Trends in Incidence of Childhood Leukemia,Khon Kaen,Thailand, 1985-2002

Background: The Khon Kaen Cancer Registry (KKCR), providing both hospital and population-based ‍registration, was established in 1984 in the Faculty of Medicine, Khon Kaen University. Leukemia is the most ‍common cancer among Thai children in Thailand, including both curable and preventable types, but no assessment ‍of trends has hitherto been performed. Objective: To perform a statistical assessment of the incidence trend of ‍childhood leukemia in Khon Kaen, Thailand, between 1985 and 2002. Methods: Population-based cases of childhood ‍leukemia registered between 1985 and 2002 were retrieved from the KKCR and cases with an ICD-O diagnosis ‍(coding C42) in children under 15 were selected. Incidence trends were calculated using the Generalized Linear ‍Model method (GLM), which generates incidence-rate-based logarithms. Results: Of the 277 cases of leukemia, ‍boys were affected two times more frequently than girls and half of the cases were 0-4 years of age. Most diagnoses ‍were histologically- or cytologically-proven and the most common type (affecting two-thirds, 65.7%) was acute ‍lymphoblastic leukemia (ALL). The overall, age-standardized rate (ASR) for leukemia was 31.9 per million (95%CI: ‍28.1 to 35.7); 40.3 per million (95%CI: 34.2 to 46.4) in boys and 27.0 (95%CI: 21.8 to 32.2) in girls. Incidence has ‍been increasing by 2.4% per year in boys (95% CI: -0.5 to 5.3) and 4.1% per year in girls (95% CI: 1.1 to 7.2). ‍Conclusions: This incidence-rate-based logarithm indicates that childhood leukemia has been increasing, suggesting ‍further epidemiological research on causes and possible prevention is needed.     

Childhood Cancer Incidence and Survival 1985-2009, Khon Kaen,Thailand

Background: The Khon Kaen Cancer Registry (KKCR) was established in 1984. Previous population-basedincidences and survivals of childhood cancer in Thailand were determined using a short cancer registration period.Materials and Methods: Data were retrieved of all children residing in Khon Kaen, between 0–15 years, diagnosedas having cancer and registered in the KKCR (1985-2009). The follow-up censored date was December 31, 2012.The childhood cancers were classified into 12 diagnostic groups, according to the International Classificationof Childhood Cancer. The incidence was calculated by the standard method. Survival of childhood cancer wasinvestigated using the KKCR population-based registration data and overall survival calculated using the KaplanMeier method. Results: In the study period, 912 newly diagnosed cases of childhood cancer were registered.The respective mean and median age was 6.4 (SD=4.6) and 6 (0-14) years. The age-peak for incidence was 0–4years. The age-standardized rate (ASR) was 83 per million. Leukemia was the most common cancer (N=360,ASR 33.8) followed by neoplasms of the central nervous system (CNS, N=150, ASR 12.8) and lymphoma (N=79,ASR 7.0). The follow-up duration totaled 101,250 months. The death rate was 1.11 per 100 person-months(95%CI: 1.02 -1.20). The 5-year overall survival was 52% (95%CI: 53-56.9) for all cancers. The respective 5-yearoverall survival for (1) acute lymphoblastic leukemia (ALL), (2) acute non-lymphoblastic leukemia (ANLL), (3)lymphoma, (4) germ cell tumors, (5) renal tumors, (6) retinoblastoma, (7) soft tissue tumors, (8) CNS tumors,(9) bone tumors, (10) liver tumors, and (11) neuroblastoma was (1) 51%, (2) 37%, (3) 63%, (4) 74%, (5) 67%,(6) 55%, (7) 46%, (8) 44%, (9) 36%, (10) 34%, and (11) 25%. Conclusions: The incidence of childhood canceris lower than those of western countries. Respective overall survival for ALL, lymphoma, renal tumors, livertumors, retinoblastoma, soft tissue tumors is lower than that reported in developed countries while survival forCNS tumors, neuroblastoma and germ cell tumors is comparable.     

