2017 Vol.29(1)

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Original Article
Cancer incidence and mortality in China in 2013: an analysis based on urbanization level
Wanqing Chen, Rongshou Zheng, Siwei Zhang, Hongmei Zeng, Tingting Zuo, Changfa Xia, Zhixun Yang, Jie He
2017, 29(1): 1-10. doi: 10.21147/j.issn.1000-9604.2017.01.01
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ObjectiveTo explore the cancer patterns in areas with different urbanization rates (URR) in China with data from 255 population-based cancer registries in 2013, collected by the National Central Cancer Registry (NCCR).MethodsThere were 347 cancer registries submitted cancer incidence and deaths occurred in 2013 to NCCR. All those data were checked and evaluated based on the NCCR criteria of data quality, and qualified data from 255 registries were used for this analysis. According to the proportion of non-agricultural population, we divided cities/counties into 3 levels: high level, with URR equal to 70% and higher; median level, with URR between 30% and 70%; and low level, with URR equal to 30% and less. Cancer incidences and mortalities were calculated, stratified by gender and age groups in different areas. The national population of Fifth Census in 2000 and Segi’s population were applied for age-standardized rates.ResultsQualified 255 cancer registries covered 226,494,490 populations. The percentage of cases morphologically verified (MV%) and death certificate-only cases (DCO%) were 68.04% and 1.74%, respectively, and the mortality to incidence rate ratio (M/I) was 0.62. A total of 644,487 new cancer cases and 399,275 cancer deaths from the 255 cancer registries were submitted to NCCR in 2013. The incidence rate was 284.55/100,000 (314.06/100,000 in males, 254.19/100,000 in females), and the age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 190.10/100,000 and 186.24/100,000 with the cumulative incidence rate (0−74 age years old) of 21.60%. The cancer mortality was 176.28/100,000 (219.03/100,000 in males, 132.30/100,000 in females), and the age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 110.91/100,000 and 109.92/100,000, and the cumulative mortality rate (0−74 age years old) was 12.43%. Low urbanization areas were high in crude cancer incidence and mortality rates, middle urbanization areas came next to it followed by high urbanization areas. After adjusted by age, there was a U-shaped association between age-standardized incidence (ASIRC and ASIRW) and the urbanized ratio with the middle urbanization areas having the lowest ASIRC and ASIRW. Unlike with the age-standardized incidence, the sort order of age-standardized mortality (ASMRC and ASMRW) among three urbanization areas was reversed completely from the crude mortality. Lung cancer was the most common cancer in all areas of 255 cancer registries, followed by stomach cancer, liver cancer, colorectal cancer and esophageal cancer with new cases of 130,700, 76,200, 63,800, 60,900 and 50,200 respectively. Lung cancer was also the leading cause of cancer death in all areas of 255 cancer registries for both males and females with the number of deaths of 72,200 and 34,100, respectively. Other cancer types with high mortality in males were liver cancer, stomach cancer, esophageal cancer and colorectal cancer. In females, stomach cancer was the second cause of cancer death, followed by liver cancer, colorectal cancer and breast cancer.ConclusionsAlong with the development of socioeconomics associated with urbanization, as well as the aging population, the incidence and mortality keep increasing in China. Cancer burden and patterns are different in each urbanization level. Cancer control strategies should be implemented referring to local urbanization status.
