Population-based Osaka Cancer Registry Research Articles

Prevalence of survivors of childhood cancer based on a population-based cancer registry in Osaka, Japan.

Although the survival rate of patients with childhood cancer has greatly improved, long-term survivors face specific problems such as the late effects of cancer treatment. In this study, we estimated the number of people who had experienced childhood cancer to predict their needs for medical care and social resources. Using data from the population-based Osaka Cancer Registry, we identified children aged 0-14 years who were diagnosed with cancer between 1975 and 2019. We estimated the prevalence on December 31, 2019, and the 5- and 10-year prevalence (i.e., the number of survivors living up to 5 or 10 years after the diagnosis of cancer) over time. The prevalence proportion was age-standardized using a direct standardization method. The prevalence estimates for Osaka were applied to the national population to determine the national prevalence in Japan. Among 8186 patients diagnosed with childhood cancer in Osaka, 5252 (987 per million) survived until December 31, 2019. The 5-year prevalence per million increased from 194 in 1979 to 417 in 2019 (+116%), while the 10-year prevalence increased from 391 in 1984 to 715 in 2019 (+83%). Based on the long-term registry data, an estimated 73,182 childhood cancer survivors were living in Japan by the end of 2019. The increasing 5-year and 10-year prevalence proportions indicate the continued need for cancer survivorship support for children, adolescents, and young adults. These estimates of the prevalence of childhood cancer survivors, including long-term survivors, may be useful for policymakers and clinicians to plan and evaluate survivorship care.

Endoscopic Removal of Premalignant Lesions Reduces Long-Term Colorectal Cancer Risk: Results From the Japan Polyp Study

To date, no regional evidence of long-term colorectal cancer (CRC) risk reduction after endoscopic premalignant lesion removal has been established. We aimed to analyze this over a long-term follow-up evaluation. This was a prospective cohort study of participants from the Japan Polyp Study conducted at 11 Japanese institutions. Participants underwent scheduled follow-up colonoscopies after a 2-round baseline colonoscopy process. The primary outcome was CRC incidence after randomization. The observed/expected ratio of CRC was calculated using data from the population-based Osaka Cancer Registry. Secondary outcomes were the incidence and characteristics of advanced neoplasia (AN). A total of 1895 participants were analyzed. The mean number of follow-up colonoscopies and the median follow-up period were 2.8 years (range, 1-15 y) and 6.1 years (range, 0.8-11.9 y; 11,559.5 person-years), respectively. Overall, 4 patients (all males) developed CRCs during the study period. The observed/expected ratios for CRC in all participants, males, and females, were as follows: 0.14 (86% reduction), 0.18, and 0, respectively, and 77 ANs were detected in 71 patients (6.1 per 1000 person-years). Of the 77 ANs detected, 31 lesions (40.3%) were laterally spreading tumors, nongranular type. Nonpolypoid colorectal neoplasms (NP-CRNs), including flat (<10 mm), depressed, and laterally spreading, accounted for 59.7% of all detected ANs. Furthermore, 2 of the 4 CRCs corresponded to T1 NP-CRNs. Endoscopic removal of premalignant lesions, including NP-CRNs, effectively reduced CRC risk. More than half of metachronous ANs removed by surveillance colonoscopy were NP-CRNs. The Japan Polyp Study: University Hospital Medical Information Network Clinical Trial Registry: University Hospital Medical Information Network Clinical Trial Registry, C000000058; cohort study: UMIN000040731.

Incidence of second primary cancers among survivors of childhood cancer: A population-based study, Osaka, Japan, 1975-2015.