Trends in incidence of hepatocellular carcinoma, 1990-2009, Khon Kaen, Thailand

Background: Liver cancer is the most frequent cancer among Thais especially people in northeastern Thailand, but there has as yet been no assessment of trend. The data of all cancers in Khon Kaen can be retrieved from data base of the Khon Kaen Cancer Registry (KKCR) which was established in 1984. Objective: To assess the incidence trend of hepatocellular carcinoma in Khon Kaen, Thailand, between 1990 and 2009. Methods: Population-based cases of liver cancer registered between 1985 and 2009 were retrieved from the KKCR data base and cases with diagnosis of hepatocellular carcinoma (HCC) with the coding C22.0 according to ICD-O were selected. Incidence trends were calculated using the Jointpoint analysis. Results: There were 7,859 cases of HCC during the study period. Males were affected two times more frequently than females. The most common age group of cases was 50 and 69 years (60.3%). Most patients were diagnosed based on radiology imaging (40.6%) while the morphology verification was 7%. The age-standardized rates (ASR) were 13.1 to 49.8 per 100,000 among males and 4.8 to 38.4 per 100,000 among females depending on year of diagnosis since 1985. Remarkably, the ASRs were clearly low during first few years of starting the registration. The overall ASRs of HCC were 30.3 per 100,000 in males (95% CI: 25.9 to 34.6) and 13.1 per 100,000 (95% CI: 10.4 to 15.8) in females. During 1990-2009, the trends in incidences have been decreasing significantly with the annual percent change (APC) of 6.2% per year (95% CI: –7.6 to –4.8) in males and by 6.5% per year in females (95% CI: –8.4 to –4.9). Conclusions: The incidence trends have been decreasing in both sexes. The recent decline in incidence may represent a falling risk.     

Cervical Cancer in Khon Kaen,Thailand: Analysis of 1990-2014 Incidence Data and Prediction of Future Trends

Background: Cervical cancer is the second most common cancer of women in Thailand. There have been no reportsof incidence and future in Khon Kaen, a province in northeastern Thailand, where the relatively high prevalence givesevaluation of cervical cancer screening a high priority. Objectives: To determine cervical cancer incidence rates inKhon Kaen for 1990–2014 and predict future trends until 2029. Methods: Cancer incidence data from the Khon Kaenpopulation-based cancer registry were analyzed and age-standardized incidence rates (ASR) were estimated. Joinpointanalysis and age-period-cohort modeling were applied for data from 1990 to 2014 and the Nordpred package wasemployed to project trends from 2015 to 2029. Results: Between 1990 and 2014, a total of 3,258 cases were diagnosedwith ICD-O code C53 (invasive cervical cancer). Before 2005, an annual percentage change (APC) varied widely, withoutliers in 1993 and 1999. The APC computed with the Joinpoint software decreased at -2.8% (95% CI;-4.5 to -1.1)per year on average. After 2005, a rise was noted until 2008, after which a drop became apparent with an APC of-8.0% (95% CI; -14.5 to -1.1) per year on average. Both period and cohort effects played a role in shaping the decreasein incidence. The three projection method suggested that incidence rates would continue to decrease in the future.Conclusions: A decreasing trend in incidence of cervical cancer in Khon Kaen was noted from 1990 to 2014 with aprediction of continuous decrease until 2029. Maintenance and improvement of the screening program is advised.     

Epidemiology of oral and pharyngeal cancers in Khon Kaen, Thailand: a high incidence in females

Background: This study was aimed to describe incidence, trends, and survival of oral and pharyngeal cancers in Khon Kaen, the province situated in the northeast of Thai-land. Methods: Data on oral and pharyngeal cancer cases diagnosed during 1985 - 2001 were retrieved from the population-based cancer registry of Khon Kaen. The final status of the patients was verified by database linkage and follow-up using postcards. Results: Of 1,038 cases, 62.6% were female and 37.4% were male, with a mean age of 63 years. The age-standardized incidence rate (ASR) in females (6.2 per 100 000; 95%CI 5.7-6.7) was significantly higher than in males (3.9 per 100 000; 95%CI 3.5-4.4). Annual percent changes in ASR were 1.7 in females (p<0.05), but 1.2 in males. Lip and buccal cancers were the most common sites respectively; however, the incidence of tongue cancer was increasing in the last period. Eighty five percent of all cases were diagnosed in advanced stage (stage III and IV). The overall five-year relative survival was 43.1%. We found stage distribution and survival did not change during the study period. Conclusion: The considerably high incidence in female suggests a need for research on specific risk factors. Moreover, attempts should be made to detect oral cancers earlier in order to improve the outcomes of cancer control.     

