Taiwan Cancer Registry Research Articles

Age Specific Risks of Uterine Cancer in Type 2 Diabetes and Associated Comorbidities in Taiwan.

Simple SummaryThe incidence of uterine cancer is increasing worldwide in recent decades, especially in the young age population. In parallel, a trend of early onset of diabetes mellitus (DM) and obesity was also observed in the young population. Since DM and obesity are known risk factors of uterine cancer, we proposed to investigate the age-specific risks of uterine cancer in subjects with DM and related metabolic comorbidities. In this nationwide population-based study, we found the risk of uterine cancer in DM subjects was significantly higher in the younger age groups, especially in the age group 30–39 years. Obesity, polycystic ovarian syndrome, hyperlipidemia, statin use, and hormone replacement therapy were also significantly associated with uterine cancer in subjects younger than 50 years of age. Therefore, subjects with DM, especially younger women with respective comorbidities, should be recommended to have appropriate uterine cancer screenings for early detection.Introduction: The global incidence of uterine cancer has increased substantially in recent decades. We evaluated if the trend of increasing prevalence of diabetes mellitus (DM) and obesity are attributed to the development of uterine cancer. Methods: Using data derived from the National Health Insurance database and Taiwan Cancer Registry, multivariate Cox proportional hazards regression models were adapted to analyze the risk factors of uterine cancer with potential confounding variables. Results: There were a total of 5,104,242 women aged 30–70 years enrolled in the study and 147,772 of them were diagnosed with DM during 2005–2007. In a total of 11 years of follow-up, 14,398 subjects were diagnosed with uterine cancer. An elevated risk of uterine cancer was observed in women with DM of all ages (HR 1.66, 95% CI 1.53–1.81, p < 0.0001). The effect of DM was highest at age 30–39 years (RR 3.05, 95% CI 2.35–3.96, p < 0.0001). In the group of <50 years old, DM patients had at least a twofold higher risk of developing uterine cancer (HR 2.39, 95% CI 2.09–2.74, p < 0.0001). Subjects among all ages diagnosed with polycystic ovary syndrome (PCOS) (HR 2.91, 95% CI 2.47–3.42, p < 0.0001), obesity (HR 2.13, 95% CI 1.88–2.41, p < 0.0001), and those undergoing hormone replacement therapy (HRT) (HR 1.60, 95% CI 1.33–1.93, p < 0.0001) were also positively associated with uterine cancer. Positive associations of hyperlipidemia (HR 1.33, 95% CI 1.22–1.46, p < 0.0001) and statin use (HR 1.27, 95% CI 1.12–1.44, p = 0.0002) on uterine cancer were only observed in subjects <50 years. On the contrary, hyperlipidemia was negatively associated with uterine cancer in subjects ≥50 years (HR 0.91, 95% CI: 0.84–0.98, p = 0.0122). Conclusions: DM is in general the most important risk factor for uterine cancer, especially in premenopausal women. Obesity, PCOS, HPL, statin use, and HRT were also associated with uterine cancer in subjects younger than 50 years. Premenopausal women with DM and respective comorbidities should be aware of the development of uterine cancer.

Epidemiology and Mortality of Ovarian Cancer in Taiwan: A Population-Based Study.

Ovarian cancer is the second most common cause of death from gynecologic cancer. The aim of this study was to estimate the incidence of ovarian cancer and the trend of mortality in different histological subtypes of ovarian cancer in Taiwan. Patient information regarding ovarian cancer was provided by the Taiwan National Health Insurance database. The histological subtypes of ovarian cancer were retrieved from the Taiwan Cancer Registry database, while the survival rates were extracted from the National Death Registry database. In this population-based cohort study, the annual prevalence, incidence, and overall mortality of ovarian cancer during 2002–2015 were determined. The trend in the incidence and the mortality rate of different histologic subtypes were estimated using joinpoint regression analysis. It was found that age-standardized incidence of ovarian cancer increased from 9.46 in 2002 to 11.92 per 100,000 person-years in 2015, with an average annual percentage change of 2.0 (95% CI = 1.5–2.5). The 1-, 3-, and 5-year mortality rates of overall ovarian cancer declined progressively during the study period, especially the group of Charlson comorbidity index ≤ 1. Ovarian serous carcinoma was the most common histological subtype in Taiwan, comprising 30.9% of ovarian cancer patients in 2002–2015. This study provides valuable information for use in developing healthcare policies for ovarian cancer.

Survival of Lung Cancer Patients by Histopathology in Taiwan from 2010 to 2016: A Nationwide Study.

