Survival after Diagnosis of Cervical Cancer Patients at a Tertiary Referral Hospital in Northeast Thailand

Background: Cervical cancer (CC) is the third most common cancer in women globally, including Thailand, where the incidence rate was 16.2 cases per 100,000 individuals in 2018. Survival rates for patients with this condition have not improved over recent years. This study evaluated the survival rate and median survival time after diagnosis among CC patients, and investigated factors associated with survival in Northeast Thailand. Methods: This study included CC patients admitted to the gynecological ward at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand from 2010 to 2019. Survival rates and median survival time since the date of diagnosis and 95% confidence intervals (CIs) were calculated. Multiple cox regression was performed to investigate factors associated with survival which were quantified by adjusted hazard ratios (AHR) and their 95% CIs. Results: Of 2,027 CC patients, the overall mortality incidence rate was 12.44 per 100 person-years (95% CI: 11.7 - 13.22), median survival time was 4.82 years (95% CI: 3.92 - 5.72), and 10-year survival rate was 43.16% (95% CI: 40.71 - 45.59). The highest 10-year survival rate was 87.85% (95% CI: 82.23 - 91.78) found among those with stage I CC, followed by those who received surgical treatment, which was 81.22% (95% CI: 74.47 - 86.35). Factors that were associated with decreased survival included age ≥60 years (AHR = 1.25; 95% CI: 1.07 - 1.46), health insurance with the Universal Health Coverage Scheme (UCS) (AHR = 6.26; 95% CI: 5.13 - 7.64), malignant neoplasms histopathology (AHR = 1.36; 95% CI: 1.07 - 1.74), and treatment with supportive care (AHR = 7.48; 95% CI: 5.22 - 10.71). Conclusion: Among patients diagnosed with CC, those with stage I had the highest 10-year survival rate. CC patients with older age, UCS, malignant neoplasms histopathology, and received supportive care showed the highest survival association.     

Molecular Subtypes and Prognostic Factors among Premenopausal and Postmenopausal Thai Women with Invasive Breast Cancer: 15 Years Follow-up Data

Background and Purpose: This study focused on molecular subtypes and prognostic factors for survival of preandpost-menopausal breast cancer patients. Methods: A retrospective cohort study was performed on 523 patientswith invasive carcinoma of the breast treated at Ubon Ratchathani Cancer Hospital,Thailand from 2002 to 2016.Patient characteristics were collected based on a systematic chart audit from medical records. Prognostic factors wereperformed by observe survival analysis. A Cox regression model was used to calculate hazard ratios of death, takinginto account the age and menopause status, molecular subtype, stage of disease, histological grade, lymphatic andvascular invasion, resection margin, hormone receptor expression, and treatment modality. Results: The median timefrom the diagnosis of invasive breast cancer to the last follow-up or death was 10.2 [95% CI = 9.28-11.95] years inpremenopausal women, and 7.4 [95% CI = 6.48-8.44] years in postmenopausal cases. The overall survival estimatesat 5 and 10 years for younger woman of 71.2% and 51.8% respectively, appeared slightly better than the 68.3% and40.9% for postmenopausal women [HRadj = 1.27, 95% CI =0.99-1.63]. In the multivariate analysis, 3 prognosticindicators significantly predicted a worse overall survival in premenopausal patients, triple negative subtype [HRadj =6.03, 95% CI = 1.94-18.74], HER2-enriched status [HRadj = 4.11, 95% CI = 1.59-10.65] and stage III [HRadj = 2.73,95% CI = 1.10-6.79]. Statistically significant increased risk of death in postmenopausal patients was noted for onlychemotherapy after mastectomy [HRadj = 8.76, 95% CI = 2.88-26.61], and for a Luminal B status [HRadj = 3.55, 95%CI = 1.47-8.53]. Conclusion: Postmenopausal women with invasive breast cancer experience a significantly shortersurvival than do their premenopausal counterparts. The predictors of worse overall survival were molecular subtype,stage of disease and type of treatment administered.     

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.     

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.     

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.     

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.     

Coffee Consumption and Lung Cancer Risk: A Prospective Cohort Study in Khon Kaen Thailand

Background:  Lung cancer is a major cause of cancer death worldwide. The incidence of lung cancer in Thailand increasing, but risk factors are rarely reported. Objective: To investigate the effect of coffee consumption on lung cancer in Thai population. Methods: Between 1990 and 2001, lifestyle and demographic data were collected from 24,528 participants in the Khon Kaen Cohort Study (KKCS), who were followed through 2016, by linking to the Khon Kaen Population-based Cancer Registry. A total of 12,668 eligible participants (68.8% females, mean age 51.0 years at baseline) having complete datasets (239,488 person-years of follow up with 138 incident cases of lung cancer observed) were analyzed using a multi-variable adjusted Cox proportional hazard models. Results: Coffee consumption was associated with reduced risk for lung cancer (adj. HR = 0.54; 95% CI: 0.35-0.84) after adjusting for age and gender.  Cigarette smoking (adj. HR = 2.76; 95% CI: 1.32-5.78) and family history of cancer (adj. HR = 1.65; 95% CI: 1.10-2.48) were associated with higher risk. Conclusion: This study suggests coffee consumption may be a protective factor for lung cancer in among this cohort.     