Incidence and Survival Rates among Pediatric Osteogenic Sarcoma Cases in Khon Kaen,Thailand, 1985-2010

Background: Osteosarcoma is the most common bone cancer in children, responsible for a high rate ofamputation and death. This is the first long-term, population-based, epidemiologic and survival study inThailand. Objective: To study the incidence and survival rates of pediatric osteosarcoma in Khon Kaen.Method: Childhood osteosarcoma cases (0-19 years) diagnosed between 1985-2010 were reviewed. The datawere retrieved from the population-based data set of the Khon Kaen Cancer Registry and medical recordsfrom Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. All cases were censored until the endof April 2012. The age-standardized incidence rate (ASR) was calculated using the standard method. Survivalexperience was analyzed using the standard survival function (STATA 9.0) and presented with a Kaplan-Meiercurve. Results: 58 cases were enrolled. The overall ASR was 14.1 per million. Males and females were equallyaffected. The peak incidence was for 15-19 year-olds in both sexes (ASR=10.4 per million in males and 8.5 infemales). The 5-year overall survival rate was 27.6% (95% CI: 15.8-40.8%). The median survival time was 1.6years (95% CI: 1.2-2.1). In a subgroup analysis, the patients who received only chemotherapy survived longer(5-year survival 45.7%, median survival time 4.1 years, p=0.12). Conclusion: The incidence rate for childhoodosteosarcoma was slightly less than those reported for Western countries. The survival rate was also lower thanreports from developed countries. Further evaluation of the treatment protocol and risk factor stratification isneeded.     

Incidences,Trends and Long Term Outcomes of Retinoblastoma in Three Cancer Registries,Thailand

Background: Retinoblastoma (RB) is rare, albeit the most common primary intraocular malignancy amongchildren. To elucidate the true incidence, trend and survival, we studied incidences and trends of retinoblastomain a large population with long-term follow-up using data from 3 population-based cancer registries. Objective:To describe the incidence, trends and survival of RB between 1990 and 2009 in Khon Kaen, Songkhla and ChiangMai, Thailand. Materials and Methods: We sourced the data from the cancer registries in Khon Kaen, Songkhlaand Chiang Mai on children with retinoblastoma, diagnosed between 1990 and 2009. Retinoblastoma was definedas per the International Classification of Disease for Oncology version 3 using the code 9510/3. Incidence wasanalyzed using the standard method with the criteria of the International Association of Cancer Registries. TheKaplan-Meier method was applied to calculate cumulative survival. Trends were calculated using the log ranktest. Results: We identified 75 cases of children between 0 and 15 years of age diagnosed with RB (Khon Kaen31, Chiang Mai 20, Songkhla 24). Males and females were equally affected. The most common age group was0-4 years. The morphological verification of the disease was 90.7%. The respective ASR in Khon Kaen, ChiangMai and Songkhla was 4.4, 4.0 and 4.6 per million; for which the overall ASR for all 3 areas was 4.3 per million.The respective trend in incidence was 4, 2.8, 5.8 and 5.4 during 1990-4, 1995-9, 2000-4 and 2005-9. Overall,incidence trended gradually upward by 2% annually. The respective survival rate in Khon Kaen, Chiang Maiand Songkhla was 50, 40 and 75% (differences not significantly different at p=0.14) and the overall survival forall centers was 60%. Conclusions: Over the last two decades, the incidence and overall survival of retinoblastomahas increased. The ASRs and survival in Thailand were less than those in resource-rich countries.     

Trends in Liver Cancer Incidence between 1985 and 2009, Khon Kaen,Thailand: Cholangiocarcinoma

