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Representative prognostic data by clinical characteristics for lung cancer is not yet available in China. This study aimed to calculate the survival of lung cancer patients with different pathological evaluations, explore their predictive effects and provide information for prognosis improvement.In this multicenter cohort study, primary lung cancer patients diagnosed in 17 hospitals at three distinct levels in China between 2011-2013 were enrolled and followed up till 2020. Overall survival and lung cancer specific survival were calculated by Kaplan-Meier method. Cox proportional hazards model was applied to assess the effects of predictors of lung cancer survival.Of all the 7,311 patients, the 5-year overall and lung cancer specific survival rates were 37.0% and 41.6%, respectively. For lung cancer patients at stages I, II, III, and IV, the 5-year overall survival rates were 76.9%, 56.1%, 32.6%, and 21.4%, respectively; the lung cancer specific survival rates were 82.3%, 59.7%, 37.2%, and 26.4%, respectively. Differences of survival for each stage remained significant between histological classifications (P0.01). The 5-year overall survival rates for patients with squamous cell carcinoma, adenocarcinoma (AC), and small cell carcinoma were 36.9%, 43.3% and 27.9%, respectively; the corresponding disease-specific rates were 41.5%, 48.6% and 31.0%, respectively. Such differences were non-statistically significant at advanced stages (P=0.09). After multivariate adjustments, stage and classification remained independent predictors for the survival of lung cancer.The prognosis of lung cancer varied with the pathological stages and histological classifications, and had room for improvement. Stage was the strongest predictor, so efforts on early detection and treatment are needed.

ImportanceSurveillance endoscopy is recommended for patients with low-grade intraepithelial neoplasia (LGIN); high-quality evidence about the use of surveillance endoscopy and esophageal squamous cell carcinoma (ESCC) incidence in patients with LGIN is important but limited.ObjectiveTo estimate long-term ESCC incidence rates in patients with LGIN and the association between surveillance endoscopy and ESCC incidence.Design, Setting, and ParticipantsThis community-based, multicenter, prospective cohort study in 9 regions in rural China included patients with LGIN diagnosed by endoscopic screening between July 1, 2007, and December 31, 2016; all participants were followed up until December 31, 2021.Main Outcomes and MeasuresThe primary outcome was ESCC incidence. The ESCC standardized incidence ratio (SIR) was estimated using sex- and age-specific incidence in the general population of rural China in 2010 and hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards models.ResultsA total of 3258 patients with LGIN were included; 1772 (54.39%) were men, with a mean (SD) age of 58.21 (6.97) years. Among them, 1378 patients (42.30%) underwent at least 1 surveillance endoscopy (surveillance group) and 1880 (57.70%) did not undergo any surveillance endoscopy (nonsurveillance group). During the follow-up period (median, 7.96 years; IQR, 6.08-10.54 years), 170 ESCC cases were diagnosed, with a cumulative incidence of 6.28 per 1000 person-years. A higher incidence of ESCC (incidence rate, 7.07 per 1000 person-years) was observed in the nonsurveillance group than in the surveillance group (incidence rate, 5.14 per 1000 person-years). Patients with LGIN in the surveillance group had a lower SIR (SIR, 4.07; 95% CI, 1.13-10.34) than those in the nonsurveillance group (SIR, 5.65; 95% CI, 2.00-12.58); however, patients with LGIN in both groups had a higher risk of ESCC than the general population. Patients in the surveillance group had a 31% decreased risk of ESCC incidence (HR, 0.69; 95% CI, 0.50-0.95) compared with those in the nonsurveillance group, after adjusting for baseline risk factors.Conclusions and RelevanceIn this prospective cohort study, patients with LGIN had a higher risk of developing ESCC than the general population, and endoscopic surveillance was associated with a decrease in ESCC incidence in these patients.

