Chun Ju Chiang
National Taiwan University
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Featured researches published by Chun Ju Chiang.
Journal of Gynecologic Oncology | 2013
Ying Cheng Chiang; Chi-An Chen; Chun Ju Chiang; Tsui Hsia Hsu; Ming Chieh Lin; San Lin You; Wen-Fang Cheng; Mei-Shu Lai
Objective To investigate the changes of incidence and prognosis of epithelial ovarian cancer in thirty years in Taiwan. Methods The databases of women with epithelial ovarian cancer during the period from 1979 to 2008 were retrieved from the National Cancer Registration System of Taiwan. The incidence and prognosis of these patients were analyzed. Results Totally 9,491 patients were included in the study. The age-adjusted incidences of epithelial ovarian cancer were 1.01, 1.37, 2.37, 3.24, 4.18, and 6.33 per 100,000 person-years, respectively, in every 5-year period from 1979 to 2008. The age-specific incidence rates increased especially in serous, endometrioid and clear cell carcinoma, and the age of diagnosis decreased from sixty to fifty years old in the three decades. Patients with mucinous, endometrioid, or clear cell carcinoma had better long-term survival than patients with serous carcinoma (log rank test, p<0.001). Patients with undifferentiated carcinoma or carcinosarcoma had poorer survival than those with serous carcinoma (log rank test, p<0.001). The mortality risk of age at diagnosis of 30-39 was significantly higher than that of age of 70 years or more (test for trend, p<0.001). The mortality risk decreased from the period of 1996-1999 (hazard ratio [HR], 0.90; p=0.054) to the period after 2000 (HR, 0.74; p<0.001) as compared with that from the period of 1991-1995. Conclusion An increasing incidence and decreasing age of diagnosis in epithelial ovarian cancer patients were noted. Histological type, age of diagnosis, and treatment period were important prognostic factors for epithelial ovarian carcinoma.
Clinical Cancer Research | 2011
Kelly J. Yu; Wan Lun Hsu; Ruth M. Pfeiffer; Chun Ju Chiang; Cheng-Ping Wang; Pei-Jen Lou; Yu Juen Cheng; Patti E. Gravitt; Scott R. Diehl; Alisa M. Goldstein; Chien-Jen Chen; Allan Hildesheim
Purpose: Epstein–Barr virus (EBV) infection and a family history of nasopharyngeal carcinoma (NPC) are associated with NPC risk. We examined the risk associated with EBV markers and their clinical utility to identify NPC susceptibles within high-risk NPC families. Experimental Design: We evaluated antibody titers against viral capsid antigen (VCA) IgA, EBV nuclear antigen-1 (EBNA1) IgA, and DNase among unaffected relatives of NPC cases from 358 multiplex families in Taiwan. Incident NPC cases were identified via linkage to the National Cancer Registry. Clinical examinations of 924 individuals were also done to identify occult, asymptomatic NPC. Baseline EBV serology was used to estimate NPC risk using rate ratios with 95% CI. Associated sensitivity/specificity and receiver operating characteristic (ROC) curves were calculated. Results: A total of 2,444 unaffected individuals with 15,519 person-years (6.5 years median follow-up) yielded 14 incident NPC cases (nearly 11 times the general population rate). The absolute rate of NPC among anti-EBV EBNA1 IgA seropositives using a standard positivity cutoff versus an optimized cutoff point defined by ROC analyses was 265/100,000 person-years with a 4.7-fold increased risk of NPC (95% CI: 1.4–16) and 166/100,000 person-years with a 6.6-fold increase (95% CI: 1.5–61), respectively. Sensitivity and specificity using the optimized positivity cutoff points were 85.7% and 51.2%, respectively. It is estimated that active evaluation of 49% of individuals from high-risk NPC families seropositive for this marker could lead to earlier detection of up to 86% of NPC cases. Risks associated with the other three EBV markers were weaker. Conclusions: Future efforts are needed to identify susceptibility markers among high-risk NPC families that maximize both sensitivity and specificity. Clin Cancer Res; 17(7); 1906–14. ©2011 AACR.