Background: The Khon Kaen Cancer Registry (KKCR), having both hospital and population-based registration, was established in 1984 at the Faculty of Medicine, Khon Kaen University. Liver cancer is the most frequent malignancy among Thais from northeastern Thailand, but there has hitherto been no assessment of trends over time. Objective: To perform a statistical assessment of the incidence trends between 1985 and 2009 of liver cancer, specifically focusing on cholangiocarcinoma (CHCA). Methods: Cases of CHCA, registered between 1985 and 2009, were retrieved from the KKCR and all those with a specific ICD-O-3rd diagnosis with a coding of C22.1, C24.0, C24.8 and C24.9 were selected. Incidence trends were calculated using the generalized linear model method (GLM), which generates incidence rate based logarithms. Jointpoint analysis was used to identify the best fitting model. Results: Of the 18,589 cases of liver cancer 42% (7,859) were hepatocellular carcinoma and 58% (10,731) were CHCA. Among persons with CHCA, males were affected two times more frequently than females. Three-quarters of the cases were between 55 and 69 years of age. Morphology verified through a cytological or histological examination of tissue from the primary site (%MV) was only 10.8 % (1,141). The respective overall Age Standardized Rate (ASR) for CHCA from 1985 to 2009 was 16.8 to 62.0 per 100,000 among males and 4.8 to 25.6 per 100,000 among females. The respective, overall, ASR of CHCA among males vs. females was 44.3 per 100,000 (95% CI: 38.9 to 49.7) vs. 17.6 (95% CI: 14.5 to 20.7). Among males vs. females, the respective incidence from 1990 to 2009 has been significantly decreasing by –0.7% per year (annual percent change, APC: –0.7%, 95%CI: –2.1% to +0.8%) vs. –0.4% per year (APC: –0.4%, 95% CI: –2.1% to +1.4%).Conclusions: The rate increase in the first 5 to 6 years may be due to improved completeness of the registry, since in the subsequent 10 to 12 years there is a rather stable rate. It may be, however, that the recent decline in incidence represents a real fall in risk.     

Data Quality of Childhood Cancer in Khon Kaen,Thailand, 1990-2007

Introduction: Khon Kaen Cancer Registry (KKCR) was established in 1984. KKCR aims to collect allcancer cases in Khon Kaen Province. The poorly qualified data may lead to distort the cancer burden andmisinterpretation of policy maker. Objective: To assess data quality in childhood cancer between 1990 and 2007in Khon Kaen Province, Thailand. Materials and Methods: Data of childhood cancer cases aged less than 20 yearsdiagnosed during 1990-2007 were retrieved from the population-based data set of KKCR. All childhood cancerdata were verified before data entry. Internal consistency, percentage of morphological verification (MV%) andcancer cased of the basis of diagnosis by death certificate only (DCO%) were evaluated. The age-adjusted rate(ASR) was calculated by standard method. Results: The data of childhood cancer from KKCR is acceptablyqualified which reflects the quality of the whole registration.     

Betel Quid Chewing and Upper Aerodigestive Tract Cancers: A Prospective Cohort Study in Khon Kaen,Thailand

Background: This study aimed to determine the association between betel quid chewing and the occurrenceof upper aerodigestive tract (UADT) cancers. Methods: A cohort of 17,388 subjects, recruited and interviewedover the 1990-2001 period, in Khon Kaen, Thailand, was followed up until 2011. The data were linked to theKhon Kaen Population-Based Cancer Registry. Results: The prevalence of betel quid chewing was 15.9%, with afemale predominance (97.7%); the mean age of chewers was 57.7 years (SD 6.6). The overall incidence of UADTcancers from the cohort was 14.7 per 100,000 person-years, whereas the incidence among the chewers was 45.7.Betel nut chewing was the only major risk factor for UADT cancers in this population (HR=5.26, 95%CI=2.51-11.0), while weak associations were found for tobacco smoking and alcohol (HR=1.16, 95%CI=0.45-3.01 and 1.47,95%CI=0.72-3.03 respectively). Conclusions: We found betel quid chewing to be a main risk factor for UADTcancers, resulting in a higher incidence in females. However, further study is required to explore the potentialr isk factors among non-chewers, non-smokers, and non-drinkers     

Lifestyle-related risk factors for stomach cancer in northeast Thailand.

