Xi-Bin Sun

Time Trends of Ovarian Cancer Incidence in China

The aim of this study was to examine the trend of ovary cancer incidence from 1999 to 2010 in China and predict the burden up to 2020. Crude incidence, age specific incidence and age-adjusted incidence rates were calculated. Joinpoint regression was performed to obtain estimated annual percentages and Bayesian age-period- cohort modeling was used to predict the incidence rate until the year 2020. In China, the crude rate of ovary cancer was 7.91/100,000 and the age-adjusted rate was 5.35/100,000 overall during period 1999-2010. The rates in urban regions were higher than in rural regions. A significant rising trend during 1999-2006 was followed by a drop during 2006-2010 in age-adjusted rates for urban females. In contrast, constant rise was observed in rural women. The decrease in ovary cancer of urban areas tended to be restricted to women aged 50 years and younger. In contrast, increases of ovary cancer in rural areas appeared in virtually all age groups. Although the age-adjusted incidence rate for ovary cancer was predicted to be reduced after year 2011, the crude rate was likely to be relative stable up to 2020. The burden of ovary cancer in China will continue to be relative stable due to the aging population.

C-reactive protein and risk of breast cancer: A systematic review and meta-analysis

Associations between elevated C-reactive protein (CRP) and breast cancer risk have been reported for many years, but the results remain controversial. To address this issue, a meta-analysis was therefore conducted. Eligible studies were identified by searching the PubMed and EMBASE up to December 2014. Study-specific risk estimates were combined using a random-effects model. Altogether fifteen cohort and case-control studies were included in this meta-analysis, involving a total of 5,286 breast cancer cases. The combined OR per natural log unit change in CRP for breast cancer was 1.16 (95% CI: 1.06-1.27). There was moderate heterogeneity among studies (I2 = 45.9%). The association was stronger in Asian population (OR = 1.57, 95% CI: 1.25-1.96) compared to European (OR = 1.12, 95% CI: 1.02-1.23) and American (OR = 1.08, 95% CI: 1.01-1.16). Prediagnostic high-sensitivity CRP concentrations (OR = 1.22, 95% CI: 1.10-1.35) was superior to common CRP (OR = 1.08, 95% CI: 1.01-1.15) in predicting breast cancer risk. The meta-analysis indicated that elevated CRP levels was associated with increased risk of breast cancer. Further research effort should be performed to identify whether CRP, as a marker of inflammation, plays a direct role in breast carcinogenesis.

Incidence, survival and prevalence of esophageal and gastric cancer in Linzhou city from 2003 to 2009.

This study describes recent trends in incidence, survival and prevalence of subgroups of esophageal and gastric cancer in Linzhou city between 2003 and 2009. Data of esophageal and gastric cancer for the period of interest were extracted from the Linzhou Cancer Registry. Using information on tumor morphology or anatomical site, data were divided into six groups; esophageal squamous cell carcinoma, esophageal adenocarcinoma, other and unspecified types of esophageal cancer, and cardia, non-cardia, and unspecified anatomical site of stomach cancer. Incidence, survival and prevalence rates for each of the six cancer groups were calculated. The majority of esophageal cancers were squamous cell carcinomas (82%). Cardiac cancer was the major gastric cancer group (64%). The incidence of esophageal squamous cell carcinoma and gastric cardiac cancer increased between 2003 and 2009. Both esophageal and gastric cancer had a higher incidence in males compared with females. Overall survival was poor in all sub-groups with 1 year survival ranging from 45.9 to 65.6% and 5 year survival ranging from 14.7 to 30.5%. Prevalence of esophageal squamous cell carcinoma and gastric cardiac cancer was high (accounting for 80% overall). An increased focus on prevention and early diagnosis, especially in esophageal squamous cell carcinoma and gastric cardiac cancer, is required.

The association between human papillomavirus 16 and esophageal cancer in Chinese population: a meta-analysis

BackgroundThe role of human papillomavirus (HPV) in the development of esophageal cancer remains controversial. Our study aims to test the association between HPV 16 infection and esophageal cancer in China, providing useful information on this unclear association in Chinese population.MethodsStudies on HPV infection and esophageal cancer were identified. A random-effects model was used to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs) comparing cases with controls.ResultsA total of 1442 esophageal cancer cases and 1602 controls from 10 included studies were evaluated to estimate the association between HPV 16 infection and esophageal cancer risk. The ORs for each case–control studies ranged from 3.65 (95% CI: 2.17, 6.13) to 15.44 (95% CI: 3.42, 69.70). The pooled estimates for OR was 6.36 (95% CI: 4.46, 9.07). In sensitivity analysis, the estimates for OR ranged from 5.92 (95% CI: 4.08, 8.60) to 6.97 (95% CI: 4.89, 9.93).ConclusionsThis study indicates that HPV-16 infection may be a risk factor for esophageal cancer among Chinese population, supporting an etiological role of HPV16 in this malignancy. Results in this study may have important implications for esophageal cancer prevention and treatment in China.