Factors Affecting Survival of Cervical Cancer Patients Treated at the Radiation Unit of Srinagarind Hospital,Khon Kaen University,Thailand

This retrospective longitudinal study aimed to evaluate factors for survival of cervical cancer patients treatedwith radiation therapy. Information was retrieved from the medical records of 1,180 cervical cancer patientsand pathologic material was reviewed to confirm the diagnosis of those treated with radiation therapy atSrinagarind Hospital, Khon Kaen University between 1 January 1994 and 31 December 1999. The patientswere followed up until December 31, 2004, with current vital status determined through the hospital-basedregistry, the population-based cancer registry of Khon Kaen Province, the civil registration database, the Ministryof Interior and by mail. Data were analysed with the Kaplan-Meier, Log-rank test and Cox proportion hazardmodels. The mortality rate was 70 per 1,000 person-years with an overall 5-year survival of 62.5%. Mediansurvival was >10 years. From multivariate analyses, the factors that statistically affected survival of cervicalcancer patients included stage (p-value<0.001), hemoglobin level (p-value<0.001), interval between externaland intracavitary radiation (p-value<0.001) and fractionation (p-value=0.024). Stage III was associated with a1.65-fold mortality risk compared with stage I (95% CI=1.05-2.59). Patients with a low hemoglobin level (≤ 10g./dl.) demonstrated a 1.85-fold mortality risk compared with patients a value >12 g./dl. (95% CI=1.40-2.44). Aninterval between external and intracavitary radiation >28 days was associated with 2.28-fold mortality riskcompared with a duration of <1 day (95% CI= 1.40-2.44). The fractionation 2 faction was associated with 0.25-fold mortality risk compared with 1 fraction (95% CI=0.07-0.96). Future prospective trials should be undertakento confirm the validity of these factors and to elucidate their therapeutic implications.     

Outcomes of Treatment,Survival Rates,and Factors related to Survival of Stage III Lung Cancer Patients Treated at Srinagarind Hospital,Faculty of Medicine,Khon Kaen University,Thailand

Background: Lung cancer (LC) is the leading cause of death worldwide. Stage III lung cancer (Stage III-LC) is characterized by local metastasis. The treatments for LC differ at each stage, while for stage IIIA and IIIB treatment various approaches have been tried with uncertain results. We determined the survival time of Stage III-LC patient and compared survival among multiple factors. Methods: Data were collected from the Srinagarind Hospital-Based Cancer Registry (2014 - 2019). 324 patients from Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand, were followed up until December 31, 2021. The survival rate was estimated using Kaplan-Meier and the Log-rank test. In addition, hazard ratios (HR) and the 95% CI were estimated using Cox regression. Results: Of the 324 Stage III-LC patients, the total follow-up time was 447.3 person-years, and 288 cases died during the study, for a mortality rate of 64.4 per 100 person-years (95% CI: 57.40-72.27). The respective 1-, 3-, and 5-year survival rate was 44.1% (95% CI: 38.67-49.45), 16.2 (95% CI: 12.34-20.51), and 9.3 (95% CI: 6.14-13.31). The median survival time was 0.84 years (10.1 months) (95% CI: 0.73-1.00). After adjusting for sex and stage of disease, sequential chemoradiotherapy (SC) represented the most independent predictor of the risk of death (adjusted HR= 1.58; 95% CI: 1.41-2.18). Females had a mortality risk of 0.74-fold compared to males (adjusted HR = 0.74, 95% CI: 0.57-0.95). Stage of disease and stages IIIB and III (unknown and undefined) had a respective 1.33-fold (adjusted HR = 1.33, 95% CI: 1.00-1.84) and 1.48-fold (adjusted HR = 1.48, 95% CI: 1.09-2.00) risk of death compared to stage IIIA. Conclusion: Sex, stage of disease, and SC were related to stage III-LC survival, so physicians should emphasize combination therapy. Further research should focus on combination therapy and survival among Stage III-LC patients.     

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.     