Background: Stomach cancer is not common in Thailand but the life styles of the Thai population are changingto become more Western so that information for planning control programme of stomach cancer is necessary.The highest incidence rates of this neoplasm are found in Eastern Asia, ranging from age-standardized rates of95.5/105 (men) and 40.1/105 (women) in Yamagata, Japan to 4.1/105 (men) and 2.1/105 (women) in Khon Kaen,Northeast of Thailand. In Thailand, the estimated age-standardized incidence rates in 1993, 1996 were 4.9/105,4.1/105 in men and 3.0/105 , 2.6/105 in women. Risk factors for stomach cancer in Thai population are unclear,but possibly include low intake of vegetables and fruits, alcohol drinking, tobacco smoking and high intake ofsalt. Objective: To investigate various aspects of dietary factors, smoking, and alcohol drinking in determiningrisk of stomach cancer in Thai population. Methods: A case-control study was conducted in Khon Kaen, Thailandduring 2002-2006, to study the role of these factors in stomach cancer. 101 stomach cancer cases and 202 matchedcontrols (case : control = 1:2) by sex, age (± 3 years) and region were recruited from Srinagarind Hospital andKhon Kaen Regional Hospital, in Khon Kaen Province. All of cases were histologically confirmed. Controls hada variety of diseases, the main ones being disease of the eye. Information on dietary habits, alcohol drinking andsmoking were collected by a structured questionnaire, blood samples were collected for further study. Results:The distribution of the general characteristics by case-control status, the distribution of age and sex were similarin cases and controls. In the final analysis, the factors that found to be higher risk but not statistically significantwere long-term filter cigarette smoking (OR=1.9, 95%CI: 0.85-4.50), long-term alcohol consumption (OR=1.2,95%CI: 0.51-2.60) and low intake of vegetables and fruits (OR=1.2, 95%CI: 0.74-1.96). A high intake of vegetableoil (OR=4.5, 95%CI: 1.00.-20.17) was found to be associated with increased risk, and similar tendencies werenoted for pork oil (OR=1.4, 95%CI: 0.63-3.01) and jeaw prik (mainly chilly with plara broth) (OR=1.2, 95%CI:0 .76- 2.01). Conclusion: Our study confirmed protective effects of a high intake of fruits and vegetables againststomach cancer development and showed a high intake of sauces to increase risk of stomach cancer as in othercountries in Asia.     

Characteristics and trends in incidence of childhood cancer in Beijing,China, 2000-2009

Objective： To investigate the characteristics and incidence trends of childhood cancer in Beijing, China, from 2000 to 2009. Methods： A total of 1,274 cases with childhood cancer in Beijing from 2000 to 2009 were included in the study. All rates were age-standardized using the direct method to the world standard population and expressed per million person-years. Incidence trends were characterized by calculating annual percent change （APC） usingJoinpoint Regression Program. Results： The crude incidence rate was 106.47 per million [age-standardized rate （ASR） 113.34] between 2000 and 2009 in Beijing with the most common diagnoses, leukemia （N=505, 39.64%, ASR 45.20）, followed by central nervous system （CNS） tumors （N=228, 17.90%, ASR 19.28） and lyrnphoma （N=91, 7.14%, ASR 6.97）. The incidence for all childhood cancers combined has increased during the study period, with an APC of 5.84% [95% confidence interval （95% CI）： 1.0-10.9] after adjusted by world population. The ASR of all combined cancers in boys showed a slight, but no significant increase, with an APC of 5.33 % （95 % CI： -0.6- 11.6）; for girls, the trends increased significantly, with an APC of 6.54% （95% CI： 1.5-11.8）. Conclusions： The incidence rate of childhood cancer in Beijing was higher than the average level of China and lower than that of western countries. The incidence trends of childhood cancer, especially leukemia among girls showed a significantly increase from 2000 to 2009. While among boys, no substantially change was seen during the observed time period. Some sex-specific trends by subcategories and trends of major cancers in different age groups by cancer site merit further investigation.     

Trends in Incidences of Stomach and Colorectal Cancer in Khon Kaen,Thailand 1985-2004

