Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3)

BACKGROUND

Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology.

METHODS

We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator.

RESULTS

The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults.

CONCLUSIONS

To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.

Trends in the Incidence of Kaposi's Sarcoma and Non-Hodgkin Lymphoma in Northern Thailand during the Time Period of Universal Access to Antiretroviral Treatment, 1998-2017

PURPOSE

We evaluated the trends in incidence of Kaposi's sarcoma (KS) and Non-Hodgkin's lymphoma (NHL)  over the two decades in northern Thailand during which access to antiretroviral treatments (ART) in Thailand was scaled up.

METHODS

This is retrospective observational study. Data from 1998 to 2017 of patients diagnosed with KS and NHL from three long-standing, population-based cancer registries in northern Thailand (Chiang Mai, Lampang and Lamphun) were used to describe trends in age-adjusted incidence rate (ASR) of these cancers. The annual percent change (APC) of incidence rates were evaluated over this timeframe.

RESULTS

The incidence of KS significantly increased from 1998 to 2017 in males (APC of 6.9%) and very low incidence for evaluating change in female. NHL incidence significantly increased from 1998 to 2017, 2.2% and 1.8% per year in males and females, respectively (p<0.001).

CONCLUSION

In the last two decades, the incidence of KS in male and NHL in both sexes have increased in northern Thailand, while the incidence of KS in female remained low. The change in incidences in opposite to the decline in HIV prevalence and increase ART coverage rate supported that other associated factors attributable to the development of KS and NHL should be looked for i.e., environmental, occupational exposures and other infections.

Descriptive epidemiology of soft tissue sarcomas and gastrointestinal stromal tumors in Thailand

This study aimed to analyze burden of STS and GIST in population and survival rate which represented the current situation of treatment in Thailand. The data was collected from five population-based cancer registries around the country for the period 2001 through 2015. The Segi world standard population was used to calculated age-standardized incidence rates (ASR). Standardized rate ratios (SRR) were used to compare populations. Joinpoint Trend Analysis was used to assess changes in incidence. STATA was used to examine patient survival rates. During the study period, 4080 cases of STS and 457 cases of GIST were reported. The ASR of STS and GIST was 2.14/100,000 person-years and 0.22/100,000 person-years, respectively. The most common histological types of STS were unspecified sarcoma (24.8%), leiomyosarcoma (19.0%) and liposarcoma (11.4%). The overall ASR of STS in Thailand was relatively low compared to Western countries. The five-year survival rate was 62.6% for STS and 63.4% for GIST, which was comparable to the rates reported in other countries. This is the first report of STS and GIST from PBCRs in Thailand. Based on current healthcare service, an overall survival rates of STS and GIST are comparable to those reported from others.

An analysis of the incidence and survival rates of bone sarcoma patients in thailand: reports from population-based cancer registries 2001-2015

BACKGROUND

Epidemiology data from population-based cancer registries (PBCR) can be very valuable in the development of health policy and for improving the quality of cancer control strategies.

METHODS

This study analyzed the incidence of bone sarcomas in Thailand during 2001 - 2015 by analyzing data obtained from 5 PBCRs across country. Incidence rates per million person-years by sex, histological subtype, primary site and 5-year age group were calculated. Age-standardized incidence rates (ASR) were adjusted using the WHO's World Standard Population and comparisons between populations were done using standardized rate ratios (SRR). Incidence trends were evaluated using Joinpoint Trend Analysis. Survival rates were analyzed using STATA.

RESULTS

The ASR of bone sarcomas in Thailand was 5.1/10⁶ person-years, with an estimated 328 newly diagnosed bone sarcomas per year for the country overall. Osteosarcoma (52.5%), chondrosarcoma (18%), Ewing's sarcoma (11.6%), giant cell tumor (4.8%) and chordoma (4.7%) were the most common malignant bone tumors, representing 91.5% of all bone sarcomas. Bone sarcoma has a predilection for males (1.29:1) and an age-specific bimodal rate pattern closely related to the major histological subtypes, osteosarcoma. One- and five-year survival rates of Thai patients with bone sarcoma were 74% and 52%, respectively. Survival rates of bone sarcomas, particularly osteosarcoma, were lower than the rates reported from the United States, Europe and Japan.