Objective: Lung cancer poses a tremendous threat to the modern world. According to Taiwan’s Ministry of Health and Welfare, lung cancer took first place in total cancer deaths in 2021. This study investigated the overall lung cancer survival based on histopathology between 2010 and 2016 in Taiwan. Method: Data from 2010 to 2016 was collected from the Taiwan Cancer Registry (TCR). The characteristics and overall survival of 71,334 lung cancer patients were analyzed according to the tumor, node, metastasis (TNM) 7th staging system. Univariate and multivariate analyses were performed to identify differences in 1-year, 3-year, and 5-year survival between different histopathologies of lung cancer. Results: The 1-year overall survival rate increased from 54.07% in 2010 to 66.14% in 2016. The 3-year overall survival rate increased from 26.57% in 2010 to 41.12% in 2016 in all patients. Among the histopathologies of lung cancer, 3-year overall survival of adenocarcinoma patients increased the most and largely contributed to the increased 3-year overall survival of all lung cancer patients. Conclusions: The introduction of target therapy has led to a tremendous increase in overall survival for lung adenocarcinoma patients. However, target therapy differs by histopathology. Choosing the right target therapy and determining the correct histopathology of lung cancer is a pivotal key in increasing the overall survival of patients. Together with immune therapy, the landscape of lung cancer treatments is changing.

The Association between Smoking and Mortality in Women with Breast Cancer: A Real-World Database Analysis.

Simple SummaryThe association between smoking status and breast cancer mortality in Asian populations has not been extensively studied. In this study, we aimed to investigate the association between smoking status and mortality risk in women diagnosed with breast cancer between 2011 and 2017 using a real-world population database. Women with breast cancer with a history of smoking had a 1.25-fold higher (95% C.I.: 1.08–1.45; p = 0.0022) risk of overall mortality and a 1.22-fold higher (95% C.I.: 1.04–1.44; p = 0.0168) risk of cancer-specific mortality compared with non-smokers. Smokers who did not have comorbidities showed a significantly higher overall nmortality risk (HR: 1.20; 95% CI: 1.01–1.43; p = 0.0408) than non-smokers among women with breast cancer. Additionally, among women with breast cancer who had a history of smoking, current smokers had a 1.57-fold higher risk (95% CI: 1.02–2.42; p = 0.0407) of overall mortality compared with ever smokers. It was shown that a current smoking status is significantly associated with an increase in overall and cancer-specific mortality risk in women with breast cancer. Among women diagnosed with breast cancer, those who quit smoking had a lower mortality risk than current smokers. Our results underscore the importance of smoking cessation for women with BC.Smoking increases the cancer-specific and overall mortality risk in women with breast cancer (BC). However, the effect of smoking cessation remains controversial, and detailed research is lacking in Asia. We aimed to investigate the association between smoking status and mortality in women with BC using the population-based cancer registry. The Taiwan Cancer Registry was used to identify women with BC from 2011 to 2017. A total of 54,614 women with BC were enrolled, including 1687 smokers and 52,927 non-smokers. The outcome, mortality, was identified using Taiwan’s cause-of-death database. The association between smoking status and mortality was estimated using Cox proportional regression. Women with BC who smoked had a 1.25-fold higher (95% C.I.: 1.08–1.45; p = 0.0022) risk of overall mortality and a 1.22-fold higher (95% C.I.: 1.04–1.44; p = 0.0168) risk of cancer-specific mortality compared with non-smokers. The stratified analysis also indicated that women with BC who smoked showed a significantly higher overall mortality risk (HR: 1.20; 95% CI: 1.01–1.43; p = 0.0408) than women with BC who did not smoke among women without comorbidities. Additionally, current smokers had a 1.57-fold higher risk (95% CI: 1.02–2.42; p = 0.0407) of overall mortality compared with ever smokers among women with BC who smoked. It was shown that a current smoking status is significantly associated with an increase in overall and cancer-specific mortality risk in women with BC. Quitting smoking could reduce one’s mortality risk. Our results underscore the importance of smoking cessation for women with BC.