Background: The life styles of Thai people are changing with westernization and this would be expected to havean impact on the prevalence of cancer and other non-communicable diseases. For planning control programmes it isnecessary to monitor change over time and the present study was conducted to provide information on stomach andcolorectal cancer incidence rates in Khon Kaen Cancer Registry (KKCR), established in 1984 at the Faculty ofMedicine, Srinagarind Hospital, Khon Kaen University. Objective: To assess trends in urban and rural areas ofKhon Kaen province during 1985 - 2004. Methods: Data for stomach and colorectal cancer with an ICD-O diagnosis(coding C16 , C18 – C20) from the population-based cases of the KKCR, registered between 1985 and 2004, wereretrieved and incidence trends were calculated using the Generalized Linear Model method (GLM), which generatesincidence-rate-based logarithms. Results: The study population comprised 2,530 cases, 721 of stomach (males 449,females 272) and 1809 of colorectal (males 976, females 833) cancer. Most cases were aged 35-75 years. Accordingto the histopathological diagnosis, the most common was adenocarcinoma with over 90 percent. The overall agestandardizedincidence rates (ASR) for stomach cancer were 4.5 and 1.4 per 100 000 in males and females, respectively,during 1985-1989, 3.7 and 2.0 during 1990-1994, 3.0 and 2.2 during 1995-1999 and 3.6 and 1.8 during 2000-2004 .The respective figures for colorectal cancer were 3.3 and 2.6, 4.6 and 3.1, 5.4 and 3.5 and finally 5.8 and 5.3. In bothurban and rural areas males were affected more frequently than females, although a shift was evident towardsdecrease in the se ratio was evident for colorectal cancers over time. Discussion: The results of this study showedslight increase in the incidence of colorectal cancer in Khon Kaen province, while rates for stomach cancer remainedquite stable. The findings indicate a need for continuing research in stomach and colorectal cancer epidemiology,with subdivision into particular sites within these two sections of the gut.     

Cancer survival in Khon Kaen province,Thailand

Thailand is one of the few developing countries for which population-based cancer survival data are available. Using clinical follow-up information and reply-paid postal enquiries, 10,333 residents of Khon Kaen province registered with cancer in the period 1985–1992 were followed-up to the end of 1993. The sites of the most common cancers in the province were liver (5-year relative survival rate 9.2%), cervix (60.1%), lung (15.4%), breast (48.1%) and large bowel (41.9%). Results for Khon Kaen were compared with age-standardized survival data for the US and Scotland. Survival was consistently higher for US whites compared to Khon Kaen residents for those cancers whose prognosis is associated with early diagnosis (breast, cervix and large bowel) or the availability of intensive therapy (leukaemia and lymphoma). The main implication of these results for cancer control in Thailand is that the interventions of greatest potential benefit are those designed to promote early detection. More than one-third of all cancers in Thailand are liver tumours: primary prevention through control of hepatitis-B infection and liver fluke infestation is the only effective strategy for their control. © 1995 Wiley-Liss, Inc.     

Risk factors for colorectal cancer in northeast Thailand: lifestyle related.

Background: The incidence of colorectal cancer is variable around the world. Hiroshima, Japan had the highest incidence in men in 1997 with an age-standardized rate of 86.7 per 100,000 and New Zealand had the highest, at 40.6 per 100,000, in women. The incidence of colorectal cancer in Thailand is rather low and the latest figures for Northeast of Thailand are 7.1 per 100,000 for men and 4.7 for women. The reasons for these differences between countries are possibly due to variation in dietary habits, alcohol drinking or other cofactors. Methods: A case-control study was conducted in Khon Kaen, Northeast Thailand during 2002-2006 to study risk factors for colorectal cancer in a low risk area. Totals of 253 colorectal cancer cases (males 135, females 118) and 253 age- and sex-matched controls were recruited. Information on dietary habits, alcohol drinking, smoking and other information were collected by a structured questionnaire. Blood samples were collected for further study. Both univariate and multivariate analyses were carried out. Results: In the final model of multivariate analysis, the significant risk factors for colorectal cancer were a family history of cancer (OR=1.9 95%CI=1.2-2.9) and meat consumption (OR=1.0 95%CI=1.0007-1.0026). For BMI, subjects with higher BMI unexpectedly had a lower risk of colorectal cancer (OR=0.5 95%CI=0.3-0.8). Conclusion: Our study confirmed risk factors for colorectal cancer i.e. meat consumption and cancer in the family (genetic problem). However, the results for BMI are the reverse of expected, underlining one limitation of hospital-based case-control studies, in which cases are ill and admitted to the hospital at late stage.     