CONCLUSION

The lower overall survival rate of bone sarcoma represented the gap of bone sarcoma control program in Thailand. That indicates the need for improvement in health promotion, treatment process and chemotherapy for bone sarcoma patients in the future.

Temporal Trends and Geographic Patterns of Lung Cancer Incidence by Histology in Thailand, 1990 to 2014

Purpose

Lung cancer is one of the most common cancers worldwide and in Thailand. We characterize and forecast region-specific patterns of lung cancer incidence by histology and sex.

Methods

We analyzed lung cancer incidence trends in Thailand by histology (adenocarcinoma [AdC]; squamous cell carcinoma [SCC]; and large-cell, small-cell, and other carcinomas) from 1990 to 2014 in four cancer registries in three regions (north, Chiang Mai Province and Lampang Province; northeast: Khon Kaen Province; south: Songkhla Province). Annual percent change (APC) was calculated to quantify the incidence rate trends using joinpoint regression. Age-period-cohort models were used to examine the temporal trends of AdC and SCC by age, calendar year, and birth cohort. We projected the incidence of AdC and SCC up to 2030 using three independent approaches: joinpoint, age-period-cohort, and Nordpred models.

Results

AdC incidence significantly increased from 1990 to 2012 in Chiang Mai males (APC, 1.3%), Songkhla males from 2004 to 2014 (APC, 2.5%), Songkhla females from 1990 to 2014 (APC, 5.9%), and Khon Kaen females from 2005 to 2014 (APC, 3.1%). Conversely, SCC incidence significantly decreased from 1990 to 2012 in Chiang Mai males and females (APC, −1.2% and −4.8%, respectively), Lampang males and females from 1993 to 2014 (APC, −5.4% and −5.2%, respectively), and Songkhla females from 1990 to 2014 (APC, −2.1%). In general, trends of AdC and SCC correlated more with birth cohort than with calendar year. Three projection models suggested that incidence rates of AdC in Songkhla may continue to increase until 2030.

Conclusion

Temporal trends of lung cancer by histology varied among regions in Thailand. Reduction of lung cancer incidence in Thailand likely will require prevention strategies tailored to each specific region.

Childhood cancer incidence and survival in Thailand: A comprehensive population-based registry analysis, 1990-2011

BACKGROUND

Southeast Asia is undergoing a transition from infectious to chronic diseases, including a dramatic increase in adult cancers. Childhood cancer research in Thailand has focused predominantly on leukemias and lymphomas or only examined children for a short period of time. This comprehensive multisite study examined childhood cancer incidence and survival rates in Thailand across all International Classification of Childhood Cancer (ICCC) groups over a 20-year period.

METHODS

Cancer cases diagnosed in children ages 0-19 years (n = 3574) from 1990 to 2011 were extracted from five provincial population-based Thai registries, covering approximately 10% of the population. Descriptive statistics of the quality of the registries were evaluated. Age-standardized incidence rates (ASRs) were calculated using the Segi world standard population, and relative survival was computed using the Kaplan-Meier method. Changes in incidence and survival were analyzed using Joinpoint Regression and reported as annual percent changes (APC).

RESULTS

The ASR of all childhood cancers during the study period was 98.5 per million person-years with 91.0 per million person-years in 1990-2000 and 106.2 per million person-years in 2001-2011. Incidence of all childhood cancers increased significantly (APC = 1.2%, P < 0.01). The top three cancer groups were leukemias, brain tumors, and lymphomas. The 5-year survival for all childhood cancers significantly improved from 39.4% in 1990-2000 to 47.2% in 2001-2011 (P < 0.01).

CONCLUSIONS

Both childhood cancer incidence and survival rates have increased, suggesting improvement in the health care system as more cases are identified and treated. Analyzing childhood cancer trends in low- and middle-income countries can improve understanding of cancer etiology and pediatric health care disparities.

