Socioeconomic status and event free survival in pediatric acute lymphoblastic leukemia: A population-based cohort study

The impact of socioeconomic status (SES) upon childhood cancer outcomes has not been extensively examined. Our objective was to determine the association between SES and event-free survival (EFS) among children with acute lymphoblastic leukemia (ALL) diagnosed in Ontario, Canada from 1995–2011 (N = 1541) using Cox proportional hazards. Neither neighborhood-level median income quintile, distance from tertiary center, or rural residence significantly predicted EFS in the context of a universal healthcare system. Immigrant children experienced significantly superior EFS; confounding by ethnicity could not be ruled out. Confirmatory studies using additional individual-level SES variables are warranted.     

Laparoscopic versus open pancreatoduodenectomy: an individual participant data meta-analysis of randomized controlled trials

BackgroundRandomized trials have compared laparoscopic pancreatoduodenectomy (LPD) to open pancreatoduodenectomy (OPD) with conflicting results. An IPDMA may give more insight into the differences between LPD and OPD, and could identify high-risk subgroups.MethodsA systematic literature search was performed in the Pubmed, Embase, and the Cochrane library databases (October 2019). Out of 1410 studies, three randomized trials were identified. Primary outcome was major complications (Clavien-Dindo grade ≥ III). Subgroup analyses were performed for high-risk subgroups including patients with BMI of ≥25 kg/m2, pancreatic duct <3 mm, age ≥70 years, and malignancy.ResultsData from 224 patients were collected. After LPD, major complications occurred in 33/114 (29%) patients compared to 34/110 (31%) patients after OPD (adjusted odds ratio (OR) 0.62; 95% confidence interval (CI) 0.3–1.4, P = 0.257). No differences were seen for major complications and 90-day mortality LPD 8 (7%) vs OPD 4 (4%) (adjusted OR 0.2; 95% CI 0.02–1.3, P = 0.080). With LPD, operative time was longer (420 vs 318 min, p < 0.001) and hospital stay was shorter (mean difference ?6.97 days). Outcomes remained stable in the high-risk subgroups.ConclusionLPD did not reduce the rate of major postoperative complications as compared to OPD. LPD increased operative time and shortened hospital stay with 7 days.     

大数据对肿瘤登记发展的影响

对肿瘤登记和大数据的发展、大数据对肿瘤登记的作用和影响进行了系统回顾,大数据和肿瘤登记近年发展快速,大数据的发展促进了肿瘤登记的发展,而肿瘤登记发展又推动了大数据的进步.在大数据的影响下,肿瘤登记将向以下几个方向发展:(ⅰ)肿瘤登记自动化;(ⅱ)及时收集、整合和更新不同来源的肿瘤数据,提高肿瘤资料的质量、可用性和易用性,推动肿瘤资料的开放和共享,扩展肿瘤资料的应用;(ⅲ)各级医疗卫生信息中心的出现将彻底改变肿瘤登记模式;(ⅳ)采用大数据的技术和方法建立各级肿瘤数据中心;(ⅴ)医院肿瘤登记逐步开展,人群肿瘤登记覆盖率大幅提高,部分省将全民开展肿瘤登记.肿瘤登记自动化的理念和技术,迎合了大数据和肿瘤登记发展的趋势,并可借鉴应用到其他疾病的监测和研究.     

Immunity to Hepatitis-A virus: A nationwide population-based seroprevalence study from Iran

BackgroundThe mortality rate of acute Hepatitis A increases from 0.1% in the children to 1.2%, in the adults. Hepatitis A is efficiently prevented by HAV-vaccine, but the strategy for distributing this vaccine among countries is dependent on their level of immunity to HAV. This study aimed to detect the level of immunity to HAV in Iran.MethodsIn this population-based seroprevalence study, 5419 participants from 12 of provinces of Iran, including 57 urban and 120 rural areas were chosen through a multi-stage cluster random sampling. Participants were interviewed by filling checklists and 3 cc of blood sample was obtained from each of them. IBM SPSS statistics V.21 software was used for univariable and multivariable analysis of data.ResultsMean of age of Interviewees was 26.4 ± 16 years, ranging from 1 to 94 years with a male to female ratio 1.02. Overall, 3603 (66.5%) of subjects were seropositive for HAV-IgG. Among the age groups, 41.1% of children by the age 15 years and 82.6% of adults around 30 years old were immune to HAV. The Mid-point age of population immunity was 21 years. Residents of the borders of the country, people who had less access to the safe water or sanitary toilet, individuals with low socioeconomic status and persons who were a member of dense families had the most probability of seropositivity.ConclusionsThis study showed that Iran is among HAV low endemic countries and vaccination against HAV is recommended only in the high-risk population, including patients with chronic liver diseases, patients with coagulopathy, travelers to the high endemic areas, and homosexuals. Establishment of national HAV surveillance system, concerning of health system about the occurrence of the HAV outbreaks, implementation of harm reduction strategies, improving economic indices and sanitation and access to the safe water in the deprived regions is recommended.     