Background and aims Esophageal cancer risk prediction models allow for risk‐stratified endoscopic screening. We aimed to assess the quality of these models developed in the general population. Methods A systematic search of the PubMed and Embase databases from January 2000 through May 2021 was performed. Studies that developed or validated a model of esophageal cancer in the general population were included. Screening, data extraction, and risk of bias (ROB) assessment by the Prediction model Risk Of Bias Assessment Tool (PROBAST) were performed independently by two reviewers. Results Of the 13 models included in the qualitative analysis, 8 were developed for esophageal squamous cell carcinoma (ESCC) and the other 5 were developed for esophageal adenocarcinoma (EAC). Only two models conducted external validation. In the ESCC models, cigarette smoking was included in each model, followed by age, sex, and alcohol consumption. For EAC models, cigarette smoking and body mass index were included in each model, and gastroesophageal reflux disease, uses of acid‐suppressant medicine, and nonsteroidal anti‐inflammatory drug were exclusively included. The discriminative performance was reported in all studies, with C statistics ranging from 0.71 to 0.88, whereas only six models reported calibration. For ROB, all the models had a low risk in participant and outcome, but all models showed high risk in analysis, and 60% of models showed a high risk in predictors, which resulted in all models being classified as having overall high ROB. For model applicability, about 60% of these models had an overall low risk, with 30% of models of high risk and 10% of models of unclear risk, concerning the assessment of participants, predictors, and outcomes. Conclusions Most current risk prediction models of esophageal cancer have a high ROB. Prediction models need further improvement in their quality and applicability to benefit esophageal cancer screening., Risk prediction models of esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) varied widely across populations, among which more ESCC models were developed in the Asian population, and more EAC models were developed in the Western population. The studies’ quality was not high, mainly due to limitations in the statistical analysis for risk of bias (ROB) and predictors’ availability for applicability.

BACKGROUND Cancer literacy is associated with several health-related behaviors and outcomes. However, there is still a lack of nationwide surveys for cancer literacy in China. OBJECTIVE This study aims to evaluate cancer literacy in China, explore disparities, and provide scientific evidence for policy makers. METHODS A cross-sectional survey was conducted in mainland China in 2021 using the multistage probability proportional to the size sampling method. Both the reliability and validity of the questionnaire were evaluated. The awareness levels were adjusted by sampling weights and nonrepresentativeness weights to match the actual population distributions. The Rao-Scott adjusted chi-square test was applied to test geographic, demographic, and socioeconomic disparities. A generalized linear model was used to explore potential factors. RESULTS A total of 80,281 participants aged 15-74 years were finally enrolled from 21 provinces, with an overall response rate of 89.32%. The national rate of cancer literacy was 70.05% (95% CI 69.52%-70.58%). The rates were highest regarding knowledge of cancer management (74.96%, 95% CI 74.36%-75.56%) but were lowest regarding basic knowledge of cancer (66.77%, 95% CI 66.22%-67.33%). Cancer literacy was highest in East China (72.65%, 95% CI 71.82%-73.49%), Central China (71.73%, 95% CI 70.65%-72.81%), and North China (70.73%, 95% CI 68.68%-72.78%), followed by Northeast (65.38%, 95% CI 64.54%-66.22%) and South China (63.21%, 95% CI 61.84%-64.58%), whereas Southwest (59.00%, 95% CI 58.11%-59.89%) and Northwest China (57.09%, 95% CI 55.79%-58.38%) showed a need for improvement. Demographic and socioeconomic disparities were also observed. Urban dwellers, the Han ethnic group, and population with higher education level or household income were associated with prior knowledge. The questionnaire showed generally good internal and external reliability and validity. CONCLUSIONS It remains important for China to regularly monitor levels of cancer literacy, narrow disparities, and strengthen health education for dimensions with poor performance and for individuals with limited knowledge to move closer to the goal of Healthy China 2030.

Background Risk‐stratified endoscopic screening (RSES), which offers endoscopy to those with a high risk of esophageal cancer, has the potential to increase effectiveness and reduce endoscopic demands compared with the universal screening strategy (i.e., endoscopic screening for all targets without risk prediction). Evidence of RSES in high‐risk areas of China is limited. This study aimed to estimate whether RSES based on a 22‐score esophageal squamous cell carcinoma (ESCC) risk prediction model could optimize the universal endoscopic screening strategy for ESCC screening in high‐risk areas of China. Methods Eight epidemiological variables in the ESCC risk prediction model were collected retrospectively from 26,618 individuals aged 40‐69 from three high‐risk areas of China who underwent endoscopic screening between May 2015 and July 2017. The model's performance was estimated using the area under the curve (AUC). Participants were categorized into a high‐risk group and a low‐risk group with a cutoff score having sensitivities of both ESCC and severe dysplasia and above (SDA) at more than 90.0%. Results The ESCC risk prediction model had an AUC of 0.80 (95% confidence interval: 0.75–0.84) in this external population. We found that a score of 8 (ranging from 0 to 22) had a sensitivity of 94.2% for ESCC and 92.5% for SDA. The RSES strategy using this threshold score would allow 50.6% of endoscopies to be avoided and save approximately US$ 0.59 million compared to universal endoscopic screening among 26,618 participants. In addition, a higher prevalence of SDA (1.7% vs. 0.9%), a lower number need to screen (60 vs. 111), and a lower average cost per detected SDA (US$ 3.22 thousand vs. US$ 5.45 thousand) could have been obtained by the RSES strategy. Conclusions The RSES strategy based on individual risk has the potential to optimize the universal endoscopic screening strategy in ESCC high‐risk areas of China., Universal endoscopy screening is recommended for all aged 40‐69 years in high‐risk areas of China to control esophageal squamous cell carcinoma (ESCC). This study estimated risk‐stratified endoscopic (RSES) strategies based on a previously developed ESCC prediction model in a representative Chinese population from high‐risk areas. RSES would be a feasible strategy to optimize the current universal endoscopic screening strategy in high‐risk areas by increasing efficiency and decreasing screening costs.

