Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems

A tribute to radiologists (and the multidisciplinary team) in combating liver cancer

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Women's imaging and Oncology

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Male breast cancer in Hong Kong: 15-year experience from a tertiary institution

© 2015 Hong Kong College of Radiologists. Objective: Male breast cancer (MBC) is a rare disease entity and few data are available for the Chinese population. This study aimed to report MBC data from a single institution in Hong Kong to supplement existing evidence of this disease in our local population. Methods: Patients with histologically confirmed MBC treated between July 1997 and February 2012 were retrospectively identified from an institutional patient database. Clinical, pathological, treatment, and survival data were collected and subsequently analysed. Results: Within the captioned period, 52 cases of MBC were identified. The median age was 63 years, with evenly distributed tumour laterality. The majority of patients had invasive ductal carcinoma (84.6%), most of which were histologically grade II (50.0%). Almost all patients demonstrated hormone receptor positivity (oestrogen receptor-positive 98.0%, progesterone receptor-positive 96.0%), and HER2 amplification rate was 25.0%. Patients tended to present at an early stage of disease: approximately 85% presented as a T1 or T2 tumour, and 56.1 % had axillary nodal involvement. Surgery with curative intent was performed in 48 patients, with 13 (27.1 %) received adjuvant chemotherapy, and 35 (72.9%) underwent adjuvant radiotherapy. Almost all hormone receptor-positive patients received adjuvant tamoxifen. The median time to tamoxifen discontinuation was 60 months (range, 2-61 months). Discontinuation rate before 60 months was 15.9%. For those who underwent radical surgery, none developed loco-regional recurrence, and 5- and 10-year disease-free survival was 89.6% and 85.1%, respectively. The median overall survival for the entire population was 14.3 years. Conclusion: Our single-institutional data indicate that a good long-term survival outcome can be achieved in MBC following a treatment protocol similar to that established for females with breast cancer. Prospective data will be helpfid to further evaluate optimal treatment strategies as well as treatment tolerance for MBC in the Asian population.Link_to_subscribed_fulltex

Endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma

© 2015 Hong Kong College of Radiologists. Patients with early local recurrence of nasopharyngeal carcinoma with close proximity to the nearby carotid artery can be offered long-term control by endoscopic nasopharyngectomy which allows complete microscopic clearance of the recurrent tumour without damaging the carotid artery. This case report illustrates how this can be achieved without mutilating surgical procedures or further irradiation so that the patient can be spared of the associated morbidities.Link_to_subscribed_fulltex

Stereotactic body radiation therapy for hepatocellular carcinoma: Review of a local hospital

© 2017 Hong Kong College of Radiologists. Objective: To review the outcome and safety of stereotactic body radiation therapy (SBRT) for patients with hepatocellular carcinoma (HCC). Methods: Patients who underwent SBRT for HCC between January 2013 and March 2016 at Queen Elizabeth Hospital were reviewed retrospectively. Tumour response and toxicities were evaluated. Local control and overall survival rates were calculated using the Kaplan-Meier method. Results: 31 male and 8 female patients aged 54 to 90 (median, 72) years were included. 35 patients had Child- Pugh class A cirrhosis. 35 patients had viral hepatitis, of whom 33 were hepatitis B carriers. One patient was treatment native and underwent SBRT as bridging therapy prior to liver transplantation. The remaining 38 patients had received prior loco-regional therapies. The median tumour size was 1.9 cm. 29 patients had only one lesion. The SBRT doses ranged from 30 to 54 Gy in 6 to 7 fractions. After a median follow-up period of 17.8 months, 13 patients had died. The 1- and 2-year overall survival rates were 73.6% and 56.1%, respectively, and the median overall survival was 30.1 months. In 38 patients followed up at 3 months, 28.9%, 23.7%, and 42.1% had a complete response, partial response, and stable disease, respectively. The actuarial local control rate at 1 year was 82.8%. 21 patients had intrahepatic out-of-field recurrence, and four patients had distant metastasis. The 1-year intrahepatic recurrence-free survival was 50.5%, and the median intrahepatic recurrence-free survival was 15.4 months. 13 patients had grade 3 or above toxicity, of whom eight had thrombocytopaenia. One patient had grade 3 hepatic and renal toxicities and died after 2 months due to liver failure and hepatorenal syndrome. Conclusion: SBRT is effective and safe even in previously treated patients. It results in good local control with minimal severe adverse events but a relatively high intrahepatic (out-of-field) recurrence rate.Link_to_subscribed_fulltex

Coexistence of two Epstein-Barr virus-associated malignancies: Lymphoepithelioma-like cholangiocarcinoma in a patient with a history of undifferentiated nasopharyngeal carcinoma