Second primary cancer (SPC) is one of the most life-threatening late effects of childhood cancers. We investigated the incidence and survival outcomes of SPC in childhood cancer patients in Japan. Data were obtained from the population-based Osaka Cancer Registry. Individuals diagnosed with cancer at age 0-14 years during 1975-2014 and survived 2months or longer were followed through December 2015. The risk of developing SPC was assessed with standardized incidence ratio (SIR), excess absolute risk (EAR, per 100,000 person-years), and cumulative incidence. Multivariable Poisson regression analysis was carried out to assess relative risks of SPC by treatment method. Survival analysis was undertaken using the Kaplan-Meier method. Of 7229 childhood cancer survivors, 101 (1.4%) developed SPC after a median of 11.6 years. Overall SIR was 5.0, which corresponded with 84.3 EAR. The cumulative incidence was 0.9%, 2.1%, and 3.4% at 10, 20, and 30 years, respectively. Among all SPCs, the type that contributed most to the overall burden was cancers in the central nervous system (EAR=28.0) followed by digestive system (EAR=15.1), thyroid (EAR=8.3), and bones and joints (EAR=7.8); median latency ranged from 2.0 years (lymphomas) to 26.6 years (skin cancers). Patients treated with radiotherapy alone were at a 2.58-fold increased risk of developing SPC compared to those who received neither chemotherapy nor radiotherapy. Among patients who developed SPCs, 5-year and 10-year survival probabilities after SPC diagnosis were 61.7% and 52.0%, respectively. Risk-based long-term follow-up planning is essential to inform survivorship care and help reduce the burden of SPCs in childhood cancer survivors.

Hospital volume and 5-year survival in head and neck cancer patients in Osaka, Japan.

Few previous studies have examined the relationship between hospital volume and hazard of death for head and neck cancer patients. The purpose of this study was to examine the association between hospital volume and 5-year survival from diagnosis among head and neck cancer patients. Using data from the population-based Osaka Cancer Registry, hospital volume was divided into three volume groups according to the number of head and neck cancer treatments identified between 2009 and 2011. We analysed the association between hospital volume and 5-year survival among 3069 patients aged 0-79 using Cox proportional hazard models, adjusting for characteristics of patients. Compared with head and neck cancer patients in high-hospital volume, patients treated in middle- and low-hospital volume were found to have a higher risk of death (middle-hospital volume: hazard ratio = 1.26; 95% confidence interval, 1.09-1.46, low-hospital volume: hazard ratio = 1.24; 95% confidence interval, 1.06-1.46). We found a significantly higher risk of hazard of death in middle- and low-hospital volume than in high-hospital volume for head and neck cancer.

Analysis of real-world data in patients with relapsed/refractory diffuse large B cell lymphoma who received salvage chemotherapy in the rituximab era.

Although the overall clinical outcome of patients with diffuse large B cell lymphoma (DLBCL) has significantly improved, some patients still experience relapsed/refractory disease. In the rituximab era, real-world data about relapsed/refractory DLBCL are limited. To clarify the clinical outcome and prognostic factors in these patients, we conducted a retrospective analysis using data from the population-based Osaka Cancer Registry (OCR) from 2010 to 2015. In total, 189 adult patients aged up to 70years who received CHOP or a CHOP-like regimen in combination with rituximab, as well as a subsequent second-line therapy, were included in the analysis. The median age was 63years (range, 24-70). Age (> 63years), the duration of first progression-free survival (PFS), and the use of rituximab in the second-line chemotherapy were prognostic factors for overall survival (OS) after the second-line treatment. In this cohort, 48 and 11 patients received autologous and allogeneic hematopoietic stem cell transplantation (HSCT), respectively. The probabilities of 3-year OS after autologous and allogeneic HSCT were 55.7% and 18.2%, respectively. In conclusion, we found that the clinical outcome of patients with relapsed/refractory DLBCL in the rituximab era was unsatisfactory. Further improvements in treatment strategies, including novel agents, are needed.

Increased incidence of adult T cell leukemia-lymphoma and peripheral T cell lymphoma-not otherwise specified with limited improvement in overall survival: a retrospective analysis using data from the population-based Osaka Cancer Registry.

