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.     

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.     

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.     

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.     

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.     

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 Childhood Lymphoma in Khon Kaen,Thailand, 1985-2008

Background: Lymphoma is the second most common of childhood cancer in Thailand, but data on trendsover time are limited. Objective: To perform a statistic assessment of the incidence trend of childhood lymphomain Khon Kaen, Thailand, between 1985 and 2008. Method: All children aged < 15 years newly diagnosed withlymphoma according to International Childhood Cancer Classification (ICCC) during January 1, 1985- December31, 2008 were collected from data base of Khon Kaen Provincial Registry. Aged-adjusted incidence rates (ASRs)were calculated by standard method and trends were calculated using the generalized linear model method, which utilizes incidence-rate-base logarithms. Results: During 1985-2008 there were 72 children (47boys and 25 girls) who were diagnosed with lymphoma in Khon Kaen province. The peak age-group of diseasewas in the 5-9 year olds for both sexes. All cases were pathologically proven. Non-Hodgkin lymphoma (NHL)was more common than Hodgkin disease (ratio 7:1). The overall ASR was 6.04 per million (95%CI: 4.64 to 7.45)and the ASR was 7.64 per million (95%CI: 5.44 to 9.84) in boys and 4.37 per million (95%CI: 2.64 to 6.10) ingirls. Significant increases were observed for boys, since the 2006 to 2008 ASR was 15.3 per million (95%CI:5.73 to 25.0). Trend analyses during 1985 - 2008 showed that incidence among boys for lymphoma increasedby 1.38 percent per year (95%CI:- 4.6-8.3) while the incidence among girl decreased by 2.6 percent per year(95%CI:- 12-6.8). Conclusions: Our data showed that the incidence of childhood lymphoma in Khon Kaenprovince was similar to the one of Thailand but lower than those of western countries. During the past 24 years,the incidence trend seems to be increasing in boys but decreasing in girls. Interpretation is difficult without abetter understanding of what underlies the reported changes.     

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.     

Survival of Stomach Cancer Cases in Khon Kaen,Thailand 2000-2012

Background: Stomach cancer is an aggressive malignancy that is difficult to detect at an early stage and therefore is characterized by poor survival rates. Over the last two decades, there has been no report of gastric cancer survival in Khon Kaen province, Thailand. The aim of this retrospective cohort study was to provide up-to-date information about the survival of gastric cancer patients in this province. Materials and Methods: Data from Khon Kaen population-based cancer registry, Faculty of Medicine, Khon Kaen University were newly obtained on 650 patients who were diagnosed with stomach cancer during the period 1 January, 2000 to 31 December, 2012. These were then followed up until death or the end of the study (31 December 2014). We calculated the observed survival with the actuarial life table method, and relative survival, defined as the ratio of observed survival in the group of the stomach cancer patients to the expected survival in the entire Thai population from the estimated generation life tables for Thailand of five-year birth cohorts from 1900 - 2000. Results: The 5 year observed and 5 year relative survival rates were 17.2 % (95% CI: 13.54-21.14) and 18.2 % (95% CI: 14.3-22.4), respectively. The highest 5 year relative survival rates were demonstrated among patients aged 45-65, with stage I or II lesions, with adenocarcinomas, with a body of stomach location, well differentiated and receiving surgery and/or chemotherapy. Conclusions: The observed and relative survival rates were close to each other. Our findings provide basic information beneficial to development of an effective treatment system and appropriately improved population-based cancer registration.     

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.     

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.     

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.     

Numbers of New Cases and Trends of Cancer 1993-2012: Srinagarind Hospital Based Population,Khon Kaen,North-East Thailand

Background: Cancer is the most common cause of death in Thailand, where treatment outcomes andprognosis are poor and mortality rates remain high. This study reports new cancer cases and trends of allcancers registered in Srinagarind Hospital from 1993 to 2012 and also provides a picture of the cancer situationin Northeast Thailand. Materials and Methods: All new cases of cancer registered in the hospital-based cancerregistry at Faculty of Medicine, Srinagarind Hospital, Khon Kaen University during 1993-2012 were included inthe study. Results and Conclusions: The number of new cancer cases has gradually increased each year duringthe last 20 years. The three most common cancers at present in males are liver and bile duct cancer, lung cancerand colorectal cancer, respectively. In females, liver and bile duct, breast and thyroid cancers are now the mostfrequent. Interestingly, the number of cases of both liver and bile duct cancer and colorectal cancer in malesnoticeably increased during the second decade of the study. Additionally, breast cancer greatly increased in thesame decade and lung cancer in females climbed into the top five most common cancers. Thyroid cancer hasalso risen steadily in the last decade. Trends of common cancers are similar to those throughout Thailand.     