© 2015 Hong Kong College of Radiologists. Undifferentiated nasopharyngeal carcinoma is particularly common in Southern China and is consistently associated with Epstein-Barr virus. In contrast, lymphoepithelioma-like carcinoma of the bile duct is a rare disease and not always associated with Epstein-Barr virus. We report the first case of coexisting Epstein-Barr virus-associated nasopharyngeal carcinoma and lymphoepithelioma-like carcinoma of the bile duct in a Chinese patient.Link_to_subscribed_fulltex

Management of chordoma in a tertiary hospital in Hong Kong

© 2017 Hong Kong College of Radiologists. Objectives: To report the clinical characteristics, treatment, and outcome of 25 patients with chordoma. Methods: The medical records of 25 patients with chordoma treated in a regional hospital in Hong Kong between January 2000 and June 2016 were retrospectively reviewed. Their clinical, pathological, treatment, and survival data were collected and analysed. Results: Of the 25 patients, 14 had skull base and 11 had sacral tumours; 78.6% and 100% were conventional chordoma, respectively. Their median ages were 41 and 64 years, respectively. In the skull base cohort, all 14 patients underwent surgery but none achieved R0 resection, and 13 received adjuvant radiotherapy. In the sacral cohort, eight of 11 patients underwent surgery and three of them achieved R0 resection. Four patients received postoperative radiotherapy. The 5-year local control rates for skull base and sacral chordoma were 29.6% and 17.9%, respectively, with a median time to progression of 42 (range, 8-68) and 33 (range, 4-76) months, respectively. The 5-year overall survival rates were 64.3% and 72.2%, respectively. Conclusion: Treatment outcome of chordoma patients in our hospital was suboptimal. Strategies to improve outcome should be explored.Link_to_subscribed_fulltex

Pancreatic neuroendocrine tumours

© 2017 Hong Kong College of Radiologists. Neuroendocrine tumours (NETs) are a heterogeneous group of malignancies that can arise in different organs. Although NETs account for only 0.5% of all malignancies, their incidence has significantly increased in recent years. In the Asia Pacific region, the most common site of primary NETs is the pancreas. Many new treatment modalities have been shown to be effective in treating NETs. This study re views the diagnosis, management, and prognosis of pancreatic NETs.Link_to_subscribed_fulltex

Method of regulatory network that can explore protein regulations for disease classification

Objective: To develop regulatory network to explore and model the regulatory relationships of protein biomarkers and classify different disease groups. Methods: Regulatory network is constructed to be a hopfield-like network with nodes representing biomarkers and directional connections to be regulations in between. The input to the network is the measured expression levels of biomarkers, and the output is the summation of regulatory strengths from other biomarkers. The network is optimized towards minimizing the energy function that is defined as the measure of the disagreement between the input and output of the network. To simulate more complicated regulations, a sigmoid kernel function is imposed on each node to construct a non-linear regulatory network. Results: Two datasets have been used as test beds, one dataset includes patients of nasopharyngeal carcinoma with different responses to chemotherapy drug, and the other consists of patients of severe acute respiratory syndrome, influenza, and control normals. The regulatory networks among protein biomarkers were reconstructed for different disease conditions in each dataset. We demonstrated our methods have better classification capability when comparing with conventional methods including Fisher linear discriminant (FLD), K-nearest neighborhood (KNN), linear support vector machines (linSVM) and radial basis function based support vector machines (rbfSVM). Conclusion: The derived networks can effectively capture the unique regulatory patterns of protein markers associated with different patient groups and hence can be used for disease classification. The discovered regulation relationships can potentially provide insights to revealing the molecular signaling pathways.In this paper, a novel technique of regulatory network is proposed on purpose of modeling biomarker regulations and classifying different disease groups. The network is composed of a certain number of nodes that are directionally connected in between in which nodes denote predictors and connections to be the regulation relationship. The network is optimized towards minimizing its energy function with biomarker expression data acquired from a specific patient group, thus the optimized network can model the regulatory relationship of biomarkers under the same circumstance. To simulate more complicated regulations, a sigmoid kernel function is imposed on each node to construct a non-linear regulatory network. The regulatory network can extract unique features of each disease condition, thus one immediate application of regulatory network is to classifying different diseases. We demonstrated that regulatory network is capable of performing disease classification through comparing with conventional methods including FLD, KNN, linSVM and rbfSVM on two protein datasets. We believe our method is promising in mining knowledge of protein regulations and be powerful for disease classification. © 2009 Elsevier B.V.Link_to_subscribed_fulltex