OBJECTIVE: China and the United States (the U.S.) have the heaviest colorectal cancer (CRC) burden with considerable variations in temporal trends. This study aims to analyze the temporal patterns of CRC burden and its risk factors in China and the U.S. across the past three decades. METHODS: Data were extracted from the Global Burden of Disease (GBD) Study in 2019, including cases, deaths, disability-adjusted life-years (DALYs), age-standardized rate (ASR), and summary exposure value (SEV) of CRC in China and the U.S. between 1990 and 2019. Annual average percentage changes (AAPCs) of CRC burden were calculated using the Joinpoint regression model. The mortality in CRC attributable to potential risk factors was characterized by countries, gender, and age groups. RESULTS: In 2019, there were 607,900 and 227,241 CRC cases, and 261,777 and 84,026 CRC deaths in China and the U.S., respectively. The age-standardized incidence rate (ASIR) was 30.55 per 100,000 in China and 41.86 per 100,000 in the U.S., and the age-standardized mortality rate (ASMR) was 13.86 per 100,000 in China and 14.77 per 100,000 in the U.S. CRC incidence, mortality, and DALY rate in the U.S. showed downward trends in the past three decades (AAPC=−0.47, −1.06, and −0.88, respectively), while upward trends were observed in China (AAPC=3.11, 1.05, and 0.91, respectively). Among the cause of CRC, the leading risk factor contributing to CRC death was low milk in China and smoking in the U.S., respectively. CONCLUSIONS: From 1990 to 2019, the burden of CRC in China increased dramatically, particularly for males and middle-aged and elderly people. The management of the major risk factors associated with the high burden of CRC should be enhanced.

Some gastric cancer prediction models have been published. Still, the value of these models for the application in real-world practice remains unclear. We aim to summarize and appraise modeling studies for gastric cancer risk prediction and identify potential barriers to real-world use.This systematic review included studies that developed or validated gastric cancer prediction models in the general population.A total of 4,223 studies were screened. We included 18 development studies for diagnostic models, 10 for prognostic models, and 1 external validation study. Diagnostic models commonly included biomarkers, such as Helicobacter pylori infection indicator, pepsinogen, hormone, and miRNA. Age, sex, smoking, body mass index, and family history of gastric cancer were frequently used in prognostic models. Most of the models were not validated. Only 25% of models evaluated the calibration. All studies had a high risk of bias, but over half had acceptable applicability. Besides, most studies failed to clearly report the application scenarios of prediction models.Most gastric cancer prediction models showed common shortcomings in methods, validation, and report. Model developers should further minimize the risk of bias, improve models' applicability, and report targeting application scenarios to promote real-world use.

The participation and results for liver cancer screening are rarely reported. The aim of this study was to determine the participation rates and factors affecting participation rates as well as to report the detection rate for liver cancer in an organized screening program.The organized screening program for liver cancer was conducted in 12 rural sites. The risk of developing liver cancer was initially evaluated for each participant. High-risk individuals were offered α-fetoprotein measurement and ultrasonography examination. Potential risk factors associated with the participation rate were screened by fitted generalized linear mixed logistic regression models through reporting odds ratios (ORs) with 95% CIs.A total of 358,662 eligible participants completed the basic surveys, and 54,745 were evaluated to be at high risk of liver cancer. Of these high-risk individuals, 40,543 accepted the screening services. Determinants of participation for screening behavior included older age, being female, being positive for hepatitis B surface antigen, having a family history of liver cancer, chronic depression, and low income. The detection rate for liver cancer was estimated to be 0.41% (95% CI, 0.35-0.48).This study reported several significant factors associated with the screening behaviors for liver cancer.Participation rate and results for liver cancer screening in rural areas are rarely reported. The determinants associated with adherence rates and early detection rate of liver cancer in an organized screening program for liver cancer were assessed. A possible positive correlation between the participation rates and the early detection rate was observed among attendees of screening. These new finds could be beneficial to increasing the participation rate of screening.