2015年中国胃癌流行特征分析

目的 估算2015年我国胃癌的发病死亡情况和分布特征,为肿瘤防控研究和政策制定提供参考依据。方法 对2018年全国肿瘤登记中心501个登记处的2015年肿瘤登记数据进行评估,其中368个肿瘤登记处的数据符合入选标准,按城乡、性别以及年龄分层,结合2015年全国人口数据,估计全国胃癌的发病和死亡情况。中国人口标化率（中标率）采用2000年全国人口普查的标准人口年龄构成,世界人口标化率（世标率）采用Segi''s世界标准人口结构计算。结果 2015年368个登记地区覆盖人口309 553 499人,男性156 934 140人,女性152 619 359人。估计全国胃癌新发病例40.3万例,发病率为29.31/10万,中标率为18.68/10万,世标率为18.57/10万,0~74岁累积发病率为2.29%,居发病癌谱第二位。胃癌死亡病例29.09万例,死亡率为21.16/10万,中标率为13.08/10万,世标率为12.92/10万,0~74岁累积死亡率为1.5%,居癌症死亡顺位第三位。总体上,胃癌发病率（男性中标率为26.54/10万,女性中标率为11.09/10万）和死亡率（男性中标率为18.75/10万,女性中标率为7.72/10万）男性均高于女性,农村地区均高于城市地区（农村中标发病率为21.82/10万,城市中标发病率为16.37/10万;农村中标死亡率为15.84/10万,城市中标死亡率为11.05/10万）。胃癌年龄别发病率和死亡率在40岁之前较低,40岁后开始上升,在80~岁达到高峰。胃癌病例数自50~岁开始显著增多,高峰出现在60~70岁组,大量病例累积在55~80岁。不同性别、城乡地区年龄别发病率和死亡率与全人群总体趋势相似,但男性高于女性,农村高于城市。结论 我国胃癌发病有明显的性别、年龄和城乡分布差异,可根据高发年龄和高危人群特征优化筛查项目和防控方案,以期降低我国胃癌的疾病负担。     

2003~2007年中国皮肤黑色素瘤发病与死亡分析

[目的]分析中国肿瘤登记地区2003~2007年皮肤黑色素瘤的发病率与死亡率,为皮肤黑色素瘤防治提供科学依据。[方法]对全国44个肿瘤登记地区上报的2003~2007年肿瘤登记数据进行审核,选取数据合格32个登记地区,计算比较2003~2007年不同地区、年龄、性别发病(死亡)率和标化发病(死亡)率。同时对北京市、上海市、林州市和启东市1988~2007年间的皮肤黑色素瘤发病和死亡数据进行描述性分析。[结果]2003~2007年中国肿瘤登记地区皮肤黑色素瘤发病率为0.49/10万(男性0.52/10万,女性0.46/10万;城市地区0.55/10万,农村地区0.26/10万),中标率为0.27/10万,世标率为0.35/10万。皮肤黑色素瘤死亡率为0.24/10万(男性0.26/10万,女性0.22/10万;城市地区0.27/10万,农村地区0.15/10万),中标率为0.12/10万,世标率为0.17/10万。32个登记地区中,标化发病率和标化死亡率最高的大连市。与1988年比,近20年北京市、上海市的皮肤黑色素瘤发病率和死亡率上升。[结论]2003~2007年我国皮肤黑色素瘤发病率和死亡率水平较低,但城市地区发病和死亡有上升趋势,应重视对其的预防和控制。