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Background and purpose: Effective treatment for cervical cancer patients is one of the global strategies to eliminate cervical cancer. By analyzing the metastasis characteristics and survival status of patients with distant metastasis of cervical cancer from a hospital-based cancer registry data, our study provided real-world evidence for better survival of cervical cancer and finally eliminating cervical cancer. Methods: A total of 572 cervical cancer patients who had metastasis cancer at the initial diagnosis or developed distant metastasis during follow-up in Fudan University Shanghai Cancer Center from 2008 to 2017 were included in this study. Medical records review, telephone visits and death registry data linkage were applied in collecting endpoint data. The first follow-up date was the diagnose date of metastasis, and the last follow-up date was November 1, 2020. Kaplan-Meier method was applied in evaluating the 1-, 3- and 5-year overall survival (OS) rates for overall and site-specific patients. Results: The median follow-up time was 38.93 months, and 348 cases died during the follow-up. 72.55% were single site metastasis, and 27.45% were multiple metastases. Among all metastatic sites, the proportion of lung metastasis was the highest, 41.26%, 15.21% to bone, and 11.54% to liver. After metastasis, the 1-year, 3-year and 5-year OS rates were 62.29% (95% CI: 62.25-62.33), 33.13% (95% CI: 33.08-33.18) and 23.42% (95% CI: 23.37-23.47), respectively. In single site metastasis, 1-year OS was the highest after metastasis to the lung (72.52%). Besides, there was no significant difference among different metastatic sites, both in 3-year and 5-year OS. Conclusion: The most frequent distant metastatic sites of cervical cancer are lung, bone and liver. The survival rate after metastasis is poor. Further research with systematic treatment strategy is required for better survival.

Background and purpose: Follow-up data of 6 737 patients undergoing surgery for gastric cancer were collected based on hospital registration, and the 1-, 3- and 5-years observed overall survival (OS) rates and disease-free survival (DFS) rates were analyzed to provide real-world research evidence for the prevention and control of gastric cancer and policy making in China. Methods: A total of 6 737 gastric cancer patients who underwent surgical treatment at Fudan University Shanghai Cancer center from 2015 to 2020 were included in this study. Clinical information and the follow-up endpoint data were collected through medical records review, telephone visits and death registry data linkage. The last follow-up date was November 30, 2023. Kaplan-Meier method was applied in evaluating the 1-, 3- and 5-year OS rate and DFS rate, and survival data were described by different subgroups including age group, gender, treatment period, tumor staging, and pathological characteristics. Results: With a median follow-up time of 50.99 months, the 5-year OS rate of surgically resected gastric cancer patients was 70.37%, and 5-year DFS rate in Ⅰ-Ⅲ stage cases was 69.46%. The 5-year OS rates of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 94.32%, 82.56%, 51.01% and 23.97%, respectively. The differences in survival among patients with different age, tumor location, gross classification, Borrmann classification and Laurence classification were significant. Conclusion: Staging is an important factor directly affecting the survival of gastric cancer patients. Screening and early diagnosis and treatment in large population, especially high-risk group, should be strengthened to further improve the patients’ survival.

Background and purpose: Artificial intelligence (AI) technology is increasingly being used in the medical field. This study aimed to assess the effectiveness of artificial intelligence ultrasound system for identifying breast lesions in Chinese women and its role in breast cancer early detection. Methods: A prospective study was conducted on healthy women aged 35-74 years who came to Fudan University Shanghai Cancer Center from August 2020 to December 2020 for breast ultrasonography. All the women were examined by AI-assisted ultrasound first, and then by conventional ultrasonography. We compared the differences between AI-assisted ultrasound and conventional ultrasonography in identifying breast lesions in Chinese women. One year later, we looked up the hospital medical history and Shanghai Cancer Registration Management System for the final diagnosis of breast cancer. Results: A total of 360 women were included in the study and received breast examinations using both AI-assisted ultrasound and conventional ultrasound. A total of 2 504 breast lesions were detected, of which, 2 217 were detected by AI-assisted ultrasound, with a lesion recognition rate of 88.5%. Conventional ultrasound identified 1 090 lesions, with a lesion recognition rate of 43.5%. Using conventional ultrasound as the standard, the sensitivity and specificity of AI-assisted ultrasound for Breast Imaging Reporting and Data System (BI-RADS) level 4 and above lesions were 93.3% (95% CI: 80.7-98.3) and 100.0% (95% CI: 99.5-100.0), respectively. During one-year follow-up, 10 patients were diagnosed with breast cancer, and 8 of whom were identified by both AI-assisted ultrasound and conventional B ultrasound. The sensitivity of AI-assisted ultrasound and conventional ultrasound for breast cancer was 80.0% (95% CI: 44.2-96.4), and the specificity was 88.6% (95% CI: 84.6-91.6). Conclusion: AI-assisted ultrasound has good identification ability for breast lesions in Chinese women. The recognition ability for high-risk breast lesions (BI-RADS 4A and above) and early breast cancer is equivalent to that of conventional ultrasound, which is suitable for breast cancer screening in large-scale community of women with general risk.