Cancer incidence in northern Thailand: Results from six population-based cancer registries 1993-2012

Rapid changes in social and economic development have led to cancer becoming a major cause of national morbidity and mortality in Thailand. Cancer registries have been critical in documenting subnational cancer patterns and transitions in the country; with the establishment of six registries in northern Thailand, a comprehensive assessment of the scale and profile of cancer is now possible in the region. Cancers of the liver, lung, colorectum, breast and cervix were the major cancers 2008-2012, although variations in the profiles of cancer were observed, with a very high incidence of liver cancer seen among males in Phrae, corresponding to one in 11 men developing the disease in a lifetime. Based on data from Lampang and Chiang Mai 1993-2012, rates of lung and cervical cancer incidence have declined, while liver, colorectal and breast cancer incidence have been increasing up to 2012. A more detailed investigation of the incidence trends for specific cancer sites and subtypes at the local level are crucial to the monitoring and evaluation of the cancer control interventions implemented within the Thai national cancer control programme (NCCP). Priority should be given to extend the capacity of the new registries in northern Thailand, ensuring improvement in quality and utilization of the data to drive epidemiologic research and cancer control.

National and Subnational Population-Based Incidence of Cancer in Thailand: Assessing Cancers with the Highest Burdens

In Thailand, five cancer types-breast, cervical, colorectal, liver and lung cancer-contribute to over half of the cancer burden. The magnitude of these cancers must be quantified over time to assess previous health policies and highlight future trajectories for targeted prevention efforts. We provide a comprehensive assessment of these five cancers nationally and subnationally, with trend analysis, projections, and number of cases expected for the year 2025 using cancer registry data. We found that breast (average annual percent change (AAPC): 3.1%) and colorectal cancer (female AAPC: 3.3%, male AAPC: 4.1%) are increasing while cervical cancer (AAPC: -4.4%) is decreasing nationwide. However, liver and lung cancers exhibit disproportionately higher burdens in the northeast and north regions, respectively. Lung cancer increased significantly in northeastern and southern women, despite low smoking rates. Liver cancers are expected to increase in the northern males and females. Liver cancer increased in the south, despite the absence of the liver fluke, a known factor, in this region. Our findings are presented in the context of health policy, population dynamics and serve to provide evidence for future prevention strategies. Our subnational estimates provide a basis for understanding variations in region-specific risk factor profiles that contribute to incidence trends over time.

Breast Cancer in Lampang, a Province in Northern Thailand: Analysis of 1993-2012 Incidence Data and Future Trends

BACKGROUND

The recent epidemiologic transition in Thailand, with decreasing incidence of infectious diseases along with increasing rates of chronic conditions, including cancer, is a serious problem for the country. Breast cancer has the highest incidence rates among females throughout Thailand. Lampang is a province in the upper part of Northern Thailand. A study was needed to identify the current burden, and the future trends of breast cancer in upper Northern Thai women.

MATERIALS AND METHODS

Here we used cancer incidence data from the Lampang Cancer Registry to characterize and analyze the local incidence of breast cancer. Joinpoint analysis, age period cohort model and Nordpred package were used to investigate the incidences of breast cancer in the province from 1993 to 2012 and to project future trends from 2013 to 2030.

RESULTS

Age-standardized incidence rates (world) of breast cancer in the upper parts of Northern Thailand increased from 16.7 to 26.3 cases per 100,000 female population which is equivalent to an annual percentage change of 2.0-2.8%, according to the method used. Linear drift effects played a role in shaping the increase of incidence. The three projection method suggested that incidence rates would continue to increase in the future with incidence for women aged 50 and above, increasing at a higher rate than for women below the age of 50.

CONCLUSIONS

The current early detection measures increase detection rates of early disease. Preparation of a budget for treatment facilities and human resources, both in surgical and medical oncology, is essential.