Peripheral T cell lymphomas (PTCL) are a heterogeneous group of non-Hodgkin lymphomas with poor outcomes. Adult T cell leukemia-lymphoma (ATL) and PTCL-not otherwise specified (PTCL-NOS)-are 2 common mature T cell lymphomas in Japan. Since it is unclear whether novel agents and treatment strategies incorporating hematopoietic cell transplantation have contributed to improved clinical outcomes in the real world, we performed a retrospective analysis using data from the population-based Osaka Cancer Registry. From 1977 to 2014, 1274 and 1143 patients were diagnosed with ATL or PTCL-NOS, respectively. Recently, the incidence of both diseases has gradually increased, and the age at diagnosis has risen. The 3-year overall survival (OS) rates in ATL patients were 12.0% in era 1 (1977-1999), 12.4% in era 2 (2000-2008), and 17.5% in era 3 (2009-2014) (P < 0.001). The 3-year OS rates in PTCL-NOS patients were 27.6% in era 1, 36.2% in era 2, and 35.0% in era 3 (P = 0.049). In conclusion, the incidences of ATL and PTCL-NOS have been increasing, particularly in elderly individuals. Clinical outcomes have improved in recent decades but are still unsatisfactory in both diseases. Thus, effective new treatment strategies incorporating novel agents are needed to further improve clinical outcomes in patients with ATL and PTCL-NOS.

Clinical Outcomes of Patients with Adult T Cell Leukemia-Lymphoma in a Nonendemic Metropolitan Area: A Retrospective Analysis of the Population-Based Osaka Cancer Registry.

Adult T cell leukemia-lymphoma (ATL) is a mature T cell malignancy associated with human T cell leukemia virus type I (HTLV-1), a retrovirus that is endemic in southwestern Japan. Because of population migration, cases of ATL are expected to increase in nonendemic areas. Here, to clarify the outcomes of patients with ATL in the nonendemic metropolitan area of Osaka, we retrospectively analyzed data from the population-based Osaka Cancer Registry from 2010 to 2015. This analysis included 91 patients age ≤70 years who received chemotherapy for ATL. With a median follow-up of 988 days in surviving patients, the probability of 2-year overall survival (OS) was 21.9% (95% confidence interval [CI], 14.1% to 30.9%) and the median OS was 9.8 months (95% CI, 7.3 to 13.5 months). The probability of 2-year OS was 22.2% in the nontransplant group (n=63) and 21.4% in the transplant group (n=28), without a statistically significant difference between the 2 groups. Allogeneic transplantation was not a favorable prognostic factor in patients with ATL in propensity score-adjusted analysis (P=.86, log-rank test). More clinical studies are needed to improve the clinical outcomes of patients with ATL in nonendemic areas.

Epidemiologic and Clinical Analysis of Cervical Cancer Using Data from the Population-Based Osaka Cancer Registry.

Cervical cancer screening rate is extremely low and the governmental recommendation of HPV vaccine has been suspended for 5 years in Japan. Here, we utilized data from the Osaka Cancer Registry, collected between 1976 and 2012, to evaluate cervical cancer trends in Japan. Age-adjusted incidence, relative survival, and conditional survival rates were calculated using multiple imputation methods and period analyses in 25,826 cervical cancer cases. Association of survival rates and clinical factors, including patients' age, clinical stage, and treatment procedures, were also analyzed. A trend for significantly decreasing age-adjusted incidence of cervical cancer (per 100,000) began in 1976 but reversed after 2000, increasing significantly to date (annual percent change = 3.8, 95% confidence interval, 2.7-4.8; age-adjusted rate: 28.0 in 1976, 9.1 in 2000, 14.1 in 2012). The 10-year relative survival rate improved significantly after 2002, especially in cases of "localized" and "adjacent organs" disease; this was likely due to the introduction of concurrent chemotherapy and radiation. The conditional 5-year relative survival rate improved significantly yearly until the fourth survival year. In the surgery-based group, we observed no age-dependent differences in outcomes. Unexpectedly, however, prognosis for younger age groups was poorer in the radiation-based treatment group. These results indicate that although relative survival rates have recently increased, treatment for more advanced cases with distant metastasis requires further improvement. In addition, this study is the first to suggest that age might be an important predictor of radiotherapy resistance in cervical cancer.Significance: A large-cohort analysis of cervical cancer cases reveals that age-adjusted incidence in Japan has increased since 2000 and that age may negatively correlate with resistance to radiotherapy.