The Association of Visibility and Adenocarcinoma Lung Cancer in Southern Taiwan

Background/Aim Studies on association between lung cancer and long-term exposure to air pollution are limited due to the unavailability of air pollution data. The study aims to assess association of visibility, a proxy indicator of long-term air pollution exposure, with adenocarcinoma lung cancer. Methods Our study area is in southern Taiwan, an industrial area with 2.7 million people in 5.7 thousand km². Annual lung cancer incidence data with the ICD-O-3 codes from C34.0-C34.9 were obtained from Taiwan Cancer Registry (TCR) from 1997 to 2018. Age-adjusted incidence of lung cancers were standardized by the WHO 2000 world standard population. Hourly atmospheric visibility data from 1961 to 2022 were obtained from Taiwan Central Weather Bureau. 30-years moving averages were then calculated from 1967 onward to represent long-term visibility in the study area. Linear regression models were employed to estimate associations of 30-years averaging visibility annual age-adjusted lung cancers incidence for both adenocarcinoma and non-adenocarcinoma from 1997 to 2018. Results From 1997 to 2018, southern Taiwan&amp;#x27;s adenocarcinoma lung cancer incidence increased from 8.93 to 25.81 per 100,000 population, while non-adenocarcinoma incidence decreased from 14.61 to 10.41 per 100,000 population. The 30-years averaged visibility in the study area declined from 14.90 km to 7.65 km in the same period. Reducing visibility is significantly associated adenocarcinoma lung cancer, with a 2.43% (95% confidence interval [CI]: 2.77-2.11, adjusted R2 value: 0.92) increase in incidence by 1 km decrease in visibility during this period. Such associations exist for both females and males with increasing incidence of 2.57% (95% CI: 2.92-2.22, adj R2: 0.92) and 2.32% (95% CI: 2.69-1.95, adj R2: 0.89) by 1 km visibility reduction, respectively. By contrast, visibility reduction was not associated with increased in non-adenocarcinoma incidence. Conclusions Long-term visibility reduction is associated with increase in adenocarcinoma lung cancer incidence but not with non-adnocarcinoma.

A 40-year follow-up study of liver cancer risk in Taiwan:An age-period-cohort analysis and joinpoint regression analysis

Objectives Malignant neoplasm of liver and intrahepatic bile ducts is a leading cause of cancer-related mortality in Taiwan. The objective of this study was to investigate the effects of age, period, and birth cohort on liver and intrahepatic bile ducts cancer incidence in Taiwan. Methods We tracked the incidence rate of malignant neoplasm of liver and intrahepatic bile ducts (ICD-10 code C22) from 1980 to 2019, with data from the Taiwan Cancer Registry. We then calculated age-standardized incidence rates (ASIRs) for liver and intrahepatic bile ducts cancer based on the world standard population in 2000. Joinpoint regression was used to evaluate the trend change, and age-period-cohort models were used to investigate the effects of age, period, and birth cohort on liver and intrahepatic bile ducts cancer incidence. Results From 1980 to 2019, there were 278,363 newly reported cases of liver and intrahepatic bile ducts cancer, for a crude incidence rate of 32.17 cases per 100,000 person-years. The ASIR exhibited a significant increase from 1980 to 2000 (APC = 7.4%, 95% CI: 6.9‒7.8%, P = &amp;#x3c;0.001), maintained at the plateau from 2000 to 2009, and then declined. The risk of liver and intrahepatic bile ducts cancer in the population peaked in 2005-2010. The population born between 1965 and 1975 had the highest risk of developing liver and intrahepatic bile ducts cancer compared to the other cohort. The cancer risk dropped after hepatitis B vaccination program since 1980s. Conclusions Hepatitis B vaccination program may decrease the risk of liver and intrahepatic bile ducts cancer in Taiwan. Appropriate vaccination program is advised for countries with similar exposures.

Environmental pollution from nephrite jade mines and lung cancer risk in a nearby community: An age-period-cohort analysis and joinpoint regression analysis in Fengtian, Taiwan

BACKGROUND AND AIM: Nephrite is a nonasbestiform asbestos mineral comprised of microcrystalline tremolite and/or actinolite. Fengtian is a small village in Taiwan located near asbestos and nephrite mines. The objective of this study was to investigate the effects of age, period, and birth cohort on lung cancer incidence in the surrounding communities. METHODS: We tracked the incidence rate of lung cancer (ICD-9 code 162: cancers of the trachea, bronchus, or lung) from 1980 to 2019, with data from the Taiwan Cancer Registry. We then calculated age-standardized incidence rates (ASIRs) for lung cancer based on the world standard population in 2000. Joinpoint regression was used to evaluate the trend change, and age-period-cohort models were used to investigate the effects of age, period, and birth cohort on lung cancer incidence. RESULTS: From 1980 to 2019, there were 278 newly reported lung cancer cases, for a crude incidence rate of 60.7 cases per 100,000 person-years. The ASIR of lung cancer exhibited a significant increase from 1980 to 2010 (APC = 6.8%, 95% CI: 4.0‒9.7%, P &amp;#x3c; 0.01) and then declined. The risk of lung cancer in the population peaked 40 years after nephrite mining commenced. The population born between during the mass production of asbestos and nephrite had an increased risk of developing lung cancer. The lung cancer risk in the community decreased 30 years after the cessation of nephrite mining. CONCLUSIONS: Nephrite mining may increase the risk of lung cancer in nearby communities. Appropriate medical monitoring is warranted for individuals with similar exposures.

Surgical outcome predictor analysis following hand-assisted or pure laparoscopic transperitoneal nephroureterectomy using the Taiwan upper urinary tract urothelial carcinoma database.