Comparing Survival of Oral Cancer Patients Before and After Launching of the Universal Coverage Scheme in Thailand

Background: As the treatment modalities for oral cancer have been relatively consistent during the last two decades, this study was conducted to compare survivals of oral cancer patients in Khon Kaen Province before and after the universal coverage scheme (UC) was launched in Thailand. Materials and Methods: The data were retrieved from the populationbased cancer registry of Khon Kaen for oral cancer patients diagnosed during 19922001 (preUC), and 20042012 (postUC). To compare survival of the two cohorts, Kaplan Meier and log rank tests were employed. Results: Of 1,196 patients, 65% were females and the median age was 65 years. The most common primary sites were lip (31.0%), tongue (29.9%), and buccal mucosa (14.6%). The proportion of early stage cancer increased from 20.4 % in preUC to 41.3% in postUC. The overall 5year survival rate was 36.5% (95% CI 32.640.9) for preUC and 32.4% (95% CI 28.836.4) for postUC. The declining survival was mainly due to an increasing proportion of tongue cancer. However, no survival improvement was demonstrated on subgroup analysis of the tongue cancer patients. Conclusions: After the universal coverage scheme had been launched, early diagnosis increased, but no significant gain in survival for oral cancer patients was achieved.     

The Accuracy of Fecal Immunochemical Test in Colorectal Cancer Screening: A Meta-Analysis

Objective: To investigate the accuracy of OC-Sensor and colorectal cancer screening in a population-based randomized controlled trial at Khon Kaen province, Thailand. Methods: The MOOSE Guidelines for Systematic Reviews and Meta-Analyses of Observational Studies was applied. Eligibility criteria were English language, hand searching was conducted using Medline databases from 2010 to 2021 for identify literatures reviews of OC-Sensor and colorectal cancer screening. The initials screen based on the research titles and abstracts, final screenings based on full-text reports. Synthesis the results with meta-analysis using fixed effect model, random effect model, determined statistically significant with p-value < 0.05.  Confirmed the pooled effect sizes of high heterogeneity by meta-regression including tested precision of each estimates by bubble plot using STATA version 14. Results: Meta-regression showed sensitivity of OC- sensor = 72.54% (95% CI: 65.82-79.25), and specificity of OC- sensor = 89.59% (95% CI: 87.23-91.95). Conclusions: Sample size and cut-off of fecal hemoglobin concentration in each study were differed but sub-group analysis and sensitivity analysis were not considered for this analysis because population, setting and location for detected cancer of included study are not differences.     

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.     

Survival Time and Molecular Subtypes of Breast Cancer after Radiotherapy in Thailand

Background: Breast cancer is an important cause of death among women. One way of classifying differentforms of breast cancer is by molecular features, usually in terms of the four subtypes: luminal A, luminalB, HER2-enriched, and triple negative. Objectives: This study aimed to investigate the association betweenmolecular subtypes and survival among breast cancer patients treated with radiotherapy. Materials and Methods:A retrospective cohort study was conducted. The subjects were 272 breast cancer patients who had receivedtreatment in the radiotherapy unit at Srinagarind Hospital, Thailand, between 1 January, 1999, and 31 May,2009. The end of the study was 1 June, 2014. Overall survival was defined as the time elapsing between initialregistration at the radiotherapy unit and death or the end of the study. Survival curves were estimated by theKaplan-Meier method, and a multivariate analysis was performed using Cox’s proportional hazard regressionmodel. Results: The patient mean age was 47.5±10.4 at the time of diagnosis. Of the 272 patients, 146 (53.7%)were classified as luminal A, 12 (4.4%) as luminal B, 30 (11.0%) as HER2-enriched, and 84 (30.9%) as triplenegative. The overall survival rates at 1, 3 and 5 years were 87.1%, 68.4% and 59.2%, respectively. According tomolecular subtypes, HER2-enriched patients had the lowest 5-year survival rate (30.0 %, 95%CI: 15.02-46.55).The median follow-up time was 8.37 years. In the Cox model analysis a higher risk of death was found for patientswith HER2-enriched (HRadj=3.34, 95%CI:1.96-5.67), triple negative (HRadj=2.17, 95%CI: 1.44-3.27), and stageIIlB (HRadj=2.20, 95%CI: 1.16-4.17) cancers. Conclusions: The worst survival rates were among patients classifiedas HER2-enriched, triple negative and at stage IIIB. Early detection and an advanced treatment modality areneeded to help these patients.     

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.     