Hepatology | 2015
Chun Ju Chiang; Ya-Wen Yang; Jin–De Chen; San Lin You; Hwai I. Yang; M.-H. Lee; Mei-Shu Lai; Chien-Jen Chen
A national viral hepatitis therapy program was launched in Taiwan in October 2003. This study aimed to assess the impact of the program on reduction of end‐stage liver disease (ESLD) burden. Profiles of national registries of households, cancers, and death certificates were used to derive incidence and mortality of ESLDs from 2000 to 2011. Age‐gender–adjusted incidence and mortality rates of hepatocellular carcinoma (HCC) and chronic liver diseases (CLDs) and cirrhosis of adults ages 30‐69 years were compared before and after launching the program using Poissons regression models. A total of 157,570 and 61,823 patients (15%‐25% of those eligible for reimbursed treatment) received therapy for chronic hepatitis B and C, respectively, by 2011. There were 42,526 CLDs and cirrhosis deaths, 47,392 HCC deaths, and 74,832 incident HCC cases occurred in 140,814,448 person‐years from 2000 to 2011. Male gender and elder age were associated with a significantly increased risk of CLDs and cirrhosis and HCC. Mortality and incidence rates of ESLDs decreased continuously from 2000 to 2003 (before therapy program) through 2004‐2007 to 2008‐2011 in all age and gender groups. The age‐gender–adjusted rate ratio (95% confidence interval; P value) in 2008‐2011 was 0.78 (0.76‐0.80; P < 0.001) for CLDs and cirrhosis mortality, 0.76 (0.75‐0.78; P < 0.005) for HCC mortality, and 0.86 (0.85‐0.88; P < 0.005) for HCC incidence using 2000‐2003 as the reference period (rate ratio = 1.0). Conclusions: The national viral hepatitis therapy program has significantly reduced the mortality of CLDs and cirrhosis and incidence and mortality of HCC. (Hepatology 2015;61:1154–1162)
American Journal of Epidemiology | 2011
Wan Lun Hsu; Kelly J. Yu; Yin-Chu Chien; Chun Ju Chiang; Yu Juen Cheng; Jen Yang Chen; Mei Ying Liu; Sheng Ping Chou; San Lin You; Mow Ming Hsu; Pei-Jen Lou; Cheng-Ping Wang; Ji Hong Hong; Yi Shing Leu; Ming Hsui Tsai; Mao Chang Su; Sen Tien Tsai; W. Y. Chao; Luo Ping Ger; Peir Rong Chen; Czau Siung Yang; Allan Hildesheim; Scott R. Diehl; Chien-Jen Chen
In the present study, the authors compared the long-term risk of nasopharyngeal carcinoma (NPC) of male participants in an NPC multiplex family cohort with that of controls in a community cohort in Taiwan after adjustment for anti-Epstein-Barr virus (EBV) seromarkers and cigarette smoking. A total of 43 incident NPC cases were identified from the 1,019 males in the NPC multiplex family cohort and the 9,622 males in the community cohort, for a total of 8,061 person-years and 185,587 person-years, respectively. The adjusted hazard ratio was 6.8 (95% confidence interval (CI): 2.3, 20.1) for the multiplex family cohort compared with the community cohort. In the evaluation of anti-EBV viral capsid antigen immunoglobulin A and anti-EBV deoxyribonuclease, the adjusted hazard ratios were 2.8 (95% CI: 1.3, 6.0) and 15.1 (95% CI: 4.2, 54.1) for those positive for 1 EBV seromarker and positive for both seromarkers, respectively, compared with those negative for both EBV seromarkers. The adjusted hazard ratio was 31.0 (95% CI: 9.7, 98.7) for participants who reported a family history of NPC and who were anti-EBV-seropositive compared with individuals without such a history who were anti-EBV-seronegative. The findings suggest that both family history of NPC and anti-EBV seropositivity are important determinants of subsequent NPC risk and that the effect of family history on NPC risk cannot be fully explained by mediation through EBV serologic responses.
International Journal of Cancer | 2009
Kelly J. Yu; Wan Lun Hsu; Chun Ju Chiang; Yu Juen Cheng; Ruth M. Pfeiffer; Scott R. Diehl; Alisa M. Goldstein; Patti E. Gravitt; Chien-Jen Chen; Allan Hildesheim
Genetic and environmental factors have been implicated in the etiology of nasopharyngeal carcinoma (NPC), a tumor known to be closely associated with Epstein‐Barr virus (EBV) infection. Studies have reported familial aggregation of NPC and have suggested the possible aggregation of NPC and other cancers. We evaluated familial aggregation of cancer in 358 high‐risk families with two or more NPC cases enrolled in a NPC genetics study in Taiwan. Participants were linked to the Taiwan National Cancer Registry to identify incident cancers diagnosed after study enrollment (started in 1996) and before December 31, 2005, or death. In total, 2,870 individuals from the NPC Multiplex Family Study contributed 15,151 person‐years over an average of 5.3 years of follow‐up. One hundred ten incident cancers were identified. Multiple‐primary standardized incidence ratios (MP‐SIRs) were computed to evaluate overall cancer risk associated with infectious agents and with other tumors. The overall MP‐SIR was 1.3 (95% CI: 1.1–1.6), which was largely explained by an excess in NPC (MP‐SIR = 15; 95% CI: 10–23). Exclusion of incident NPC diagnoses led to an overall MP‐SIR of 1.0 (95% CI: 0.83–1.3). Similarly, the observed excess risk of cancers associated with infectious agents (MP‐SIR = 2.0; 95% CI: 1.5–2.6) was driven by the excess in NPC; exclusion of NPC cases led to a reduced MP‐SIR that did not differ from 1.0. Analysis of the largest NPC multiplex family study to date confirms the presence of coaggregation of NPC within families in Taiwan but does not provide evidence for a broader familial syndrome involving NPC and other tumors.