PurposeTaiwan has a high incidence of upper tract urothelial carcinoma (UTUC). This study aimed to compare the surgical outcomes following transperitoneal hand-assisted laparoscopic nephroureterectomy (TP-HALNU) and transperitoneal pure laparoscopic nephroureterectomy (TP-LNU) from the Taiwan nationwide UTUC collaboration database using different parameters, including surgical volumes.Materials and methodsThe nationwide UTUC collaboration database includes 14 hospitals in Taiwan from the Taiwan Cancer Registry. We retrospectively reviewed the records of 622 patients who underwent laparoscopic nephroureterectomy between July 1988 and September 2020. In total, 322 patients who received TP-LNU or TP-HALNU were included in the final analysis. Clinical and pathological data and oncological outcomes were compared.ResultsOf the 322 patients, 181 and 141 received TP-LNU and TP-HALNU, respectively. There were no differences in clinical and histopathological data between the two groups. No differences were observed in perioperative and postoperative complications. There were no significant differences in oncological outcomes between the two surgical approaches. In the multivariate analysis, the cohort showed that age ≥70 years, positive pathological lymph node metastasis, tumors located in the upper ureter, and male sex were predictive factors associated with an increased risk of adverse oncological outcomes. A surgical volume of ≥20 cases showed a trend toward favorable outcomes on cancer-specific survival [hazard ratio (HR) 0.154, p = 0.052] and marginal benefit for overall survival (HR 0.326, p = 0.019) in the multivariate analysis.ConclusionAlthough different approaches to transperitoneal laparoscopic nephroureterectomy showed no significant differences in surgical outcomes, age, sex, lymph node metastasis, and tumor in the upper ureter in the following period were predictive factors for oncological outcomes. Higher surgical volume did not impact disease-free survival and bladder recurrence-free survival but was associated with improved overall survival and cancer-specific survival. Exploration of unknown influencing factors is warranted.

Expanding Sorafenib Treatment for Hepatocellular Carcinoma Beyond Barcelona Clinic Liver Cancer Stage C Patients: A National Study

Background/Aim: The reimbursement criteria of sorafenib for advanced hepatocellular carcinoma (HCC) were expanded in 2016 by Taiwan’s National Health Insurance (NHI) to include patients without macrovascular invasion or extrahepatic spread. This study explored sorafenib treatment outcomes before and after this expansion. Patients and Methods: The NHI database was searched for patients who initiated sorafenib treatment between January 1, 2013, and December 31, 2017. Clinical variables were retrieved from the Taiwan Cancer Registry database. Overall survival (OS) and time to treatment discontinuation (TTD) were calculated as the times from the first sorafenib prescription date until death and the final prescription date, respectively. Results: A total of 13,862 patients were included. The median age was 64 years, 78.1% of patients were male. Approximately a quarter of patients (25.1%) received sorafenib after the criteria expansion and exhibited significantly longer OS (median 7.9 vs. 6.6 months, p&lt;0.001) and TTD (median 3.0 vs. 2.6 months, p=0.003) compared with patients who started before. These results were verified in patients with available data regarding clinical prognostic factors (n=9,378, 67.7% of the entire study population). In the multivariate analysis, sorafenib prescription after criteria expansion remained an independent predictor of longer OS [hazard ratio (HR)=0.87, p&lt;0.001] and TTD (HR=0.93, p=0.004). In the subgroup analysis, these trends were consistently observed across different patient subgroups. Conclusion: Patients with HCC who received sorafenib treatment after the reimbursement criteria expansion exhibited longer OS and TTD.

Tooth extraction within 2 weeks before radiotherapy and osteoradionecrosis: A nationwide cohort study.

The theory of at least 2-week waiting period between tooth extraction and head and neck radiotherapy could reduce osteoradionecrosis remains controversial. Thus, this study examined the theory and associated factors. Data were retrieved from the National Health Insurance Research Database, Taiwan Cancer Registry Database, and Cause of Death Statistics. We included 24,353 patients with head and neck cancer who received radiotherapy from 2011 to 2017 and were followed up until 2019. The patients were divided into three groups: those undergoing tooth removal 2-8 weeks before radiotherapy, those undergoing tooth removal within 2 weeks before radiotherapy, and others. Confounding factors were clinical information, physical conditions, and risky habits. We used the Cox regression model to assess osteoradionecrosis risk. No significant difference in osteoradionecrosis risk was observed between those undergoing tooth extraction within 2 weeks before radiotherapy and the other groups. An irradiation dose of ≥60 Gy, chemotherapy, tumor excision, post-radiotherapy tooth extraction, mandibulectomy, hyperlipidemia, and oral cavity as the tumor subsite were significantly positively associated with osteoradionecrosis risk. A waiting period of ≥2 weeks between tooth extraction and radiotherapy did not significantly reduce osteoradionecrosis risk.