Influencing factors of inpatient expenditure pattern for cancer in China, 2015
Lan Lan, Yue Cai, Tao Zhang, Ruixian Wu, Ming Xue, Qun Meng
2017, 29(1): 11-17. doi: 10.21147/j.issn.1000-9604.2017.01.02
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ObjectiveWe analyzed the proportion of cancer-caused hospitalization expenses in total hospitalization expenses from national authoritative data and explored influencing factors of the proportion so as to provide effective data information for more rational utilization of health resources.MethodsTwo-level lineal regression model was used to explore influencing factors of ratios of the cancer inpatient expenditure over the total inpatient expenditure of hospitals in China in 2015. A total of 40.76 million inpatient medical records were used to generate the outcome variables, while the explanatory variables were from hospital information database and China Health and Family Planning Statistical Yearbook and literatures.ResultsInpatient expenditure pattern for cancer (IEPC) varied largely across provinces, ranging from 3.03% to 19.61%. The major sources of variability were from the differences of hospital level and number of beds. There was homogeneity within a province, while heterogeneity between the provinces. Rising one level of the hospital led to the increase of 0.475 natural logarithm units of IEPC averagely. The number of beds increasing 1,000 each made the natural logarithm of IEPC increase one unit averagely.ConclusionsOur study showed that a considerable proportion of IEPC variation could be explained by the differences of hospital level and number of beds. It implied that it is possible to estimate disease-specific ratio of inpatient expense taking into account key influencing factors in China. Furthermore, this study is an input to economic and financial analyses and provides evidence for future study on the national economic burden of cancer.
Clinical characteristics and response to tyrosine kinase inhibitors of patients with non-small cell lung cancer harboring uncommon epidermal growth factor receptor mutations
Yan Zhang, Zheng Wang, Xuezhi Hao, Xingsheng Hu, Hongyu Wang, Yan Wang, Jianming Ying
2017, 29(1): 18-24. doi: 10.21147/j.issn.1000-9604.2017.01.03
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ObjectiveTo investigate the clinical features of patients with non-small cell lung cancer (NSCLC) harboring uncommon epidermal growth factor receptor (EGFR) mutations, and the treatment outcomes of EGFR tyrosine kinase inhibitors (TKIs) in these patients.MethodsWe retrospectively analyzed the data of 128 NSCLC patients pathologically diagnosed with uncommon EGFR mutation in the Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College and Beijing Hospital from January 2010 to December 2015, including 40 advanced patients who received EGFR-TKI.ResultsAmong the total 128 patients, 11 patients were non-adenocarcinoma, including squamous carcinoma (3.9%), adenosquamous carcinoma (2.3%), large cell carcinoma (0.8%), and composite neuroendocrine carcinoma (1.6%). Single mutations accounted for 75.0% (96/128), including G719X (29.7%), S768I (18.0%), 20 exon insertion (13.3%), L861Q (12.5%), De novo T790M (0.8%), and T725 (0.8%). Thirty-two patients harbored complex mutations. Forty advanced patients received EGFR-TKI, the objective response rate (ORR) was 20.0%, the disease control rate (DCR) was 85.0%, and the progression-free survival (PFS) was 6.4 [95% confidence interval (95% CI), 4.8−7.9] months. The exploratory analysis of tumor response and PFS in 33 patients with G719X/S768I/L861Q subtypes showed that ORR was 21.2% (7/33), the DCR was 93.9% (31/33), and PFS was 7.6 (95% CI, 5.8−9.4) months. Patients with exon 20 insertion mutation and De novo T790M experienced rapid disease progression with PFS no more than 2.7 months.ConclusionsUncommon EGFR-mutant NSCLCs are heterogeneous, EGFR-TKIs can have different efficacy in this specific subtype, and thus further individual assessment is required for each case.