Cancer Epidemiology | 2015
Yen Lin Liu; Wei-Cheng Lo; Chun Ju Chiang; Ya-Wen Yang; Meng-Yao Lu; Wen-Ming Hsu; Wan Ling Ho; Meng-Ju Li; James S. Miser; Dong-Tsamn Lin; Mei-Shu Lai
Studies have found lower risk of childhood cancer among Asian children. We aim to characterize the recent incidence and incidence-trend of childhood cancer in Taiwan after the National Health Insurance program was launched in March 1995. Data were extracted from the Taiwan Cancer Registry, a population-based database established in 1979. Cases diagnosed at age 0-14 from 1996 to 2010 were analyzed and categorized according to the International Classification of Childhood Cancer, Third Edition (ICCC-3). In total, 8032 childhood cancer cases were included, with a microscopic verification rate of 93.9%. The overall age-standardized rate (ASR) of incidence adjusted to the 2000 World Standard Population is 125.0 cases/million, with a male-to-female ratio of 1.3. The top five cancer types (ICCC-3 subgroup[s]; ASR per million) are acute lymphoblastic leukemia (Ia, 30.3), acute myeloid leukemia (Ib; 9.4), non-Hodgkin lymphoma (IIb,c,e, 9.0), extracranial germ cell tumor (Xb,c; 8.3), and neuroblastoma (IVa; 7.8). The median age of diagnosis was 6 years for both genders. During the study period, the ASR of childhood cancer has been increasing at a rate of 1.2% per year (95% confidence interval, 0.6-1.7%). In contrast to Western countries, China, Japan, and Taiwan have lower incidence of childhood cancer; however, Taiwans incidence rates of childhood germ cell tumors and hepatic tumors are higher. In conclusion, this population-based study reveals that the incidence rate of childhood cancer in Taiwan is rising consistently. The high incidence of germ cell tumors warrants further investigation.
Oncologist | 2014
Ching-Hung Lin; Po Ya Chuang; Chun Ju Chiang; Yen Shen Lu; Ann-Lii Cheng; Wen Hung Kuo; Chiun-Sheng Huang; Mei-Shu Lai; San Lin You; Chao Hsiun Tang
BACKGROUND A rapid surge of young-female breast cancer (YFBC) has been observed in Taiwan and other East Asian countries. We recently reported that these cases of YFBC, in contrast to their Western counterparts, are predominantly luminal A subtype. YFBC in Asia may have distinct clinicopathological features and outcomes. METHODS Data collected prospectively by participating hospitals were retrieved from the Taiwan Cancer Database. A total of 15,881 women with newly diagnosed stage I-III breast cancer in 2002-2006 were included. The age at diagnosis was categorized into nine 5-year groups (from <30 years to ≥65 years). Clinicopathological variables and patient disease-free survival (DFS) were compared by age group. RESULTS The rates of stage I, estrogen receptor-positive (ER+), and progesterone receptor-positive breast cancer were higher in the younger patients (<50 years) than in the older patients (≥50 years). Univariate analysis showed that the 40-44 and 45-49 age groups were significantly associated with longer DFS than the other age groups. In the ER+ subgroup, multivariate analysis consistently showed that the 40-44 age group was significantly associated with longer DFS than the other age groups except for the 45-49 age group. In contrast, multivariate analysis of the ER-negative subgroup revealed no significant difference of DFS between the 40-44 age group and other age groups. CONCLUSION Emerging YFBC in Taiwan is uniquely associated with favorable pathological features and better outcomes and should not be regarded as the mirror image of its Western counterpart.