Substantial progress has been made in cancer screening in China due to the substantial efforts of all levels of the government. Four large-scale population-based screening programs have been launched since 2005. In these programs, individuals at high risk for the most common types of cancer are screened with no cost. However, there are still wide gaps remaining between the cancer screening objectives and reality. In this review, we summarize the current status of cancer screening, identify the major achievements and challenges of cancer screening, and propose some suggested improvements based on the existing evidence. The main challenges include low participation rates, the uneven distribution of medical sources, inadequate funding, and insufficient screening quality. Some suggestions that should be considered to improve the quality of cancer screening include advertising to increase awareness, providing universal training of staff involved in screening programs, optimizing the definition of high-risk populations, integrating new technologies into cancer screening programs, and implementing appropriate management measures among individuals with positive screening results.

Mild and moderate dysplasia are major premalignant lesions of esophageal squamous cell carcinoma (ESCC); however, evidence of the progression risk in patients with these conditions is extremely limited. We aimed to assess the incidence and risk factors for advanced neoplasia in patients with mild-moderate dysplasia.This prospective cohort study included patients with mild-moderate dysplasia from 9 regions in rural China. These patients were identified from a community-based ESCC screening program conducted between 2010 and 2016 and were offered endoscopic surveillance until December 2021. We estimated the incidence of advanced esophageal neoplasia, including severe dysplasia, carcinoma in situ, or ESCC, and identified potential risk factors using the Cox regression model.The 1183 patients with mild-moderate dysplasia were followed up over a period of 6.95 years. During follow-up evaluation, 88 patients progressed to advanced neoplasia (7.44%), with an incidence rate of 10.44 per 1000 person-years. The median interval from the progression of mild-moderate dysplasia to advanced neoplasia was 2.39 years (interquartile range, 1.58-4.32 y). A total of 74.47% of patients with mild-moderate dysplasia experienced regression to nondysplasia, and 18.09% showed no lesion progression. Patients with mild-moderate dysplasia who had a family history of esophageal cancer and were age 55 years and older showed 97% higher advanced neoplasia yields than all patients with mild-moderate dysplasia.In a country with a high incidence of ESCC, patients with mild-moderate dysplasia showed an overall risk of advanced neoplasia progression of 1.04% per year. Patients with mild-moderate dysplasia would be recommended for endoscopic surveillance during the first 2 to 3 years.

Objective There is little information about contributions of the well-known risk factors to the liver cancer burden. We conducted a comparative study to estimate the liver cancer burden attributable to major risk factors. Methods Liver cancer deaths for adults were estimated from 978 county-level surveillance points in China in 2014. Risk factors were identified from the International Agency for Research on Cancer and the World Cancer Research Fund International. Population attributable fraction (PAF) by age, sex, and province was calculated using multiple formulas. Results In total, 72.4% of liver cancer deaths could be attributable to the studied risk factors. Hepatitis B virus (HBV) was responsible for the largest fraction of liver cancer burden in both genders (PAF=55.6% in males, PAF=46.5% in females). PAFs for liver cancer burden attributable to smoking (15.7% vs. 4.8%), and alcohol drinking (10.3% vs. 1.6%) were significantly higher in males than in females. The burden of HBV-attributable deaths was the highest in Qinghai province. Conclusions HBV still contributes to the majority of liver cancer burden than any other risk factors. Targeted preventive measures should be implemented based on the degree of contributions of risk factors to liver cancer deaths.

Although previous studies have shown a decreased incidence of prostate cancer in men with HIV/AIDS, the consensus has not been reached. Our aim is to conduct a systematic review and meta-analysis to assess the risk of prostate cancer among people with HIV/AIDS. We systematically searched PubMed, Web of Science, Embase, and Cochrane Library until March 2020. Cohort studies were included if they compared the prostate cancer risk between people with HIV/AIDS and uninfected controls or the general population. The summary standardized incidence ratio (SIR) and 95% confidence interval (CI) were calculated using a random-effects model. A total of 27 studies were included for analysis, with more than 2780 males with HIV/AIDS developing prostate cancer. The results showed that HIV infection was associated with a decreased risk of prostate cancer incidence (SIR, 0.76; 95% CI, 0.64–0.91; P = 0.003), with significant heterogeneity (P