MAGI1 inhibits migration and invasion via blocking MAPK/ERK signaling pathway in gastric cancer
Shuqin Jia, Jiajia Lu, Tingting Qu, Yi Feng, Xiaohong Wang, Caixia Liu, Jiafu Ji
2017, 29(1): 25-35. doi: 10.21147/j.issn.1000-9604.2017.01.04
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ObjectiveTo explore the association of membrane-associated guanylate kinase inverted 1 (MAGI1) with gastric cancer (GC) and the related molecular mechanisms.MethodsThe reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC) were utilized to measure the MAGI1 expression level in GC tissues. Quantitative real-time PCR and Western blotting were used to ensure the MAGI1 expression in GC cell lines. Small hairpin RNA (shRNA) was applied for knockdown of endogenous MAGI1 in GC cells. MTT assay and colony formation assay, scratch wounding migration assay and transwell chamber migration assay, as well as transwell chamber invasion assay were employed respectively to investigate the GC cell proliferation, migration and invasion in MAGI1-knockdown and control GC cells. The potential molecular mechanism mediated by MAGI1 was studied using Western blotting and RT-PCR.ResultsRT-PCR and IHC verified MAGI1 was frequently expressed in matched adjacent noncancerous mucosa compared with GC tissues and the expression of MAGI1 was related to clinical pathological parameters. Functional assays indicated that MAGI1 knockdown significantly promoted GC cell migration and invasion. Further mechanism investigation demonstrated that one pathway of MAGI1 inhibiting migration and invasion was mainly by altering the expression of matrix metalloproteinases (MMPs) and epithelial-mesenchymal transition (EMT)-related molecules via inhibiting MAPK/ERK signaling pathway.ConclusionsMAGI1 was associated with GC clinical pathological parameters and acted as a tumor suppressor via inhibiting of MAPK/ERK signaling pathway in GC.
Prognostic factors for transarterial chemoembolization combined with sustained oxaliplatin-based hepatic arterial infusion chemotherapy of colorectal cancer liver metastasis
Hangyu Zhang, Jianhai Guo, Song Gao, Pengjun Zhang, Hui Chen, Xiaodong Wang, Xiaoting Li, Xu Zhu
2017, 29(1): 36-44. doi: 10.21147/j.issn.1000-9604.2017.01.05
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ObjectiveTo investigate the prognostic factors in chemorefractory colorectal cancer liver metastasis (CRCLM) patients treated by transarterial chemoembolization (TACE) and sustained hepatic arterial infusion chemotherapy (HAIC). MethodsBetween 2006 and 2015, 162 patients who underwent 763 TACE and HAIC in total were enrolled in this retrospective study, including 110 males and 52 females, with a median age of 60 (range, 26−83) years. Prognostic factors were assessed with Log-rank test, Cox univariate and multivariate analyses. ResultsThe median survival time (MST) and median progression-free survival (PFS) of the 162 patients from first TACE/HAIC were 15.6 months and 5.5 months respectively. Normal serum carbohydrate antigen 19-9 (CA19-9, <37 U/mL) (P<0.001) and carbohydrate antigen 72-4 (CA72-4, <6.7 U/mL) (P=0.026), combination with other local treatment (liver radiotherapy or liver radiofrequency ablation) (P=0.034) and response to TACE/HAIC (P<0.001) were significant factors related to survival after TACE/HAIC in univariate analysis. A multivariate analysis revealed that normal serum CA19-9 (P<0.001), response to TACE/HAIC (P<0.001) and combination with other local treatment (P=0.001) were independent factors among them. ConclusionsOur findings indicate that serum CA19-9 <37 U/mL and response to TACE/HAIC are significant prognostic indicators for this combined treatment, and treated with other local treatment could reach a considerable survival benefit for CRCLM. This could be useful for making decisions regarding the treatment of CRCLM.