Consolidative chemotherapy after definitive concurrent chemoradiotherapy for esophageal squamous cell carcinoma patients: a population based cohort study

BackgroundThe role of consolidative chemotherapy (CCT) for locally advanced esophageal squamous cell carcinoma (LA-ESCC) patients treated with definitive concurrent chemoradiotherapy (dCCRT) is unclear. We aimed to compare the overall survival (OS) of those treated with vs without CCT via a population based approach.MethodsEligible LA-ESCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between those with vs without CCT. We also evaluated the OS in supplementary analyses via alternative approaches.ResultsOur primary analysis consisted of 368 patients in whom covariates were well balanced after PS weighting. The HR of death when CCT was compared to without was 0.67 (95% confidence interval 0.52–0.86, P = 0.002). The HR of IECM was 0.66 (P = 0.04). The HR of OS remained similarly in favor of CCT in supplementary analyses.ConclusionsWe found that CCT was associated with significantly improved OS for LA-ESCC patients treated with dCCRT. Randomized controlled trials were needed to confirm this finding.

Improved overall survival is associated with adjuvant chemotherapy after definitive concurrent chemoradiotherapy for N3 nasopharyngeal cancer

Concurrent chemoradiotherapy is the established treatment for locally advanced nasopharyngeal carcinoma (NPC). However, there is no evidence supporting routine adjuvant chemotherapy. We aimed to demonstrate the effect of adjuvant chemotherapy on survival and distant metastasis in high-risk N3 NPC patients. We linked the Taiwan Cancer Registry and Cause of Death database to obtain data. Clinical N3 NPC patients were divided as those receiving definitive concurrent chemoradiotherapy (CCRT) with adjuvant 5-fluorouracil and platinum (PF) chemotherapy and those receiving no chemotherapy after CCRT. Patients receiving neoadjuvant chemotherapy were excluded. We compared overall survival, disease-free survival, local control, and distant metastasis in both groups using Cox proportional hazards regression analysis. Propensity-score matching was also performed to evaluate the independent effect of adjuvant PF in a matched cohort with similar baseline characteristics. We included 431 patients (152 and 279 patients in the adjuvant PF and observation groups, respectively). Median follow-up was 4.3 years. The 5-year overall survival were 69.1% and 57.4% in the adjuvant PF chemotherapy and observation groups, respectively (p = 0.02). Adjuvant PF chemotherapy was associated with a lower risk of death (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.43–0.84; p = 0.003), even after adjusting for baseline prognostic factors (HR 0.61, 95% CI 0.43–0.86; p = 0.005). Distant metastasis-free survival at 12 months was higher in the adjuvant PF chemotherapy group than in the observation group (98% vs 84.8%; p < 0.001). After adjusting for baseline prognostic factors, adjuvant PF chemotherapy was associated with freedom from distant metastasis (HR 0.11, 95% CI 0.02–0.46; p = 0.003). Adjuvant chemotherapy was also associated with a decreased risk of death (HR 0.59, 95% CI 0.41–0.85, p = 0.004) in a propensity score-matched cohort. Prospective evaluation of adjuvant PF chemotherapy in N3 NPC patients treated with definitive CCRT is warranted because adjuvant PF chemotherapy was associated with improved overall survival and decreased risk of distant metastasis.

Risk of cardiovascular disease among different fluoropyrimidine-based chemotherapy regimens as adjuvant treatment for resected colorectal cancer.

BackgroundPatients with colorectal cancer (CRC) are more likely to develop cardiovascular disease (CVD) than those without cancer. Little is known regarding their CV risk after operative chemotherapy. We aimed to compare the risk of CV disease among different fluoropyrimidine derivatives.MethodsWe assembled a nationwide cohort of patients with newly diagnosed CRC between 2004 and 2015 who received fluoropyrimidine-based adjuvant chemotherapy for resected CRC by linking the Taiwan Cancer Registry (TCR), National Health Insurance Research Database (NHIRD), and Taiwan Death Registry (TDR). All eligible patients were followed from CRC diagnosis (index date) until a CV event, death, loss to follow-up, or December 31st 2018, whichever came first. CV outcomes included acute myocardial infarction (AMI), life-threatening arrhythmia (LTA), congestive heart failure (CHF), and ischemic stroke (IS). We used stabilized inverse probability of treatment weighting using propensity score (SIPTW) to balance all covariates among the three chemotherapy groups: tegafur-uracil (UFT), non-UFT, and mixed. In addition, survival analysis was conducted to examine the association between study outcomes and chemotherapy groups.ResultsFrom 2004 to 2015, 10,615 (32.8%) patients received UFT alone, 14,511 (44.8%) patients received non-UFT, and 7,224 (22.3%) patients received mixed chemotherapy. After SIPTW, the UFT group had significantly lower all-cause mortality and cancer-related death rates than the other two chemotherapy groups. However, the UFT group had significantly higher rates of cancer death, ischemic stroke, and heart failure than those of the other two chemotherapy groups. The UFT group also had a significantly higher AMI rate than the mixed group. There was no significant difference in LTA among the three groups. Similar findings were observed in the subgroup analysis (stage II and age <70 years, stage II and age ≥70 years, stage III and age <70 years, stage III and age ≥70 years) as the overall population was observed.ConclusionHigher heart failure and ischemic stroke rates were found in the UFT group than in the other two chemotherapy groups, especially those with stage III CRC and ≥70 years of age. Careful monitoring of this subset of patients when prescribing UFT is warranted.