Prevalence of Human Papillomavirus 16 in Esophageal Cancer Among the Chinese Population: a Systematic Review and Meta-analysis

BACKGROUND AND AIM No firm evidence of HPV infection in esophageal cancer has been established to date. The aim of this meta-analysis was to investigate the prevalence of HPV 16 in esophageal cancer in China, which had a high burden of the disease. MATERIALS AND METHODS Studies on HPV infection and esophageal cancer were identified and a random-effects model was used to pool the summary prevalence and corresponding 95% confidence intervals (CIs). RESULTS A total of 3,429 esophageal cancer cases were evaluated from 26 eligible studies in this meta-analysis. The summary estimate for HPV16 prevalence was 0.381 (95% CI: 0.283, 0.479). The prevalence varied by geographical areas of the study, publication year, HPV detection method and types of specimen. In sensitivity analysis, HPV 16 prevalence ranged from 0.368 (95% CI: 0.276, 0.460) to 0.397 (95% CI: 0.286, 0.508). CONCLUSIONS The results indicate a relatively high level of HPV 16 prevalence in esophageal cancer among Chinese population, although there was variation between different variables. Further studies are needed to elucidate the role of HPV in esophageal carcinogenesis with careful consideration of study design and laboratory detection method, providing more accurate assessment of the HPV status in esophageal cancer.

Effectiveness of endoscopic gastric cancer screening in a rural area of Linzhou, China: results from a case–control study

In China, a large burden of gastric cancer has remained, and endoscopic screening was expected to reduce gastric cancer mortality. Therefore, a population‐based case–control study was conducted to evaluate the screening effect. The gastric cancer screening program was initiated in Linzhou in the year 2005, and endoscopic examination with indicative biopsy, for residents aged 40–69 years, was used to detect early cancer and precancerous lesion. In this study, cases were defined as individuals who had died of gastric cancer, which were selected from Linzhou Cancer Registry database. Controls were residents (six per case), who had not died of gastric cancer, from the same area as the case, and matched by gender and age (±2 years). The exposure status, whether cases and controls ever attended the screening or not, was acquired by inspecting the well‐documented screening records. Conditional logistic regression model was used to estimate the odds ratios (OR) and their 95% confidence intervals (95% CI). A total of 313 cases and 1876 controls were included in our analysis. Compared with subjects who never participated in screening, the overall OR for individuals who ever participated in screening was 0.72(95% CI: 0.54–0.97). The OR for lag time 4 years or longer was 0.68(95% CI: 0.47–0.98) and the OR for those who were aged 50–59 years were 0.56 (0.37–0.85). The results suggest a 28% reduction in risk of gastric cancer mortality by endoscopic screening, which may have significant implications for gastric cancer screening in rural areas of China.

Prognostic Impact of Cyclin D1, Cyclin E and P53 on Gastroenteropancreatic Neuroendocrine Tumours

Conventional classifications of gastroenteropancreatic neuroendocrine tumours (GEP- NETs) are rather unsatisfactory because of the variation in survival within each subgroup. Molecular markers are being found able to predict patient outcome in more and more tumours. The aim of this study was to characterize the expression of the proteins cyclin D1, cyclin E and P53 in GEP- NETs and assess any prognostic impact. Tumor specimens from 68 patients with a complete follow-up were studied immunohistochemically for cyclin D1, cyclin E and P53 expression. High cyclin D1 and cyclin E immunostaining (≥ 5% positive nuclei) was found in 48 (71%) and 24 (35%) cases, and high P53 staining (≥ 10% positive nuclei) in 33 (49%) . High expression of P53 was more common in gastric neuroendocrine tumors and related to malignant behavior, being associate with a worse prognosis on univariate analysis (RR=1.9, 95%CI=1.1-3.2). High expression of cyclin E was significantly associated with shorter survival in the univariate analysis (RR=2.0, 95%CI=1.2-3.6) and multivariate analysis (RR=2.1, 95%CI=1.1-4.0). We found no significant correlation between the expression of cyclin D1 and any clinicopathological variables. Our study indicated a prognostic relevance for cyclin E and P53 immunoreactivity. Cyclin E may be an independent prognostic factor from the 2010 WHO Classification which should be evaluated in further studies.