Upregulation of kazrin F by miR-186 suppresses apoptosis but promotes epithelial-mesenchymal transition to contribute to malignancy in human cervical cancer cells
Chang Liu, Jinghua Wang, Yang Hu, Hong Xie, Min Liu, Hua Tang
2017, 29(1): 45-56. doi: 10.21147/j.issn.1000-9604.2017.01.06
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ObjectivePrevious studies have identified that kazrin is a constituent of desmosome and influences intercellular adhesion, growing development and morphology. We previously cloned another new isoform, kazrin F and found that it has anti-apoptotic effects on human glioma cell line. To further explore whether kazrin F is involved in tumorigenesis, we investigated its expression and role in cervical cancer (CC) cells. MethodsThe role of kazrin F and miR-186 in CC was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, colony formation, transwell, and apoptosis assays. Using enhanced green fluorescent protein (EGFP) reporter assays, reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blot analysis, we identified kazrin F post-transcriptional regulation by miR-186.ResultsWe demonstrate that kazrin F is highly expressed in CC tissues compared with the adjacent noncancerous tissues and promotes cell proliferation, colony formation, migration and invasion in HeLa and C33A cells by suppressing apoptosis and facilitating epithelial-to-mesenchymal transition (EMT). Furthermore, miR-186 was confirmed as a regulator of kazrin F dysregulation. An EGFP reporter assay proved that miR-186 directly targets the 3'-untranslated region (3'UTR) of kazrin F and downregulates its expression, and miR-186 expression showed an inverse correlation with kazrin F levels in CC tissues. In addition, overexpression of miR-186 suppressed the malignant behaviors of CC cells. The ectopic expression of kazrin F rescued the inhibitory effects of miR-186. ConclusionsOur findings indicate that the upregulation of kazrin F due to downregulated miR-186 levels contributes to malignancy, and highlight the significance of kazrin F in CC tumorigenesis.
Extranodal involvement in young patients with diffuse large B-cell lymphoma: distribution, prognostic value and treatment options
Shuna Yao, Junbo Li, Zhihua Yao, Yuanlin Xu, Junfeng Chu, Jiuyang Zhang, Shuiling Jin, Yangyang Huang, Jianbo Zhang, Jie Ma, Yan Zhao, Shujun Yang, Yanyan Liu
2017, 29(1): 57-65. doi: 10.21147/j.issn.1000-9604.2017.01.07
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ObjectiveExtranodal involvement represents a peculiar presentation of diffuse large B-cell lymphoma (DLBCL). Previous studies have suggested that older patients are more prone to extranodal involvement. This study retrospectively addressed the distribution, prognostic value and treatment options of extranodal involvement in young patients with DLBCL.MethodsA total of 329 patients were enrolled according to the inclusion requirements. The effects of gender, extranodal involvement, age-adjusted international prognostic index (aaIPI), rituximab infusion and radiotherapy on patient outcomes were evaluated.ResultsAmong these patients, 59% presented extranodal involvement in 16 anatomic sites. More than one instance was linked to many poorer clinical characteristics and poorer survival compared with either nodal disease or one instance. In patients with one extranodal lesion, multivariate analysis revealed that the site of extranodal involvement, but not the aaIPI or rituximab infusion, was independently related to the outcome, and radiotherapy had a negative influence on survival.ConclusionsExtranodal involvement is common in younger patients and exhibits a ubiquitous distribution. The site of extranodal involvement is of strong prognostic significance. Radiotherapy for extranodal lesions does not improve patient outcomes.