In the year 2023, 1 958 310 new cancer cases and 609 820 cancer deaths are projected to occur in the United States, estimated by Cancer Statistics, published by American Cancer Society. An accelerated decline in mortality rate of cancer continues since it reached the peak in 1991. The treatment advance brought survival benefit to patients which mainly contribute to the decline along with tobacco control and screening. COVID-19 pandemic caused 350 831 mortality and ranked 3rd in cause of death in 2020, and the mortality had a significant increase in multiple causes of death including cancer. By comparing the data of China and the United States released by GLOBOCAN database in 2020, it is found that, although the influence of the pandemic on cancer has not been evaluated. Although the incidence and mortality of cancer differ between US and China, the experiences are worth learning. Improving the standardization of diagnosis and treatment, enhancing the accessibility of cancer health care, upgrading the coverage of screening and increasing the human papillomavirus (HPV) vaccination rate are proven to be effective ways to reduce the mortality of cancer.

Background and purpose: Currently, several studies have demonstrated that body mass index (BMI) is a prognostic factor in breast cancer. The study aimed to assess the association pattern of BMI with mortality risk among patients of different age groups. Methods: This retrospective cohort study included the clinical characteristics and survival status of 25 629 patients diagnosed with breast cancer and subsequently hospitalized in Fudan University Shanghai Cancer Center between January 1, 2008 and December 31, 2016. The association between BMI and prognosis of breast cancer patients in different age subgroups was analyzed using Cox proportional hazards regression model with restricted cubic splines adjusting the main prognostic factors. Results: BMI and age were both influencing factors of breast cancer prognosis, and there was a significant interaction (P = 0.011). The pattern of association between risk of death and BMI differed among different age groups. A "J-shaped" association between risk of death and BMI was observed in the patients younger than 35 years, with a BMI of 20.16 kg/m2 corresponding to the lowest risk of death. In the age group of 35-60 years, no significant change in the risk of death was observed in patients with BMI below 23 kg/m2, and the risk of death in patients with BMI above 23 kg/m2 increased with increasing BMI; A "U-shaped" association between risk of death and BMI was observed in the patients older than 60 years, with a BMI of 23.86 kg/m2 being the lowest. The risk of death was more sensitive to changes in BMI in patients aged less than 35 years than in those aged 35-60 years and those aged more than 60 years. Conclusion: BMI and age have a significant interaction in the prognosis of breast cancer when adjusted for potential confounding factors. The association pattern between the risk of death and BMI of patients in different age groups is different. For patients under 35 years old, the lowest risk of death corresponds to BMI at diagnosis of about 20 kg/m2, while for patients over 60 years old, the lowest risk of death corresponds to a BMI at diagnosis of about 24 kg/m2.

Background and purpose: We analyzed the distribution of metastatic sites and survival of lung cancer patients with metastases based on hospital registration to provide real-world data support for the treatment and survival management of lung cancer patients. Methods: A total of 1 490 lung cancer patients who developed metastasis during the follow-up in Fudan University Shanghai Cancer Center from 2008 to 2017 were enrolled in this study. Medical records review, telephone visits and death registry data linkage were applied in collecting endpoint data. The effects of age at diagnosis, gender and histological subtype on the distribution of metastases were studied. The Kaplan-Meier method was used to evaluate the overall survival (OS) rates of different metastatic sites. Results: The median follow-up time was 40.8 months. During the follow-up period, 937 cases died from all causes. 67.7% of patients only had single-site metastasis, while 32.3% of patients had multiple-site metastases. The common metastatic sites were bone (33.8%), brain (33.6%), lung (22.8%), liver (12.0%) and adrenal gland (3.7%). Female patients had more metastases to brain (37.8% vs 31.4%). Younger patients were more likely to develop multiple-site metastases, and small cell carcinomas patients had more brain metastases (47.2%) and liver metastases (20.9%). Lung metastasis featured relatively best survival (1-year OS rate: 78.3%, 3-year OS rate: 47.1%, 5-year OS rate: 29.5%), whereas liver metastasis had relatively the worst prognosis (1-year OS rate: 46.4%, 3-year OS rate: 15.2%, 5-year OS rate: 3.6%). Conclusion: The proportions of bone and brain metastases in lung cancer patients with metastasis are high. The distribution of metastatic sites is associated with gender, age at diagnosis and histological type. The prognosis of patient with different metastatic sites is different. Mechanisms or clinical treatment plans can be studied for different metastatic sites to improve the prognosis of late-stage lung cancer patients in future research.

Background and purpose: Metastasis remains the cause of 90% of death from cancer. By analyzing the distribution of metastatic sites and survival status of 20 000 metastatic cancer patients from a hospital-based cancer registry database, this study provides the real-world data for the cancer treatment and survival management in China. Methods: A total of 20 067 cancer patients who were diagnosed as having metastatic caner or developed metastasis during the follow-up in Fudan University Shanghai Cancer Center from 2008 to 2017 were included in this study. Medical records review, telephone visits and death registry data linkage were applied in collecting endpoint data. The first follow-up date was the diagnosis date of metastasis, and the last follow-up date was November 1, 2020. Kaplan-Meier method was applied in evaluating the 1-, 3- and 5-year overall survival (OS) rates for overall cancer and site-specific cancer patients. Results: The median follow-up time was 46.7 months, 13 170 cases died during the follow- up, 60.05% was single-site metastasis, and 39.95% was multiple-site metastasis. Among all metastable sites, the proportion of metastasis to liver was 33.82%, 26.25% to lung, 26.22% to bone, and 9.22% to brain. The incidence of brain metastasis was the highest in lung cancer patients among all cancer types (31.14%). Liver was the most frequent metastatic site in pancreatic cancer (77.85%), and bone was the most frequent metastatic site in patients with prostate cancer (83.20%). Subgroup analysis showed that liver metastasis was easier to be observed in males than in females (35.46% vs 31.89%, P