Childhood cancer incidence and survival 2003-2005, Thailand: study from the Thai Pediatric Oncology Group

Background: Previous population-based incidences of childhood cancer in Thailand were achieved by extrapolating from data limited to a small number of cancer registries, not from the whole country. In addition, survival of childhood cancer patients is often described in specialized hospitals and/or institutions, but not in the general population. Methods: All children aged 0–15 years who were newly diagnosed as having cancer were registered from 18 treatment centers during 2003-5 and classified into 12 diagnostic groups according to the International Classification of Childhood Cancer. Incidences were calculated by a standard method and survival was investigated using the ThaiPOG (Thai Pediatric Oncology Group) population-based registration data. Overall survival was calculated by the Kaplan Meier method. Results: In the study period (2003-5) 2,792 newly diagnosed cases of childhood cancer were registered, with mean and median ages of 6.5 (SD=0.13) and 5.0 (0-14) years, respectively. The age-peak was between 1 and 4 years and the age-standardized rate (ASR) was 74.9 per million. Leukemia was the most common cancer (N=1421, ASR 38.1) followed by lymphoma (N=266, ASR 6.4) and neoplasms of the central nervous system (CNS, N=246, ASR 6.3). The follow-up duration totaled 101,250 months. The death rate was 1.11 per 100 person-months (95%CI: 1.02 -1.20). The 5-year overall survival was 54.9% (95%CI: 53.0%-56.9%) for all cancers. The respective, 5-year overall survival for (1) acute lymphoblastic leukemia (ALL), (2) acute non-lymphoblastic leukemia (ANLL), (3) lymphoma, (4) retinoblastoma, (5) renal tumors, (6) liver tumors, (7) germ cell tumors, (8) CNS tumors, (9) neuroblastoma, (10) soft tissue tumors and (11) bone tumors were (1) 64.5%, (2) 35.1%, (3) 59.5%, (4) 73.1%, (5) 70.4%, (6) 44.5%, (7) 70.6%, (8) 41.7%, (9) 33.6%, (10) 50.1%, and (11) 33.7%. Conclusions: The incidence of childhood cancer is lower than in western countries. Respective overall survival for ALL, lymphoma, renal tumors, liver tumors, retinoblastoma, soft tissue tumors is lower than those reported in developed countries while for CNS tumors, neuroblastoma and germ cell tumors the figures are comparable.     

Gastric Cancer: the Roles of Diet,Alcohol Drinking,Smoking and Helicobacter pylori in Northeastern Thailand

The incidence of gastric cancer in the countries of South East Asia is variable, ranging from age-standardized ‍rates of 20.9/105 (men) and 10.4/105 (women) in Hanoi, Vietnam to 4.1/105 (men) and 2.1/105 (women) in Khon Kaen, ‍Thailand. The reasons for these differences are unknown. Possible explanations are differences in dietary habits, ‍alcohol drinking, smoking and/or the prevalence of infection with Helicobacter pylori (H. pylori). A case-control ‍study was conducted in Khon Kaen, Thailand, to study the role of these factors in gastric cancer carcinogenesis. 131 ‍gastric cancer cases and 262 matched controls were recruited for the study. Information on dietary habits, alcohol ‍drinking and smoking were collected by a structured questionnaire. Blood samples were available from 111 cases ‍and 232 controls for H. pylori assay. Using an unconditional logistic regression model controlling for age and sex, we ‍assessed the effects of dietary habits, alcohol drinking, smoking and H. pylori infection on the risk of gastric cancer. ‍A high intake of salt (OR=1.8; 95%CI 1.1-3.0) and fermented foods (OR=1.9; 95%CI 1.1-3.3) was found to be ‍associated with an increased risk. Preference for spicy food was not associated with gastric cancer risk in this ‍population. Although there were negative associations between gastric cancer and vegetable and fruit intake, they ‍were rather weak (OR 0.8 for both) and non significant. There were also weak (non-significant) associations with ‍smoking and alcohol consumption, and no association with H. pylori infection (OR=0.6; 95%CI 0.4-1.0). Infection of ‍H. pylori was associated with various indicators of crowding. ‍     

Risk Factors for Cholangiocarcinoma in Khon Kaen,Thailand: A Nested Case-Control Study

The present nested case-control study within the Khon Kaen cohort study was conducted to assess riskfactors for cholangiocarcinoma (CCA) development. Cases were 108 subjects with proven CCA by ultrasoundat least and controls also numbered 108, matched by sex, age (not more than 3 years difference) and period ofrecruitment to the cohort (not more than 3 months difference). A questionnaire was constructed based on thatemployed for the Khon Kaen cohort study recruitment. McNemar’s chi-square test and conditional logisticregression were used for crude analysis and multivariables analysis. Results revealed a sex ratio of 2:1 formales:females. The current study found a statistically significant association when adjusted for other potentialcovariate factors between cholangiocarcinoma and the consumption of total fruits 1.0-2.08 times per day (OR0.32; 95%CI: 0.12-0.88) and history of Opisthorchis viverrini (OV) eggs in stools at recruitment plus consumptionof meat < 0.45 times per day (OR 2.99; 95%CI: 1.04-8.62). The findings suggest that OV infestation is thestrongest risk factor for development of cholangiocarcinoma and also suggests decrease in risk among individualswho consume more fruit.     