The rate of germ cell and sex cord stromal ovarian cancer is increasing at different rates in the US and in Asia: Why? (185)

<b>Objectives:</b> To study the incidence and trends of non-epithelial ovarian cancer (OC) in the United States as compared to Asia. <b>Methods:</b> Data were obtained from the United States Cancer Statistics (USCS) Public Use Databases and the Taiwan Cancer Registry of Taiwan Health and Welfare Data Center (HWDC) from 2001 to 2017. SEER*Stat 8.3.9, Joinpoint regression program 4.8.0.1, and Excel were used to calculate the incidence and trends. <b>Results:</b> From 2001 to 2017, the incidence of germ cell and sex cord-stromal tumors in the US was 0.42 and 0.26 per 100,000, while In Asia, the incidence was 0.74 and 0.33 per 100,000, respectively. While the average annual percent change (AAPC) has been increasing for non-epithelial OC in both the US and Asia, the increase is markedly greater in Asia. In Asia, the incidence is increasing at three times the rate for sex cord-stromal tumors (1.7 vs 5.7 AAPC) and at nearly 5.5 times the rate for germ cell tumors (0.3 vs 1.6 AAPC), compared to the US. For germ cell tumors, the peak age incidence is younger in the US versus Asia (20-24 years vs 25-29 years, respectively). While for sex cord-stromal tumors, the peak age incidence is older in the US versus Asia (65-69 years vs 50-54 years, respectively). <b>Conclusions:</b> The overall incidence of germ cell and sex cord-stromal OCs is increasing in both the US and Asia. However, it is approximately 50 percent higher in Asia as compared to the US. Further investigation should investigate the role that genetic and environmental factors play in explaining these trends.

Feasibility of international trials of rare epithelial ovarian cancers based on trends in the United States and Asia (163)

Objectives: To investigate the feasibility of international clinical trials in rare ovarian cancers by first studying the incidence and trends of the rare histologic subtypes in the United States (US) and Asia. Methods: Data were obtained from the United States Cancer Statistics (USCS) Public Use Databases and Taiwan Cancer Registry of Taiwan Health and Welfare Data Center (HWDC) for a diagnosis of ovarian clear cell carcinoma, endometrioid carcinoma, mucinous carcinoma, or carcinosarcoma between 2001 to 2017. SEER*Stat 8.3.9, Joinpoint regression program 4.8.0.1, and Excel were used to calculate the incidence and trends. Results: In 2017, the incidence of ovarian clear cell carcinoma, endometrioid carcinoma, mucinous carcinoma, or carcinosarcoma was 0.81, 0.51, 0.47, or 0.25 per 100,000 in the US, and 1.58, 1.17, 1.08, or 0.15 per 100,000 in Asia, respectively. Over the last 18 years, the average annual percent change (AAPC) in clear cell carcinoma did not change in the US and increased by 6.2% in Asia. The AAPC for ovarian endometrioid carcinoma decreased by 2.7% in the US and increased by 2.9% in Asia. Although the rate of carcinosarcoma is increasing in both the US and Asia, it is 16-fold higher in Asia compared with the US, with an AAPC for ovarian carcinosarcoma of 6.4% in Asia versus 0.4% in the US. The rate of ovarian mucinous carcinoma decreased in both the US and Asia with an AAPC of 2.0% versus 0.9%, respectively. Conclusions: The AAPC of ovarian clear cell carcinoma, endometrioid carcinoma, and carcinosarcoma is increasing at higher rates in Asia than in the US, providing justification to utilize global recruitment strategies for clinical trial investigational treatments and interventions in rare ovarian cancers. Objectives: To investigate the feasibility of international clinical trials in rare ovarian cancers by first studying the incidence and trends of the rare histologic subtypes in the United States (US) and Asia. Methods: Data were obtained from the United States Cancer Statistics (USCS) Public Use Databases and Taiwan Cancer Registry of Taiwan Health and Welfare Data Center (HWDC) for a diagnosis of ovarian clear cell carcinoma, endometrioid carcinoma, mucinous carcinoma, or carcinosarcoma between 2001 to 2017. SEER*Stat 8.3.9, Joinpoint regression program 4.8.0.1, and Excel were used to calculate the incidence and trends. Results: In 2017, the incidence of ovarian clear cell carcinoma, endometrioid carcinoma, mucinous carcinoma, or carcinosarcoma was 0.81, 0.51, 0.47, or 0.25 per 100,000 in the US, and 1.58, 1.17, 1.08, or 0.15 per 100,000 in Asia, respectively. Over the last 18 years, the average annual percent change (AAPC) in clear cell carcinoma did not change in the US and increased by 6.2% in Asia. The AAPC for ovarian endometrioid carcinoma decreased by 2.7% in the US and increased by 2.9% in Asia. Although the rate of carcinosarcoma is increasing in both the US and Asia, it is 16-fold higher in Asia compared with the US, with an AAPC for ovarian carcinosarcoma of 6.4% in Asia versus 0.4% in the US. The rate of ovarian mucinous carcinoma decreased in both the US and Asia with an AAPC of 2.0% versus 0.9%, respectively. Conclusions: The AAPC of ovarian clear cell carcinoma, endometrioid carcinoma, and carcinosarcoma is increasing at higher rates in Asia than in the US, providing justification to utilize global recruitment strategies for clinical trial investigational treatments and interventions in rare ovarian cancers.