BACKGROUND Evidence of the effects of cancer prevention knowledge on the risk of developing cancer remains scarce. The objective of this study was to prospectively examine the association of cancer prevention awareness levels with cancer risk in a population-based cancer screening cohort in China. METHODS This prospective cohort study included 164,341 participants aged 40 to 69 years with no history of cancer and with available information on cancer prevention core knowledge in the Esophageal, Stomach, and Liver Cancer Screening Program. Participants were recruited from 18 rural regions across 4 provinces in China from 2007 to 2014 and were followed until December 31, 2015. The core knowledge of cancer prevention content included 9 items, with a total score ranging from 0 to 100. Cox proportional hazards regression models and restricted cubic spline analysis were used to estimate hazard ratios and 95% CIs. RESULTS High cancer prevention knowledge scores were inversely associated with the overall risk of cancer (group 4 vs group 1: hazard ratio, 0.669; 95% CI, 0.576-0.776). Subgroup analysis showed that this inverse association could be observed in women, participants with lower educational or income levels, and those without a family history of cancer. Restricted cubic spline analysis exhibited a nonlinear (L-shaped) relation between cancer knowledge scores and cancer risk (overall P

The mortality benefit of esophageal squamous cell carcinoma (ESCC) screening has been reported in several studies; however, the results of ESCC screening programs in China are suboptimal. Our study aimed to develop an ESCC risk prediction model to identify high-risk individuals for population-based esophageal cancer screening. In total, 86 745 participants enrolled in a population-based esophageal cancer screening program in rural China between 2007 and 2012 were included in the present study and followed up until December 31, 2015. Models for identifying individuals at risk of ESCC within 3 years were created using logistic regressions. The area under the receiver operating curve (AUC) was determined to estimate the model's overall performance. A total of 298 individuals were diagnosed with ESCC within 3 years after baseline. The model of ESCC included the predictors of age, sex, family history of upper gastrointestinal cancer, smoking status, alarming symptoms of retrosternal pain, back pain or neck pain, consumption of salted food and fresh fruits and disease history of peptic ulcer or esophagitis (AUC of 0.81; 95% confidence interval: 0.78-0.83). Compared to the current prescreening strategy in our program, the cut-off value of 10 in the score-based model could result in 3.11% fewer individuals subjected to endoscopies and present higher sensitivity, slightly higher specificity and lower number needed to screen. This score-based risk prediction model of ESCC based on eight epidemiological risk factors could increase the efficiency of the esophageal cancer screening program in rural China.

China is faced with heavy burdens caused by lung cancer, which has climbed to the top of both cancer incidence and mortality spectrums. The age-standardized rates of incidence and mortality have shown a trend of gradual up-trends in the last decades, while the crude rates rise much quickly due to the aging of population. Although the improvement in health care has contributed to better survival of lung cancer, its prognosis is still challenging. Apart from the common risk factors such as tobacco use, air pollution, and occupational hazards, some specific factors like Chinese-style cooking also have posed great threats to human health. In light of such national conditions, specific interventions should be conducted to curb the burden of lung cancer including smoking cessation, improvement of air quality, early detection and effective treatment of lung cancer.

Objective National Health Commission of the People's Republic of China collaborated with many ministries and commissions government and initiated a population-based cancer screening program in high-risk area of rural China, targeting three types of cancer that are most prevalent in these areas, including esophageal, stomach and liver cancer. This study protocol was reported to show the design and evaluate the effectiveness of cancer screening and appropriate screening strategies of three cancers in rural China. Methods and analysis A two-step design with cancer risk assessment based on questionnaire interview, Hepatitis B surface antigen (HBsAg) test strip and subsequent clinical intervention for high-risk populations was adopted free of charge at the local hospitals designated in the program. Ethic and dissemination This study was approved by the Institutional Review Board of Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The results will evaluate the effectiveness of cancer screening and appropriate screening strategies in rural China.

Objective To summarize the cancer burden and trends in China, compare the differences among China, Japan, and South Korea and discuss possible causes of the disparities. Methods Incidence and mortality data were extracted from the online cancer database including the GLOBOCAN 2018 and the Global Burden of Disease Study 2017. Trend analysis was conducted using the join-point analysis, and annual percent changes were calculated. Results Cancers resulted in approximately 62.9 million disability-adjusted life years (DALYs) in China in 2017. Lung cancer had the greatest contribution, followed by liver cancer, stomach cancer, and esophageal cancer. The trajectory of progress in the reduction of liver and stomach cancers was observed in China. However, China still faced a heavy burden of lung cancer and a growing burden of cancers related to westernized lifestyle such as colorectal cancer, while Japan and South Korea have achieved reductions in colorectal cancer and lung cancer, respectively. Besides, China had a lower age-standardized cancer incidence rate but higher cancer mortality and DALY rates than Japan and South Korea. Conclusions China is in the cancer transition stage with a rising burden of colorectal, prostate, and breast cancers along with a heavy burden of lung and upper digestive tract cancers. Taking into consideration the effectiveness of screening and tobacco control in Japan and South Korea, improvement in the current tobacco control policy and cancer screening systems may contribute to cancer control in China.