Pravastatin Use and the Five-year Incidence of Cancer in Coronary Heart Disease Patients: from the Prevention of Coronary Sclerosis Study

BACKGROUNDAlthough the short-term safety of statins is well established, their potential carcinogenicity in the long term is still being debated. The aim of this study was to investigate the association between statin-therapy and the incidence of cancer in coronary heart disease patients.METHODSThe subjects were 263 patients with coronary heart disease who were from Osaka prefecture and who were admitted to the Osaka Medical Center for Cancer and Cardiovascular Diseases between September 28, 1991 and March 31, 1995. The five-year cancer incidence among the subjects was checked using the database of the institution-based cancer registry of the hospital as well as the population-based Osaka Cancer Registry. The Cox’s proportional hazards ratios (HRs) of all cancer incidence and observed/expected (O/E) ratios by cancer site were calculated.RESULTSCancer incidence was observed in 17 patients during the follow-up period. Age (HR=1.16 per one year of age) and continuous smoking during the period (HR=5.82 compared to not smoking during the period) were significantly associated with cancer incidence using multivariable analysis. After being adjusted for sex, age, total serum cholesterol level and smoking habit, the HR of cancer incidence with pravastatin use was 0.78 (95% confidence interval: 0.18-3.46). In the O/E analysis, significantly elevated risks were found for bladder cancer in all the subjects (HR=8.93), as well as in the pravastatin use patients (HR=13.76).CONCLUSIONSPravastatin use for 5 years did not indicate an increase in over all cancer risk.

Survival of Testicular Cancer Patients in Osaka, Japan

Testicular cancer is one of those cancers for which the prognosis has improved remarkably since the introduction of effective chemotherapy. Study subjects were 709 testicular cancer patients who were registered to the population-based Osaka Cancer Registry (OCR) as diagnosed between 1975 and 1992. The testicular cancer patients diagnosed/treated in the Osaka Medical Center for Cancer and Cardiovascular Diseases (OMCC) were also analyzed for comparison. The 5-year relative survival was 75.2% for the total of 709 patients and 77.9% for those diagnosed during 1990-92. These figures were much lower than those for patients in the USA and in Europe. In contrast, the 5-year survival of the 113 patients diagnosed in the OMCC during 1975-93 was 91.5% and similar to those in the USA and in Europe. The present study suggests that there are problems in the speed and extent of diffusion of effective chemotherapy for testicular cancer in Osaka.

Effects of mass screening for neuroblastoma on incidence, mortality, and survival rates in Osaka, Japan.

To evaluate the effects of mass screening for neuroblastoma, time trends of incidence, mortality, and survival of neuroblastoma in Osaka Prefecture were analyzed. Data for this analysis was obtained from the population-based Osaka Cancer Registry. Time trends of incidence and mortality rates were analyzed by calendar year and by birth cohort. Survival was compared between before and after the introduction of systematic screening. From 1970-94, 457 cases of neuroblastoma and 182 deaths from neuroblastoma were observed in Osaka. The annual age-standardized incidence rate per million children increased from 7.5 in 1970-84 to 20.5 in 1985-94, while the mortality rates did not differ between these two periods. Analysis by birth cohort showed that the incidence rate at 0 year of age per 100,000 live births increased from 2.30 in 1970-79 (unscreened) to 19.80 in 1988-89 (screening by high-performance liquid chromatography, HPLC). The incidence rate in children 1 and 2-4 years of age also increased according to the introduction of HPLC. The mortality rate in children 1-4 years of age per 100,000 live births slightly decreased from 3.87 in 1970-79 to 3.30 in 1988-89, which was presumed to be derived from the improvement in survival due to the progress in treatment. It is strongly suggested that mass screening for neuroblastoma causes harm because of overdiagnosis, and it has little effect on decreasing the incidence and the mortality of neuroblastoma at 1-4 years of age.