PEG-asparaginase in BFM-90 regimen improves outcomes in adults with newly diagnosed lymphoblastic lymphoma
Wen Zheng, Hanyun Ren, Xiaoyan Ke, Mei Xue, Yongqing Zhang, Yan Xie, Ningjing Lin, Meifeng Tu, Weiping Liu, Lingyan Ping, Zhitao Ying, Chen Zhang, Lijuan Deng, Xiaopei Wang, Yuqin Song, Jun Zhu
2017, 29(1): 66-74. doi: 10.21147/j.issn.1000-9604.2017.01.08
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ObjectiveAlthough L-asparaginase (L-ASP) is a standard treatment for lymphoblastic lymphoma (LBL), hypersensitivity reactions by some patients limit its application. Polyethylene glycol-conjugated asparaginase (PEG-ASP) has a lower immunogenicity and is a standard treatment in all pediatric acute lymphoblastic leukemia (ALL). In this study, we investigated the efficacy and toxicity of PEG-ASP instead of L-ASP as used in the BFM-90 regimen (PEG-ASP-BFM-90) for adult LBL.MethodsBetween June 2012 and July 2015, we treated 30 adult patients with newly diagnosed LBL, using PEG-ASP-BFM-90 in a prospective, multicenter and single-arm clinical study at 5 participating institutions in China.ResultsAll the 30 patients, including 19 males and 11 females with a median age of 30 (range: 18−62) years, completed 128 times of the PEG-ASP, with the median of 4 (range: 2−6) times. Patients did not receive radiotherapy at this time. The overall response rate was 86.7% (26/30), with 50.0% (15/30) complete response and 36.7% (11/30) partial response. The 3-year overall survival was 46.0% [95% confidence interval (95% CI), 28.2%−64.8%], and the 3-year progression-free survival was 43.0% (95% CI, 25.7%−62.0%). Major adverse events were myelosuppression, reduced fibrinogen, liver dysfunction and digestive tract toxicities. No allergic reaction and no treatment-related mortality or severe complications were recorded.ConclusionsOur clinical data and observed outcomes indicate that 1 dose of PEG-ASP can replace multiple doses of native L-ASP in BFM-90, with predominantly grade 3−4 neutropenia for adult LBL, and no therapy-related deaths. The effect is similar to previous reports of PEG-ASP-containing regimens for adult ALL. Major advantages include less serious allergic reactions, 2−3 weeks of action duration, and convenience for patients and physicians.
Attitudes towards pain management in hospitalized cancer patients and their influencing factors
Fangli Lou, Shaomei Shang
2017, 29(1): 75-85. doi: 10.21147/j.issn.1000-9604.2017.01.09
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ObjectiveTo investigate patients' attitudes towards cancer pain management and analyze the factors influencing these attitudes.MethodsThe self-developed Demographic and Disease-Related Information Questionnaires, Pain Management Barriers Questionnaire-Taiwan form (BQT), and Pain Knowledge Questionnaire were administered to 363 pairs of hospitalized cancer patients and their caregivers from the oncology departments of 7 hospitals in Beijing, China.ResultsThe average patient score for attitudes towards pain management was 2.96±0.49. The dimension scores indicated good attitudes in three areas (scores <2.5), "Desire to be good" (2.22±1.04), "Fatalism" (2.08±0.81) and "Religious fatalism" (1.86±1.00), and poor attitudes in six areas (scores ≥2.5), "Tolerance" (3.83±0.96), "Use of analgesics as needed (p.r.n.)" (3.73±1.01), "Addiction" (3.44±1.05), "Disease progression" (3.28±1.26), "Distraction of physicians" (3.16±1.07) and "Side effects" (2.99±0.68). Two factors were entered into the regression equation: the caregivers' attitudes towards cancer pain management and the patients' pain knowledge. These two factors explained 23.2% of the total variance in the patients' average scores for their attitudes towards cancer pain management.ConclusionsThe patients' attitudes towards cancer pain management were poor and could be influenced by the caregivers' attitudes and the patients' pain knowledge, and thus need to be improved.
Review Article
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in treatment of gastric cancer with peritoneal carcinomatosis
Lynne M. Ellison, Yangao Man, Alexander Stojadinovic, Hongwu Xin, Itzhak Avital
2017, 29(1): 86-92. doi: 10.21147/j.issn.1000-9604.2017.01.10
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Although gastric cancer with peritoneal carcinomatosis is associated with poor prognosis and is generally treated with palliative systemic therapy, recent studies have shown that cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may prove to be an efficacious treatment option. In addition to reviewing the natural history of gastric cancer with peritoneal carcinomatosis, this mini-review examines literature on the efficacy of CRS and HIPEC as compared to chemotherapy and surgical options. Both randomized and non-randomized studies were summarized with the emphasis focused on overall survival. In summary, CRS and HIPEC are indeed a promising treatment option for gastric cancer with peritoneal carcinomatosis and large randomized clinical trials are warranted.