Objective The number of liver cancer patients in China accounts for more than half of the world. However, China currently lacks national, multicenter economic burden data, and meanwhile, measuring the differences among different subgroups will be informative to formulate corresponding policies in liver cancer control. Thus, the aim of the study was to measure the economic burden of liver cancer by various subgroups. Methods A hospital-based, multicenter and cross-sectional survey was conducted during 2012-2014, covering 39 hospitals and 21 project sites in 13 provinces across China. The questionnaire covers clinical information, sociology, expenditure, and related variables. All expenditure data were reported in Chinese Yuan (CNY) using 2014 values. Results A total of 2,223 liver cancer patients were enrolled, of whom 59.61% were late-stage cases (III-IV), and 53.8% were hepatocellular carcinoma. The average total expenditure per liver cancer patient was estimated as 53,220 CNY, including 48,612 CNY of medical expenditures (91.3%) and 4,608 CNY of non-medical expenditures (8.7%). The average total expenditures in stage I, II, III and stage IV were 52,817 CNY, 50,877 CNY, 50,678 CNY and 54,089 CNY (P>0.05), respectively. Non-medical expenditures including additional meals, additional nutrition care, transportation, accommodation and hired informal nursing were 1,453 CNY, 839 CNY, 946 CNY, 679 CNY and 200 CNY, respectively. The one-year out-of-pocket expenditure of a newly diagnosed patient was 24,953 CNY, and 77.2% of the patients suffered an unmanageable financial burden. Multivariate analysis showed that overall expenditure differed in almost all subgroups (P

We aimed to evaluate the long-term efficacy of the hepatitis B vaccine in China. In an initial efficacy study, participants were collected from a cluster-randomized clinical trial conducted in 1983-90 in Qidong. All the participants in the vaccination group were vaccinated at birth, 1 and 6 months of age, and no intervention was implemented to the control group. In this 37-year extended follow-up study, the Poisson regression method was employed to derive rates per 10

Effect of 5 μM 24-epibrassinolide (EBR) on delaying the senescence of ‘Huayou’ kiwifruit and possible defense mechanisms were elucidated during ambient storage. Results revealed that EBR treatment retarded decrease in firmness as well as increase in weight loss and total soluble solid content in kiwifruit. EBR treatment prevented the increase of membrane permeability and suppressed the accumulation of malondialdehyde. EBR treatment postponed the degradation of starch to soluble sugars, resulting from the inactivation of amylase activity. EBR treatment also inhibited the activity of acid invertase, neutral invertase, sucrose phosphate synthase, sucrose synthase, hexokinase and fructokinase, and subsequently EBR-treated fruit exhibited the lower contents of sucrose, glucose and fructose. These results suggest that EBR treatment could be an innovative solution to delay the senescence of kiwifruit by regulating sugar metabolism.

ObjectivesTo systematically review and critically appraise published studies of risk prediction models for breast cancer in the general population without breast cancer, and provide evidence for future research in the field.DesignSystematic review using the Prediction model study Risk Of Bias Assessment Tool (PROBAST) framework.Data sourcesPubMed, the Cochrane Library and Embase were searched from inception to 16 December 2021.Eligibility criteriaWe included studies reporting multivariable models to estimate the individualised risk of developing female breast cancer among different ethnic groups. Search was limited to English language only.Data extraction and synthesisTwo reviewers independently screened, reviewed, extracted and assessed studies with discrepancies resolved through discussion or a third reviewer. Risk of bias was assessed according to the PROBAST framework.Results63 894 studies were screened and 40 studies with 47 risk prediction models were included in the review. Most of the studies used logistic regression to develop breast cancer risk prediction models for Caucasian women by case–control data. The most widely used risk factor was reproductive factors and the highest area under the curve was 0.943 (95% CI 0.919 to 0.967). All the models included in the review had high risk of bias.ConclusionsNo risk prediction models for breast cancer were recommended for different ethnic groups and models incorporating mammographic density or single-nucleotide polymorphisms among Asian women are few and poorly needed. High-quality breast cancer risk prediction models assessed by PROBAST should be developed and validated, especially among Asian women.PROSPERO registration numberCRD42020202570.