Secular trends of intrahepatic cholangiocarcinoma in a high endemic area: A population-based study.

BACKGROUNDIntrahepatic cholangiocarcinoma (ICC) is one of the most aggressive malignancies. However, because of its scarcity there are limited population-based data available for investigations into its epidemiologic characteristics. In Taiwan, we have a national cancer registry database that can be used to evaluate the secular trends of ICC.AIMTo evaluate secular trends of ICC according to age, sex, and risk factors in Taiwan.METHODSIn this population-based study, we used the national Taiwan Cancer Registry database. Age-standardized and relative percent changes in incidence rates were used to describe secular trends in incidence rates and sex ratios of ICC in Taiwan.RESULTSThe age-standardized ICC incidence rate among males increased from 1.51 per 100000 in 1993-1997 to 4.07 per 100000 in 2013-2017 and among female from 1.73 per 100000 to 2.95 per 100000. The incidence in females tended to plateau after 2008-2012. For males, the ICC incidence increased as age increased. In the long-term incidence trend of ICC in females, the incidence of the four age groups (40-44, 45-49, 50-54 and 55-59 years) remained stable in different years; although, the incidence of the 60-64 group had a peak in 2003-2007, and the peak incidence of the 65-69 and 70-74 groups occurred in 2008-2012. Among males, beginning at the age of 65, there were increases in the incidence of ICC for the period of 2003-2017 as compared with females in the period of 2003-2017.CONCLUSIONIncreased incidence of ICC occurred in Taiwan over the past two decades. The increased incidence has progressively shifted toward younger people for both males and females.

Declining trends of prevalence of Helicobacter pylori infection and incidence of gastric cancer in Taiwan: An updated cross-sectional survey and meta-analysis.

We aimed to assess the latest prevalence and secular trend of Helicobacter pylori infection and its association with the incidence and mortality of gastric cancer in Taiwan. Adults naive to H.pylori eradication received 13 C-urea breath test (13 C-UBT), H.pylori stool antigen test, and serology test during 2019-2020 in this prospective screening program. Children and adolescent aged between 7 and 19 years received 13 C-UBT for H.pylori screening. We also conducted a systematic review and meta-analysis to assess the secular trend of prevalence of H.pylori from 1990 to 2020 in Taiwan. The secular trends of age-standardized incidence and mortality of gastric cancer were obtained from the Taiwan Cancer Registry. A total of 1494 participants were enrolled, including 294 children or adolescents and 1200 adults. The overall prevalence of active H.pylori infection by 13 C-UBT was 26.6% (397/1494), which was 30.8% in adults and 9.5% in adolescents/children. The age-standardized prevalence of active H.pylori infection was 32.3% in adults after adjustment of the population structure in Taiwan. Of the 29 studies including 38,597 subjects eligible for the meta-analysis, the pooled prevalence of H.pylori infection decreased from 63.8% (95% CI: 55.9%-71%) in 1990-2000 to 28.2% (95% CI:21.8%-35.6%) in 2016-2020. The age-standardized incidence and mortality of gastric cancer have also declined from 15.2 to 10.75 per 100,000, respectively, in 1999 to 9.29 and 5.4 per 100,000, respectively, in 2019. The prevalence of H.pylori infection has declined in Taiwan, which correlates with the declining trends of age-standardized incidence and mortality of gastric cancer in Taiwan.

