Background
To assess the impact of treatment delay on survival of oral/oropharyngeal cancer (OSCC).
Methods
We followed 5743 OSCCs between 2004 and 2009 from a population‐based screening program and ...ascertained death until the end of 2012.
Results
The hazard ratios (HRs) of mortality from OSCC were 1.46 (1.30‐1.65) and 1.18 (1.04‐1.33) in univariable and multivariable analyses, respectively, for treatment delay longer than 6 weeks compared with that shorter than 3 weeks. The corresponding figures were 1.12 (1.01‐1.24) and 1.00 (0.91‐1.11) for treatment delay between 3 and 6 weeks. Advancing age (1.01), higher stage (stage II: 1.84, stage III: 2.97, stage IV: 6.33), cancer in tongue (1.37), or hard palate (1.63) had higher HR of mortality (P < .05). However, treatment at medical center had a lower mortality (0.83, 0.75‐0.91) than local/regional hospital.
Conclusions
Treatment delay longer than 6 weeks for OSCCs detected via a population‐based screening program had unfavorable survival.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background and Aim
The aim of this study is to identify gastric cancer burden in Indigenous Taiwanese peoples and conduct a project to evaluate how to reduce the disparities most effectively in ...Indigenous communities.
Methods
First, we quantified the health disparities in gastric cancer in Indigenous peoples using data from the cancer registries during the period of 2006–2014. Second, we identified parameters that might be associated with Helicobacter pylori infection or help identify a good eradication strategy.
Results
Gastric cancer incidence (24.4 vs 12.3 per 100 000 person‐years) and mortality rates (15.8 vs 6.8 per 100 000 person‐years) were higher in Indigenous than in non‐Indigenous, with 2.19‐fold (95% confidence interval CI: 2.06–2.33) and 2.47‐fold (2.28–2.67) increased risk, respectively. In Indigenous communities, H. pylori infection was more prevalent in Indigenous than in non‐Indigenous (59.4% vs 31.5%, P < 0.01). Regression analyses consistently showed that either the mountain or plain Indigenous had 1.89‐fold (95% CI: 1.34–2.66) and 1.73‐fold (95% CI: 1.24–2.41) increased risk for H. pylori infection, respectively, as compared with non‐Indigenous, adjusting for other baseline characteristics. The high infection rates were similarly seen in young, middle‐aged, and older adults. Program eradication rates using clarithromycin‐based triple therapy were suboptimal (73.7%, 95% CI: 70.0–77.4%); the habits of smoking (1.70‐fold, 95% CI: 1.01–2.39) and betel nut chewing (1.54‐fold, 95% CI: 0.93–2.16) were associated with the higher risk of treatment failure.
Conclusion
Gastric cancer burden is higher in Indigenous Taiwanese peoples than in their non‐Indigenous counterparts. Eliminating the prevalent risk factor of H. pylori infection is a top priority to reduce this health disparity.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background
To elucidate the impact of varying anatomic sites on advanced stage of and death from oral cancer.
Methods
A total of 27 717 oral cancers mainly from a population‐based visual inspection ...program in Taiwan from 2004 to 2009 was followed until the end of 2012.
Results
Using lip cancer as reference, the odds ratios (95% confidence interval CI) of advanced stage of cancer were 2.20 (1.92‐2.51) for tongue, 2.60 (2.28‐2.97) for buccal, 2.68 (2.20‐3.28) for floor of mouth, 2.96 (2.52‐3.47) for hard palate, 6.04 (5.17‐7.05) for gingiva, and 10.83 (9.20‐12.74) for oropharynx. The estimated hazard ratios (95% CI) for oral cancer death increased from 1.48 (1.31‐1.67) in buccal, 1.61 (1.43‐1.82) in tongue, 1.68 (1.41‐1.99) in floor of mouth, 1.79 (1.57‐2.05) in gingiva, 1.97 (1.71‐2.26) in hard palate, and 2.15 (1.89‐2.45) in oropharynx.
Conclusion
Different anatomic sites had variations in advanced stage of and death from oral cancer and need vigilant surveillance.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background: Mass screening of high-risk populations for oral cancer has proven to be effective in reducing oral cancer mortality. However, the magnitude of the effectiveness of the various screening ...scenarios has rarely been addressed. Methods: We developed a simulation algorithm for a prospective cohort under various oral cancer screening scenarios. A hypothetical cohort of 8 million participants aged ≥30 years with cigaret smoking and/or betel quid chewing habits was constructed based on parameters extracted from studies on oral cancer screening. The results of a population-based screening program in Taiwan and a randomized controlled trial in India were used to validate the fitness; then, the effectiveness of the model was determined by changing the screening parameters. Results: There was a reduction in the risk of advanced oral cancer by 40% (relative risk RR = 0.60, 95% confidence interval CI:0.59-0.62) and oral cancer mortality by 29% (RR = 0.71, 95% CI: 0.69-0.73) at the 6-year follow-up in a screening scenario similar to the biennial screening in Taiwan, with a 55.1% attendance rate and 92.6% referral rate. The incremental effect in reducing advanced oral cancer was approximately 5% with a short 1-year screening frequency, and the corresponding reduction in mortality was, on average, 6.5%. The incremental reduction in advanced oral cancer per 10% increase in the compliance rate was 3% to 4%, while only 1% to 2% reduction was noted per 10% increase in the referral rate. The effectiveness of screening in reducing advanced oral cancer was 5% to 6% less when both betel quid chewing and alcohol drinking habits were present. Conclusion: Our computer simulation model demonstrated the effect of screening on the reduction in oral cancer mortality under various scenarios. The results provide screening policymakers with the necessary guidance to implement screening programs to save lives.