Background: Risk-stratified endoscopic screening (RSES), which provides endoscopies to individuals at high risk for esophageal cancer (EC), has been suggested to improve screening efficiency. We aimed to assess the cost-effectiveness of RSES and identify the optimal thresholds for EC screening in high-risk areas of China. Methods: From a healthcare system perspective, a Markov model was constructed to compare the cost-effectiveness of 13 RSES strategies (under different threshold scores of EC risk), universal endoscopic screening strategy, and no screening. Six cohorts of 100 000 women and men with different start ages (40, 45, 50, 55, 60 and 65 years) with follow-up to age 77 years. The incremental cost-effectiveness ratio (ICER), i.e., the incremental cost per quality-adjusted life-years (QALYs) gained, was the primary outcome. Univariate and probabilistic sensitivity analyses were conducted. Findings: Compared with no screening, as the score threshold of the RSES was lowered, additionally gained QALYs increased, with 49−172 QALYs and 329−1258 QALYs gained from 40 years to 65 years. RSES in all age scenarios had ICERs less than 1×GDP per capita (US$10 276/QALY), and 11 RSES strategies with threshold scores of 3–13 had lower ICERs than universal endoscopic screening. Compared to universal endoscopic screening, which had the largest health gains than no screening, RSES with threshold scores of 8, 9, and 10 decreased cost by US$ 0‧35 0–47 million and reduced endoscopies by 7692–9943 with a slight decrease in QALYs. At a willingness-to-pay threshold of US$10 276/QALY, RSES (with threshold scores of 8 and 9) and universal endoscopic screening had a 43‧8–51‧7% and a 49‧6–67‧5% probability of being the most cost-effective at the age of

Background Prediction of liver cancer risk is beneficial to define high-risk population of liver cancer and guide clinical decisions. We aimed to review and critically appraise the quality of existing risk-prediction models for liver cancer. Methods This systematic review followed the guidelines of CHARMS (Checklist for Critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies) and Preferred Reporting Items for Systematic Reviews and Meta (PRISMA). We searched for PubMed, Embase, Web of Science, and the Cochrane Library from inception to July 2020. Prediction model Risk Of Bias Assessment Tool was used to assess the risk of bias of all potential articles. A narrative description and meta-analysis were conducted. Results After removal irrespective and duplicated citations, 20 risk prediction publications were finally included. Within the 20 studies, 15 studies performed model derivation and validation process, three publications only conducted developed procedure without validation and two articles were used to validate existing models. Discrimination was expressed as area under curve or C statistic, which was acceptable for most models, ranging from 0.64 to 0.96. Calibration of the predictions model were rarely assessed. All models were graded at high risk of bias. The risk bias of applicability in 13 studies was considered low. Conclusions This systematic review gives an overall review of the prediction risk models for liver cancer, pointing out several methodological issues in their development. No prediction risk models were recommended due to the high risk of bias.Systematic review registration: This systematic has been registered in PROSPERO (International Prospective Register of Systemic Review: CRD42020203244).

Background We initiated the first multi-center cluster randomized trial of endoscopic screening for esophageal cancer and gastric cancer in China. The objective of the study was to report the baseline screening findings in this trial. Methods We recruited a total of 345 eligible clusters from seven screening centers. In the intervention group, participants from high-risk areas were screened by endoscopy; in non-high-risk areas, high-risk individuals were identified using a questionnaire and advised for endoscopy. Lugol’s iodine staining in esophagus and indigo carmine dye in stomach were performed to aid in the diagnosis of suspicious lesions. The primary outcomes of this study were the detection rate (proportion of positive cases among individuals who underwent endoscopic screening) and early detection rate (the proportion of positive cases with stage 0/I among all positive cases). Results A total of 149,956 eligible subjects were included. The detection rate was 0.7% in esophagus and 0.8% in stomach, respectively. Compared with non-high-risk areas, the detection rates in high-risk areas were higher, both in esophagus (0.9% vs. 0.1%) and in stomach (0.9% vs. 0.3%). The same difference was found for early-detection rate (esophagus: 92.9% vs. 53.3%; stomach: 81.5% vs. 33.3%). Conclusions The diagnostic yield of both esophagus and stomach were higher in high-risk areas than in non-high-risk areas, even though in non-high-risk areas, only high-risk individuals were screened. Our study may provide important clues for evaluating and improving the effectiveness of upper-endoscopic screening in China. Trial registration: Protocol Registration System in Chinese Clinical Trial Registry, ChiCTR-EOR-16008577. Registered 01 June 2016-Retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=14372