Association between Preexisting Sleep Disorders and Oncologic Outcome in Patients with Oral Cavity Squamous Cell Carcinoma: A Nationwide Propensity Score-Matched Population-Based Cohort Study.

Simple SummaryWe aimed to estimate the effects of preexisting sleep disorders on the oncologic outcomes of patients with oral squamous cell carcinoma (OSCC) after receiving standard treatments. We conducted a head-to-head propensity-score-matching-based study to mimic a randomized trial to compare the survival, locoregional recurrence, and distant metastasis rates between OSCC patients with and without sleep disorders. The patients with sleep disorders receiving curative treatments for OSCC had poorer oncologic outcomes than did those without sleep disorders. Preexisting sleep disorders may be survival predictors in patients with OSCC. Studies on how pharmacological and behavioral treatments for sleep problems improve survival benefits in patients with OSCC are warranted.Purpose: To investigate the effects of preexisting sleep disorders on the oncologic outcomes of patients receiving standard treatments for oral squamous cell carcinoma (OSCC). Methods: The patients recruited from the Taiwan Cancer Registry Database who had received surgery for stage I–IVB OSCC. The Cox proportional hazards model was used to analyze all-cause mortality, locoregional recurrence (LRR), and distant metastasis (DM). The patients were categorized into those with and without sleep disorders (Groups 1 and 2, respectively) through propensity score matching. Results: In the multivariate Cox regression analysis, the adjusted hazard ratios for all-cause mortality, LRR, and DM for Group 1 compared with Group 2 were 1.19 (95% confidence interval (CI): 1.04–1.36; p = 0.011), 1.47 (95% CI: 1.23–1.75; p < 0.001), and 1.15 (95% CI: 1.02–1.44; p = 0.025), respectively. Conclusion: OSCC patients with sleep disorders demonstrated poorer oncologic outcomes than did those without sleep disorders. Therefore, before OSCC surgery, patients with OSCC should be screened for preexisting sleep disorders because they may serve as predictors for survival in these patients. Future studies investigating the survival benefits of pharmacological and behavioral treatments for sleep problems in patients with OSCC are warranted.

Birth Cohort Effects in Breast Cancer Incidence: Global Patterns and Trends.

Breast cancer is the most common neoplasm in the world among women. The age-specific incidences and onset ages vary widely between Asian and Western countries/regions. Invasive breast cancer cases among women from 1997 to 2011 were abstracted from the International Agency for Research on Cancer and the Taiwan Cancer Registry. Age-period-cohort analysis was performed to examine the trends. The cohort effect was prominent in South Korea, Taiwan, Japan, and Thailand, possibly related to the timing of westernization. The risk of breast cancer initially rose with the birth cohorts in Hong Kong and India (both former British colonies), peaked, and then declined in recent birth cohorts. Unlike other Asian countries/regions, virtually no birth cohort effect was identified in the Philippines (a Spanish colony in 1565 and the first Asian country to adopt Western cultural aspects). Moreover, an at-most negligible birth cohort effect was identified for all ethnic groups (including Asian immigrants) in the United States. This global study identified birth cohort effects in most Asian countries/regions but virtually no impact in Western countries/regions. The timing of westernization was associated with the birth cohort effect.

Epidemiology of Aspergillosis in Cancer Patients in Taiwan.

PurposeThe incidence of aspergillosis is increasing, and the risk factors for infection include cancer, admission to the intensive care unit, chronic pulmonary diseases, immunocompromised status, and taking immunomodulatory drugs. There are limited data about the incidence of aspergillosis in patients with different types of cancer. The aim of our study was to survey the incidence of aspergillosis in different cancer types from 2006 to 2017.Patients and MethodsData were collected from the Taiwan Cancer Registry database and International Classification of Diseases, 9th, 10th Revision, and Clinical Modification codes for diagnosing aspergillosis. Patients with a history of aspergillosis before cancer were excluded, and the secondary outcome was the risk of mortality in cancer patients with and without aspergillosis after 1 year.ResultsAmong 951 cancer patients with a diagnosis of aspergillosis, there were 614 hematopoietic and reticuloendothelial system patients, 100 lung cancer patients, and 73 lymphoma cancer patients. The overall incidence rates of aspergillosis tended to increase significantly from 2006 to 2017 (from 3.50 to 13.37 per 10,000 person-years, p value: <0.0001). Regarding sex, the incidence rates of aspergillosis in males and females were 12.52 and 7.53 per 10,000 person-years, respectively. Patients with a diagnosis of aspergillosis had a 2.30-fold (95% CI: 2.14–2.48, p value: <0.0001) higher risk of mortality than those without aspergillosis.ConclusionThe incidence of aspergillosis was increased in cancer patients, and cancer patients with aspergillosis had a significantly higher risk of mortality than those without aspergillosis.