Health Insurance and Colorectal Cancer Survival in Khon Kaen,Thailand

Background: Evidence from healthcare studies demonstrates that patients’ health insurance affects serviceaccessibility and the outcome of treatment. However, assessment on how colorectal cancer survival relates to healthinsurance is limited. Objective: The study examined the association between health insurance and colorectal cancersurvival in Khon Kaen, Thailand. Methods: The retrospective cohort study was conducted with 1,931 colorectal cancerpatients from Khon Kaen cancer registry between January 1, 2003 and December 31, 2012, and was followed-up untilDecember 31, 2015. Relative survival was used to estimate the survival rate. Cox proportional hazard regression wasused to estimate the relationship between health insurance and colorectal cancer survival, represented with the hazardratio. Result: Most of the participants were males, and the median age was 62 years. The median survival time was2.25 years (95% CI: 2.00-2.51). The five-year observed survival rate and relative survival rate were 36.87 (95% CI:34.66-39.08) and, 42.28 (95% CI: 39.75-44.81), respectively. The factors that showed significant associations withpoorer survival after adjustment for gender and age were non-surgical treatments (HRadj=1.88;95%CI=1.45-2.45),advanced stage (III+IV) (HRadj=2.50; 95%CI=2.00-3.12), histological grading in poorly differentiated (HRadj=1.84;95%CI=1.32-2.56), and Universal Coverage Scheme (HRadj=1.37;95%CI=1.09-1.72). Conclusion: The survival ofcolorectal cancer patients in the Universal Coverage Scheme was likely to be poorer than in the Civil Servant MedicalBenefit Scheme. This indicates an urgent need for a national program for colorectal cancer screening in the generalpopulation and access to health insurance.     

Cancer Incidence in Thailand, 1995-1997

There are five population-based cancer registries in Thailand in different regions of the country. Four of them ‍(Chiang Mai, Khon Kaen, Bangkok, and Songkhla) have been operating since 1988 and the other (Lampang) since ‍the early 1990’s. These registries have published regular 3-year cancer incidence reports since the first in 1993 for ‍the period 1989-1991. The objective of this article is to summarize the figures of cancer incidence in Thailand during ‍1995-1997. The population of Thailand in 1996, at the middle of the period, was 27 million males and 27.5 million ‍females. Information of cancer cases residing in the five provinces was collected and abstracted from different ‍sources. Age-standardized incidence rate (ASR) of cancer in males and females was calculated for each registry and ‍that for the whole country was estimated using the five registries as representatives for the four geographical regions ‍of Thailand. The estimated number of new cancer cases in 1996 for the whole country was 35,539 men and 38,476 ‍women and the ASRs were 149.2 and 125.0 per 105 population in men and women respectively. Cancer incidences ‍greatly differed from region to region. Lung cancer was the commonest in Chiang Mai and Lampang in the Northern ‍region in both sexes. The incidence of liver cancer in Khon Kaen in the Northeastern region outnumbered all the ‍others in both sexes; cholangiocarcinoma was the major type of liver cancer. In Bangkok, lung cancer was the most ‍important cancer in males and breast cancer was in females. Though it was lung and cervix uteri cancer that ranked ‍the first in men and women in Songkhla, the rate of oral and pharyngeal cancer was exceptionally higher than in ‍other registries. The geographical variability in cancer patterns in Thailand reflects exposure of the population to ‍different risk factors unique to the different regions. In the study as a whole, there are some methodological weak ‍points in estimating the ASRs and number of cancer cases for the whole country, but the results are the most reliable ‍cancer statistics from Thailand at the moment. In conclusion, both a country-wide and region-specific cancer control ‍programmes are needed for Thailand. The national one would be for the cancers common to all regions, and the ‍provincial-level emphasis should be on cancers which are the major problems in the area.