Objective This study aimed at evaluating the efficacy of the questionnaire-based prediction model in an independent prospective cohort. Methods A cluster-randomized controlled trial was conducted in Changsha, Harbin, Luoshan, and Sheyang in eastern China in 2015-2017. A total of 182 villages/communities were regarded as clusters, and allocated to screening arm or control arm randomly. Face-to-face interview through a questionnaire interview, including of relevant risk factors of gastric cancer, was administered for each subject. Participants were further classified into high-risk or low-risk groups based on their exposure to risk factors. All participants were followed up until December 31, 2019. Cumulative incidence rates from gastric cancer between high-risk and low-risk groups were calculated and compared using the log-rank test. Cox proportional hazard regression models were applied to estimate hazard ratio (HR) and 95% confidence interval (95% CI). Results Totally, 89,914 residents were recruited with a mean follow-up of 3.47 years. And 42,015 (46.73%) individuals were classified into high-risk group and 47,899 (53.27%) subjects were categorized into low-risk group. Gastric cancer was diagnosed in 131 participants, of which 91 were in high-risk group. Compared with the low-risk participants, high-risk individuals were more likely to develop gastric cancer (adjusted HR=2.15, 95% CI, 1.23-3.76). The sensitivity of the questionnaire-based model was estimated at 61.82% (95% CI, 47.71-74.28) in a general population. Conclusions Our questionnaire-based model is effective at identifying high-risk individuals for gastric cancer.

A substantial proportion of liver cancers is attributable to chronic infection with hepatitis B and C (HBV/HCV). Liver cancer could become the second cancer, after cervical, to be effectively controlled globally, if proven interventions such as vaccination can be implemented on a large scale. In 2018, the global mortality rate for liver cancer was estimated to be 8.5 per 100 000 individuals. Given patterns of HBV infection and immigration across countries, liver cancer control requires combined, global action. Liver cancer trends vary between countries, in some Western countries, the incidence rates were relatively low but have increased in recent decades; conversely, in several Asian countries, the incidence rates have decreased over time. China has in the past contributed more than half of the global burden of liver cancer but more recently a national decline in liver cancer incidence has been observed. Here, we review the liver cancer burden and exposure to risk factors in China, compared to other countries. We also review the implementation status for primary and secondary prevention interventions and major outcomes achieved over the past three decades. Using Bayesian age-period-cohort analysis, we examine recent trends and based on these, predict that by 2050, the incidence of liver cancer in China could fall by half. We additionally survey the literature to identify current research needs, and review relevant national policies on liver cancer control in China. A comprehensive set of interventions is proposed to progress toward the long-term goal of liver cancer elimination based on the natural history and evidence-based interventions.

Cancer is still a major health problem in China although numerous efforts have been made for its prevention and control. Findings from this study showed that lung cancer remains the most common type of cancer diagnosed, and was attributed to nearly 30% of all cancer‐related deaths. The incidence of the five most common cancers, in China, in 2015, including cancers of the lungs, stomach, colorectum, liver and breast, accounted for almost 60% of all cancers diagnosed. The high cancer burden in China highlights the need for further improvement in health education, professional training and the building up an anti‐cancer network for introducing and implementing sustainable actions for cancer control.

Background and Aims In China, regional organized esophageal cancer screening programs have been implemented since 2005. However, the implementation of these screening programs is still facing some urgent challenges, especially concerning identifying high-risk individuals. This study aimed to evaluate the risk stratification potential of the current initial assessment strategy used in a mass esophageal squamous cell carcinoma (ESCC) screening program in China. Methods A total of 43,875 participants without a previous cancer history enrolled in a mass ESCC screening program in China from 2007 to 2010 who had initial assessment results were included in this study and were followed until December 31, 2015. Eight potential risk factors for ESCC were evaluated in the initial assessment strategy. A comprehensive evaluation of the association of the initial assessment results with ESCC risk was performed by propensity score matching and Cox regression analysis. Results During a median follow-up of 5.5 years, 272 individuals developed ESCC. The high-risk population assessed at baseline had a higher risk of ESCC than the non-high-risk population, with a hazard ratio (HR) of 3.11 (95% confidence interval (CI), 2.33-4.14) after adjustment for sex, age, education level, income level, and body mass index. In addition, the initial assessment results of the high-risk population were significantly associated with the risk of all esophageal cancers (HR, 3.30; 95% CI, 2.51-4.33) and upper gastrointestinal cancers (HR, 3.03; 95% CI, 2.43-3.76). Conclusions The initial screening tool in a mass ESCC screening program in China, consisting of 8 accessible variables in epidemiologic surveys, could be helpful for the selection of asymptomatic individuals for priority ESCC screening.