AgeStandardized Incidence Rates and Survival of Osteosarcoma in Northern Thailand

Osteosarcoma is a common primary malignant bone tumor in children and adolescents. Recent worldwide average incidences of osteosarcoma in people aged 0 to 24 years were 4.3 and 3.4 per million, respectively, with a ratio of 1.4:1. However, data on the incidence of osteosarcoma in Thailand are limited. This study analyzed the incidence of osteosarcoma in the upper northern region of Thailand, with a population of 5.85 million people (8.9% of the total Thai population), using data for the years 1998 to 2012, obtained from the Chiang Mai Cancer Registry (CMCR) at Chiang Mai University Hospital and the Lampang Cancer Registry (LCR) at the Lampang Cancer Hospital, a total of 144 cases. The overall annual incidence of osteosarcoma was 1.67 per million with a male:female ratio of 1.36:1. Incidences by age group (male and female) at 0 to 24, 25 to 59 and over 60 years were 3.5 (3.9 and 3.0), 0.8 (0.9 and 0.6), and 0.7 (0.8 and 0.5), respectively. The peak incidence occurred at 15 to 19 years for males and at 10 to 14 years for females. The median survival time was 18 months with a 5year survival rate of 43%. Neither the age group nor the 5year interval period of treatment was significantly correlated with survival during the 15year period studied.

Appropriateness of the standard mortality/incidence ratio in evaluation of completeness of population-based cancer registry data

BACKGROUND

The magnitude of differences in mortality incidence (M:I) ratios derived from the national mortality source and those derived from cancer registry (CR) databases may be used to determine associated factors.

METHODS

All information on cancer incidence cases and mortality cases from January 1, 2003 to December 31, 2007 were retrieved from 5 population-based cancer registries in four regions of Thailand. Two sources of mortality were used: death cases within the cancer registries and mortality statistics obtained from the Ministry of Public Health (MOPH). Plots of percentage M:I ratios from cancer registry databases and from national mortality sources against 1 minus 5 years relative survival (1-5yrRS) were used to visualize the correlation between the two mortality sources. A Poisson regression model was used to determine the influence of cancer sites and registries on the M:I ratio/[1-5yrRS].

RESULTS

There was high variability between the standard M:I ratio derived from national mortality compared with 1-5 year RS. The factors affecting M:I ratios are sources of mortality data and misclassification of topographic site as the cause of death.

CONCLUSIONS

Use of the M:I ratio is not recommended to evaluate completeness of cancer registry data when the quality of mortality data is poor.

Quality of case ascertainment in cancer registries: a proposal for a virtual three-source capture-recapture technique

BACKGROUND

The ability and behaviour of the capture-recapture method using a virtual three-source model for evaluation of the level of completeness of case ascertainment requires exploration.

METHODS

Cancer cases obtained from 9 population-based cancer registries in Thailand during 2003 to 2007 were applied for capture-recapture using a model based on clinical, pathological and mortality data. These three virtual sources were derived from three actual items common to all cancer registries: the basis of diagnosis, ICD-O morphology code, and last known patient status. Poisson regression models were fit to the data to estimate parameters which were then transformed into demographic values. A linear model was used to determine the predictors and estimated percentage of completeness (EPC) in case ascertainment among the cancer registries.

RESULTS

The EPC was greater than 97% in 5 and less than 90% in 4 registries. The worst had an EPC of 70%. The percentage death certificate only (%DCO) and the interaction between %DCO and morphological verification (MV) were significantly associated with EPC. Other factors intrinsic to registries also exerted influence on the EPC.

CONCLUSIONS

In addition to other standard indicators to monitor completeness of cancer registries, the present virtual three-source capture-recapture model can be routinely used to estimate the level of completeness of case ascertainment in cancer registries.

Cancer survival in Lampang, Thailand, 1990-2000

The Lampang cancer registry was established in 1995, with retrospective data collection since 1988. Cancer registration is currently done by passive methods. The registry is contributing data on survival for 40 cancer sites or types registered during 1990-2000. Follow-up has been carried out by passive and active methods with median follow-up ranging from 1-74 months for different cancers. The proportion having a histologically verified diagnosis for various cancers ranged between 30-100%; death certificate only (DCO) cases comprised 0-33%; 67-100% of total registered cases were included for survival analysis. Complete follow-up at five years ranged from 96-100% for different cancers. The 5-year age-standardized relative survival rate was the highest for skin non-melanoma (85%) followed by lip (81%), thyroid (74%), corpus uteri (71%) and penis (71%). The 5-year relative survival by age group showed a fluctuating trend. An overwhelmingly high proportion of cases were diagnosed with a regional spread of disease, ranging from 35-68% for different cancers, and survival was decreasing with increasing extent of disease for most cancers studied.