Risk of malignancy among patients with rheumatic conditions

Previous studies have described an increased risk of malignancy in subjects diagnosed with rheumatic conditions, most notably rheumatoid arthritis (RA). Our aim was to quantify and compare risks for site-specific malignancy among hospitalized patients with RA, osteoarthritis (OA) and other rheumatic conditions in a nationwide, population-based cohort. Subjects were identified from Scottish hospital in-patient records from 1981 to 1996 and followed up by computer linkage of the Scottish Cancer Registry and the national registry of deaths. Expected cancer incidence was calculated from national cancer rates and related to the observed incidence by the standardized incidence ratio (SIR). Among RA patients, there was an increased risk for hematopoietic [males SIR= 2.13, 95% confidence interval (CI) 1.7-2.7; females SIR = 1.76, 95% CI 1.5-2.1], lung (males SIR = 1.32, 95% CI 1.2-1.5; females SIR = 1.44, 95% CI 1.3-1.6) and prostate (SIR = 1.26, 95% CI 1.0-1.6) cancers. Reduced risk were seen for colorectal cancer (males SIR = 0.87, 95% CI 0.7-1.1; females SIR = 0.71, 95% CI 0.6-0.9) and, among females, stomach cancer (SIR = 0.70, 95% CI 0.5-1.0). The excess risk for hematopoietic cancer and the reduced risk for colorectal and stomach cancers were sustained over 10 years of follow-up. An overall decreased risk of cancer was observed for patients with OA; the greatest reductions were observed for colorectal (males SIR = 0.88, 95% CI 0.8-1.0; females SIR = 0.84, 95% CI 0.8-0.9), stomach (males SIR = 0.79, 95% CI 0.7-0.9; females SIR = 0.66, 95% CI 0.6-0.8) and lung (males SIR = 0.72, 95% CI 0.7-0.8; females SIR = 0.84, 95% CI 0.8-0.9) malignancies, with decreased risks generally still evident at 10 years of follow-up. Our results support several previous findings regarding the incidence of hematopoietic and colorectal malignancies in RA patients. In addition, we have shown a large decrease in stomach cancer among patients with OA and females with RA that warrants further investigation since it may provide clues to possible prevention strategies. To further our knowledge about the underlying mechanisms of altered risk in cancer patients with rheumatic conditions, population studies requiring primary data collection are required.     

河南省林州市人群胃癌的现时生存分析

目的:分析1988-2004年河南省林州市人群胃癌的生存率及不同时期的变化,评估当地胃癌二级预防及临床诊治的水平.方法:从林州市肿瘤登记处提取1988-2004年全部的胃癌发病和死亡个案记录,剔除重复和仅有死亡证明书(death certificate only, DCO)的病例.计算该地区的去肿瘤死因寿命表,并与胃癌发病死亡数据相链接.采用现时生存分析(period survival analysis)方法计算1990-1994年、1995-1999年和2000-2004年这3个时期的胃癌5年观察生存率和相对生存率,并绘制相对生存曲线.结果:林州市3个时期的胃癌5年相对生存率分别为26.66%、32.01%和40.43%,呈逐年上升趋势.男性患者的生存率要高于女性.前2个时期的贲门癌生存率要高于非贲门胃癌,而在2000-2004年则低于非贲门胃癌.结论:林州市人群胃癌生存率自20世纪90年代起逐渐提高,反映了当地胃癌二级预防及临床诊疗水平的不断提高.     