Factors Associated with Decisions to Attend Cervical Cancer Screening among Women Aged 30-60 Years in Chatapadung Contracting Medical Unit,Thailand

Background: This study aimed to identify factors associated with women’s decisions to attend cervical cancer screening and to explore those linked with intention to attend in the coming year and to continue regular screening. Materials and Methods: A community based case-control study was conducted among woman 30-60 years of age in catchment area of Chatapadung Contracting Medical Unit (CCMU), networking of Khon Kaen Center Hospital, Thailand. Self-administered questionnaires were used to collect data, and in-depth interviews were then performed to explore in greater detail. Results: There were 195 participants. Only one third (32.3 %) had been screened for cervical cancer within the past 5 years. Some 67.7% reported that they had not been screened becausethey had no abnormal symptoms, single marital status, and no children. Only 10.6% of those never had screening intent to be screened within the next 12 months. High family income (adjusted OR=2.16, 95%CI=1.13-4.14), good attitude towards a Pap test (OR=1.87, 95%CI=1.09-4.23), and having received a  recommendation from health care providers were important factors associated with decisions to attend cervical cancer screening (OR=1.73, 95%CI=1.01-4.63). From in-depth interviews, there were five reasons of their decisions to attend cervical cancer screening including yearly check-up, postpartum check-up, having abnormal symptom, encouragement by health care providers, and request from workplace. Conclusions: High family income, good attitude towards a Paptest, and receiving proper recommendation by health care providers, were important factors associated with decision to have cervical cancer screening among women 30-60 years old. Trying to enhance these factors and reduce barriers regarding screening, may increase the coverage rate for cervical cancer screening in Thailand.     

2006－2013年江苏省昆山市居民结直肠癌发病与死亡趋势分析

目的：结直肠癌是影响居民健康的主要癌症之一,且发病率呈现明显上升趋势。本研究探讨江苏省昆山市2006－2013年结直肠癌发病与死亡趋势。方法江苏省昆山市2006－2013年结直肠癌发病和死亡病例来源于昆山市肿瘤登记报告;计算结直肠癌粗发病（死亡）率与发病（死亡）的年龄标化率（age standardized rate,ASR）;使用平均年度变化百分比（annual percent change,APC）及其95％CI,评价结直肠癌发病率和死亡率在年份之间变化趋势。结果江苏省昆山市2006－2013年结直肠癌发病 ASR 在女性人群中呈明显上升趋势,APC＝2．3％,95％CI 为0．5％～4．2％;结直肠癌发病率总体变化趋势（APC＝0．6％,95％ CI 为－0．8％～1．9％）与男性人群（APC＝－0．8％,95％ CI 为－3.5％～1．5％）差异无统计学意义。昆山市2006－2013年结直肠癌死亡 ASR 在总体（APC ＝－5．3％,95％CI 为－9．0％～－1．6％）和女性（APC ＝－9．1％,95％CI 为－16．2％～－2．0％）人群中呈下降趋势,差异有统计学意义;而男性人群中结直肠癌死亡 ASR 的变化差异无统计学意义,APC＝－2．1％,95％CI 为－6．2％～2．0％。结论虽然结直肠癌死亡率呈现下降趋势,但是结直肠癌发病数逐年增加。因结直肠癌造成的疾病负担逐年增加,在全人群中开展结直肠癌预防控制十分必要。     

Risk Factors for Colorectal Cancer in Thailand

Background: Colorectal cancer (CRC) is one of the most common cancers worldwide. This study aimed toinvestigate the risk factors for colorectal cancer in the Thai population. Materials and Methods: A cohort studywas carried out in Khon Kaen, Thailand, including 71 cases of histologically confirmed CRC patients among 19,861participants, aged 30-69 years, who were recruited for a cohort study during the period 1990-2001. Participantswere followed-up until 31 December, 2013. To identify factors associated with the incidence of colorectal cancer,hazard ratios were evaluated using Cox proportional hazard regression. Results: No environmental variablescould be shown to be significantly related to the risk of CRC. Although in our sample, CRC was more prevalentamong males, ex-smokers, and those who drank alcohol beverages ≥ 50 gram/day, but we could not demonstratesignificantly associations (HRmale= 1.67, 95% CI, 0.80-3.49, HR ex-smokers = 1.34, 95% CI, 0.52-3.46, andHRalc≥ 50 = 1.08, 95% CI, 0.43-2.71). Individuals within the sample with a family history of cancer, workinghour >8 hours per day, and current-smokers appeared to have decrease risk of CRC, but again these relationshipcould not be shown to be significantly associated (HRfam cancer= 0.96, 95% CI, 0.85-1.09, HRwork>8= 0.84,95% CI, 0.36-1.93, and HRcurrent-smoker = 0.51, 95% CI, 0.18-1.38). Conclusions: We found no evidence ofenvironmental factors effecting the risk of CRC. There is a need for further research to determine why factorsidentified risk in other populations appear to not be associated with CRC risk in Thais.