International Journal of Cancer | 2014
Wan Lun Hsu; Yin-Chu Chien; Chun Ju Chiang; Hwai I. Yang; Pei-Jen Lou; Cheng-Ping Wang; Kelly J. Yu; San Lin You; Li Yu Wang; Shu Yuan Chen; Czau Siung Yang; Chien-Jen Chen
The cancer of upper aerodigestive tract (UADT) is a common cancers in the world. However, its lifetime risk by consumption of alcohol, betel and cigarettes remain to be elucidated. This study aimed to estimate lifetime risk of distinct UADT cancers and assess their associations with alcohol, betel and cigarette consumption. Three cohorts of 25,611 men were enrolled in 1982–1992 in Taiwan. The history of alcohol, betel and cigarette consumption was enquired through questionnaire interview. Newly developed UADT cancers were ascertained through computerized linkage with national cancer registry profile. Lifetime (30–80 years old) risk and multivariate‐adjusted hazard ratio (HRadj) of distinct UADT cancers by alcohol, betel and cigarette consumption were estimated. A total of 269 pathologically confirmed cases of UADT cancers were newly‐diagnosed during 472,096 person‐years of follow‐up. The lifetime risk of UADT cancer was 9.42 and 1.65% for betel chewers and nonchewers, 3.22 and 1.21% for cigarette smokers and nonsmokers and 4.77 and 1.85% for alcohol drinkers and nondrinkers. The HRadj (95% confidence interval) of developing UADT cancer was 3.36 (2.51–4.49), 2.02 (1.43–2.84), 1.90 (1.46–2.49), respectively, for the consumption of betel, cigarette and alcohol. Alcohol, betel and cigarette had different effect on cancers at various anatomical sites of UADT. The cancer risk from the mouth, pharynx, esophagus to larynx increased for alcohol and cigarette consumption, but decreased for betel consumption. Alcohol, betel and cigarette consumption are independent risk predictors for distinct UADT cancers.
Journal of Gynecologic Oncology | 2018
Chien An Chen; Chun Ju Chiang; Yun Yuan Chen; San Lin You; Shu Feng Hsieh; Chao Hsiun Tang; Wen-Fang Cheng
Objective Adjuvant chemotherapy was introduced in patients with early-stage ovarian cancer (OC). The benefit of standard chemotherapeutic regimens including taxane has not been established. Methods Patients with early-stage OC from the National Health Insurance Research database of Taiwan who received platinum plus cyclophosphamide (CP) or platinum plus paclitaxel (PT) for 3–6 cycles were recruited, and the disease-free survival (DFS) and overall survival (OS) were determined. Results A total of 1,510 early-stage OC patients, including 841 who received CP regimen and 699 who received PT regimen, were included. The 2 groups had a similar estimated probability of 5-year DFS (PT vs. CP, 79.0% vs. 77.6%; p=0.410) and OS (84.6% vs. 84.3%; p=0.691). Patients >50 years of age who received the CP regimen had a lower 5-year DFS than the patients ≤50 years of age who received the CP (p<0.001) or PT regimens (p=0.001). Additionally, patients >50 years of age who received the CP regimen had a worse 5-year OS compared with the other 3 groups (p=0.019) (p=0.179 for patients >50 years of age in the PT group; p=0.002 for patients ≤50 years of age in the CP group; and p=0.061 for patients ≤50 years of age in the PT group). Patients with the CP or PT regimen for 3–5 cycles had a similar 5-year DFS and OS compared to 6 cycles (p>0.050). Conclusion Chemotherapeutic regimens with taxane could be recommended for early-stage OC patients >50 years of age.
Cancer Medicine | 2018
Yung Jen Cheng; Mu Hung Tsai; Chun Ju Chiang; Sen Tien Tsai; Tsang Wu Liu; Pei-Jen Lou; Chun Ta Liao; Jin Ching Lin; Joseph Tung-Chieh Chang; Ming Hsui Tsai; Pen Yuan Chu; Yi Shing Leu; Kuo Yang Tsai; Shyuang Der Terng; Chih Yen Chien; Muh Hwa Yang; Sheng Po Hao; Chuan Cheng Wang; Ming Hsun Tsai; Helen H.W. Chen; Chin Kuo; Yuan Hua Wu
Conduct an accurate risk assessment of resected oral cavity squamous cell carcinoma (OSCC) patients by accessing a nationwide systemic investigation is pivotal to improve treatment outcomes. In this article, we tried to determine the impact of different prognostic factors for OSCC patients who received adjuvant radiotherapy (RT) after curative surgery, using Taiwans national cancer registry database (TCR). A nationwide, large population‐based study was conducted using TCR with patients identified from 2007 to 2015. The study variables included age, gender, cancer subsites, stage, histology grade, margin and extra‐nodal extension (ENE) status, treatment type, surgery to RT interval (ORI), total RT treatment time (RTT), and RT dose. Univariate and multivariate analysis were performed to identify predictors of the variables associated with overall survival (OS), cause‐specific survival (CSS), local‐regional relapse‐free survival (LRFS), and distant metastasis‐free survival (DMFS). 8986 OSCC patients treated with surgery and adjuvant RT were analyzed. In multivariate analysis, worse outcomes were associated with males, older age, subsite in the oral tongue, advanced stage, higher histologic grade, involved margin, and positive ENE. ORI only showed an adverse trend in LRFS, when exceeding 7 weeks (P = .06). RTT >8 weeks was a significant poor predictor in OS, CSS and LRFS (P < .001). Extreme RT dose (>70 Gy or ≤50 Gy) also demonstrated an adverse impact on the outcomes. Prolonged RT treatment time and extreme RT doses were identified as significantly poor prognostic predictors in OSCC patients who received adjuvant RT after curative surgery.