Joinpoint Analysis Trends in the Incidence of Colorectal Cancer in Khon Kaen,Thailand (1989 – 2012)

Objective: This study focused on recent changes in the incidence of colorectal cancer (CRC) in Khon Kaen, Thailand. Methods: Data for CRC over the period 1989 to 2012 from the population-based cancer registry of Khon Kaen province were employed. Age-standardized incidence rates (ASR) were calculated and classified into 4 age-groups for comparison. Joinpoint regression analysis was used to detect changes in trends among each line segment and an overall line was generated, whether increasing or decreasing, with annual percent change (APC) and average annual percent change (AAPC). Results: There were 3,364 CRC cases included in the analysis, 72.2% histological confirmed and 53.5% in men. Trends of ASRs generally demonstrated gradual increase over the period 1989 to 2012. For those aged under 45 or 50 years there was slight overall increase, with a somewhat zigzag pattern. From joinpoint analysis, the trends of all aged groups were found to be increasing among both men and women: aged 45 years and older group AAPC=3.40, 2.30 and 3.90, respectively); aged 50 years and older group AAPC=2.90, 2.20 and 3.40; aged under 45 years AAPC=6.30, 6.00 and 6.90; and aged under 50 years (AAPC=5.70, 3.20 and 5.70. Conclusions: ASRs for CRC have been gradually increasing in the northeast region of Thailand. Future studies should consider the subsite distribution.     

Gastro-intestinal Cancer in Indonesia

Back ground: Report on cancer incidence in Indonesia was presented in relative frequency. To lower the bias, the ‍report has been presented in age standardized cancer ratio (ASCAR). The report was a department of pathology ‍based cancer registration. The ASCAR of gastro intestinal cancer in Indonesia has some variation between pathologic ‍centres. The incidence of rectal cancer in Jogjakarta was higher than colon cancer, and stomach cancer is very low. ‍The risk factors of stomach cancer are H. Pylori infection and food consumption especially salt and the risk factor ‍of colorectal cancer is food consumption. ‍Purpose: The article will discuss the ASCAR of stomach and colorectal cancer in Indonesia. . The histopathologic ‍of stomach and colorectal cancer in Jogjakarta will be presented from the view point of pathology. ‍Method: Stomach and colorectal cancer data from 13 pathologic diagnostic centres in Indonesia were collected. ‍The pathogenesis of stomach and colorectal cancer will be discussed in correlation with the cancer prevention. ‍Result: The incidence of stomach cancer in many centres in the year of 1996 are very low from 0,00% - 0,24 % ‍for the most lowest incidence and 2.22 % - 5.60 % for the highest incidence. The higher incidence of stomach cancer ‍was in Medan 19 males (5.6%); 10 females (2.22%); Palembang 7 males (4.75%), 1 female (0.11%); Surabaya 18 ‍males (1.38%), 7 females (0.35%); Denpasar 12 males (2.97%), 1 female (0.24%), and Jakarta 55 males (4%), 28 ‍females (1.39%). The incidence of colorectal cancer is almost equal in every pathologic diagnostic centres. It is ‍interesting that the incidence of rectal cancer was higher than colon cancer. In Jogjakarta the histopathological ‍feature of stomach cancer was predominated by poorly differentiated adenocarcinoma, while colorectal cancer was ‍predominated by well differentiated adenocarcinoma. ‍Conclusion: The low incidence of gastric cancer in Indonesia in relation with H. Pylori and food consumption ‍and the high ratio between rectal and colon cancer in correlation with the food consumption and it pathogenesis ‍need further investigation. ‍     

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.     

Hospital-based Population of Elderly Cancer Cases in Northeastern Thailand

Background: The proportion of aged Thais (≥65 years old) is expected to be 30% by 2030, leading to an increased number of elderly cancer cases. Older individuals have distinct patterns of cancer and treatment needs. We therefore conducted the present study of new cancer cases and trends to get a perspective on the elderly cancer situation in Northeast Thailand. Materials and Methods: All new elderly cancer cases (≥65 years) registered in the hospital-based cancer registry at the Faculty of Medicine, Srinagarind Hospital, Khon Kaen University during 1993-2012 were included in the study. Results: Elderly patients accounted for 31.6% of all cancer patients and new cancer cases in the older age group increased 46% from the first to second decades. The absolute number of oldest old (80+ years) doubled. The top three cancers in males were liver and bile duct, lung, and colorectal. In females, the three most common cancers were liver and bile duct, oral cavity, and cervix. Cancers with the highest percentages of increase were thyroid, prostate, and colorectal. Conclusions: Elderly cancer cases are increasing. Treatment modalities and palliative care for older populations are urgently needed.