Effectiveness evaluation of organized screening for esophageal cancer: a case-control study in Linzhou city, China

In China, esophageal cancer has remained a large burden, and endoscopic screening is expected to reduce esophageal cancer mortality. Therefore, a population-based case-control study was conducted to evaluate the effect of screening. Cases were defined as individuals who had died of esophageal cancer, and controls were residents from the same area (three per case) who had not died of esophageal cancer, matched by gender and birth year. The exposure status (whether cases and controls had ever attended the screening or not) was acquired by inspecting the well documented screening records. A conditional logistic regression model was used to estimate the odds ratios (OR) and their 95% confidence intervals (95% CI). There were 253 cases and 759 controls. The reduction in risk of esophageal cancer mortality in individuals who had ever attended screening was 47% (OR: 0.53, 95% CI: 0.37–0.77). Compared with never-screened subjects, the ORs for screened subjects within 36 and 48 months before the reference date were 0.59(0.39–0.89) and 0.59(0.40–0.87); the ORs for 50–59 year old subjects were 0.48(0.28–0.85). The results suggest a 47% reduction in esophageal cancer mortality risk due to endoscopic screening, which may have significant implications for esophageal cancer screening in China, especially in rural areas.

Human papillomavirus type-18 prevalence in oesophageal cancer in the Chinese population: a meta-analysis

Globally, the prevalence of oesophageal cancer cases is particularly high in China. Since 1982, oncogenic human papillomavirus (HPV) has been hypothesized as a risk factor for oesophageal cancer, but no firm evidence of HPV infection in oesophageal cancer has been established to date. We aimed to conduct a meta-analysis to estimate the high-risk HPV-18 prevalence of oesophageal cancer in the Chinese population. Eligible studies published from 1 January 2005 to 12 July 2014 were retrieved via computer searches of English and Chinese literature databases (including Medline, EMBASE, Chinese National Knowledge Infrastructure and Wanfang Data Knowledge Service Platform). A random-effects model was used to calculate pooled prevalence and corresponding 95% confidence intervals (CIs). A total of 2556 oesophageal cancer cases from 19 studies were included in this meta-analysis. Overall, the pooled HPV-18 prevalence in oesophageal cancer cases was 4·1% (95% CI 2·7-5·5) in China, 6·1% (95% CI 2·9-9·3) in fresh or frozen biopsies and 4·0% (95% CI 2·3-5·8) in paraffin-embedded fixed biopsies, 8·2% (95% CI 4·6-11·7) by the E6/E7 region and 2·2% (95% CI 0·9-3·6) by the L1 region of the HPV gene. This meta-analysis indicated that China has a moderate HPV-18 prevalence of oesophageal cancer compared to cervical cancer, although there is variation between different variables. Further studies are needed to elucidate the role of HPV in oesophagus carcinogenesis with careful consideration of study design and laboratory detection method, providing more accurate assessment of HPV status in oesophageal cancer.

Time Trends of Esophageal Cancer Mortality in Linzhou City During the Period 1988-2010 and a Bayesian Approach Projection for 2020

In recent decades, decreasing trends in esophageal cancer mortality have been observed across China. We here describe esophageal cancer mortality trends in Linzhou city, a high-incidence region of esophageal cancer in China, during 1988-2010 and make a esophageal cancer mortality projection in the period 2011-2020 using a Bayesian approach. Age standardized mortality rates were estimated by direct standardization to the World population structure in 1985. A Bayesian age-period-cohort (BAPC) analysis was carried out in order to investigate the effect of the age, period and birth cohort on esophageal cancer mortality in Linzhou during 1988-2010 and to estimate future trends for the period 2011-2020. Age-adjusted rates for men and women decreased from 1988 to 2005 and changed little thereafter. Risk increased from 30 years of age until the very elderly. Period effects showed little variation in risk throughout 1988-2010. In contrast, a cohort effect showed risk decreased greatly in later cohorts. Forecasting, based on BAPC modeling, resulted in a increasing burden of mortality and a decreasing age standardized mortality rate of esophageal cancer in Linzhou city. The decrease of esophageal cancer mortality risk since the 1930 cohort could be attributable to the improvements of social- economic environment and lifestyle. The standardized mortality rates of esophageal cancer should decrease continually. The effect of aging on the population could explain the increase in esophageal mortality projected for 2020.