prostate cancer in China, in 2008. METHODS: Data from 36 cancer registries and the Third National Death Survey in China (2004-2005) was used to estimate the incidence, mortality and 5-year prevalence rates of prostate cancer in China in 2008. Mathematical models were used to predict the incidence and mortality of prostate cancer in the next 20 years. RESULTS: In 2008, the incidence of prostate cancer was 33 802 (2.1%), with the incidence rate as 4.3/100 000, which ranked the eighth among all the male cancers. Mortality of prostate cancer in China was 14 297 (1.2%) with the mortality rate of 1.8/100 000, which ranked eleventh among all the male cancers. The 5-year prevalence rate of prostate cancer in China was 75 535 (3.5%) with the proportion of 13.8/100 000, ranking the seventh among all the male cancers. The incidence and mortality of prostate cancer in men before the age of 60 maintained at a low level, but rose rapidly after the age of 60. Data on prediction showed that the incidence and mortality of prostate cancer in China would gradually increase in the next 20 years. CONCLUSION: Both incidence and mortality of prostate cancer in China would keep increasing in the future. Prevention and control programs for prostate cancer should be strengthened.

Interleukin-23: immunological roles and clinical implications.

Increasing evidence has revealed the importance of IL-23, which closely resembles IL-12 both structurally and immunologically, in linking innate and adaptive immunity. IL-23, produced by activated type 1 macrophages and dendritic cells (DC), possesses unique roles in the differentiation and expansion of memory T cells. IL-23 has been associated with several inflammatory diseases such as rheumatoid arthritis, inflammatory bowel disease (IBD) and Helicobacter pylori associated gastritis, mainly due to its capacity to induce a strong Th1 type immune response. IL-23 is also associated with Th17 responses and the cytokine produced by the antigen presenting cells (APC), i.e. IL-12 vs IL-23 determines in part if a response is Th1 or Th17. Recent studies have also associated chronic inflammatory diseases such as IBD, psoriasis and myocardial infarction with polymorphisms of the IL-23 receptor complex. The current review focuses on the immunological role of IL-23 and possible therapeutic avenues for inflammatory diseases.