Objective
To investigate the risk for second primary cancer in the hypopharynx and esophagus (SPC‐HE) among individuals with an initial oral/oropharyngeal cancer.
Materials and Methods
Mass screening ...data from Taiwan (2004–2009) included individuals who were ≥18 years old and smoked cigarettes and/or chewed betel quid. Occurrence of SPC‐HE was monitored until December 31, 2014. Results were expressed as adjusted relative risk (aRR) and 95% confidence interval (CI).
Results
One hundred and fifty‐eight out of 4,494 subjects with oral cancer developed SPC‐HE (incidence rate: 6.47 per 1,000 person‐years). Relative to patients with primary cancers in the lip, the risk of an SPC‐HE was higher in patients with primary cancers in oropharynx (aRR: 19.98, 95% CI: 4.72–84.55), floor of mouth (aRR: 12.13, 95% CI: 2.67–55.15), and hard palate (aRR: 7.31, 95% CI: 1.65–32.37), but not in patients with cancers in tongue (aRR: 3.67, 95% CI: 0.89–15.17) or gum (aRR: 3.99, 95% CI: 0.92–17.35). Regression analyses also showed the risk of an SPC‐HE was greater in alcohol drinkers than those who did not (aRR: 1.65, 95% CI: 1.10–2.48).
Conclusions
Compared with the initial cancer in the lip, patients with a cancer in the oropharynx, floor of mouth, and hard palate had a higher risk for the SPC‐HE.
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CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
•The risk of malignant transformation of oral potentially malignant disorders varied by subtype.•Exophytic verrucous hyperplasia had a 6 times malignant risk compared with leukoplakia.•Alcohol ...drinking elevated the malignant risk by 23%.•Betel quids chewing contributed a 4 times malignant risk for exophytic verrucous hyperplasia.
To elucidate the risk of malignant transformation to invasive oral cancer by subtypes of oral potentially malignant disorders (OPMD) and to examine the independent effects of risk factors, particularly alcohol drinking, by subtype based on a nationwide oral cancer screening program targeting at general population with habits of smoking and/or betel quids chewing.
The total of 8501 subjects diagnosed as different subtypes of OPMDs from the Taiwanese screening program between 2004 and 2009 were followed up over time to ascertain the occurrence of invasive oral cancer. The hazard ratios of malignant transformation were estimated by using Cox proportional hazards regression model.
The overall malignant rate (per 1000 person-years) to oral cancer was 8.4 (407 incident cases with an average of 5.7 years of follow-up). The highest rate was noted in exophytic verrucous hyperplasia (33), followed by erythroplakia (11.8), erythroleukoplakia (10.7), oral submucous fibrosis (OSF) (8.6), and leukoplakia (5.4). After adjusting for confounders, exophytic verrucous hyperplasia still had a 5.69 (4.47–7.24) times risk compared with leukoplakia. The corresponding figures for erythroplakia, erythroleukoplakia, and OSF were 2.25 (1.31–3.89), 2.00 (1.13–3.53), and 1.63 (1.29–2.06), respectively. Alcohol drinking elevated the overall risk of malignant transformation by 23% (1–52% and also triggered a higher risk in OSF (aHR = 1.62 (1.06–2.47)). The higher risk attributed to betel quids chewing was noted for exophytic verrucous hyperplasia (aHR = 4.23 (1.55–11.55)).
The risk of malignant transformation to oral cancer varied with the subtypes of OPMD and was elevated in OSF and verrucous hyperplasia attributed to alcohol drinking and betel quids, respectively.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Data curation for a hospital-based cancer registry heavily relies on the labor-intensive manual abstraction process by cancer registrars to identify cancer-related information from free-text ...electronic health records. To streamline this process, a natural language processing system incorporating a hybrid of deep learning-based and rule-based approaches for identifying lung cancer registry-related concepts, along with a symbolic expert system that generates registry coding based on weighted rules, was developed. The system is integrated with the hospital information system at a medical center to provide cancer registrars with a patient journey visualization platform. The embedded system offers a comprehensive view of patient reports annotated with significant registry concepts to facilitate the manual coding process and elevate overall quality. Extensive evaluations, including comparisons with state-of-the-art methods, were conducted using a lung cancer dataset comprising 1428 patients from the medical center. The experimental results illustrate the effectiveness of the developed system, consistently achieving F1-scores of 0.85 and 1.00 across 30 coding items. Registrar feedback highlights the system’s reliability as a tool for assisting and auditing the abstraction. By presenting key registry items along the timeline of a patient’s reports with accurate code predictions, the system improves the quality of registrar outcomes and reduces the labor resources and time required for data abstraction. Our study highlights advancements in cancer registry coding practices, demonstrating that the proposed hybrid weighted neural-symbolic cancer registry system is reliable and efficient for assisting cancer registrars in the coding workflow and contributing to clinical outcomes.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
BackgroundTo elucidate the impact of varying anatomic sites on advanced stage of and death from oral cancer.MethodsA total of 27 717 oral cancers mainly from a population‐based visual inspection ...program in Taiwan from 2004 to 2009 was followed until the end of 2012.ResultsUsing lip cancer as reference, the odds ratios (95% confidence interval CI) of advanced stage of cancer were 2.20 (1.92‐2.51) for tongue, 2.60 (2.28‐2.97) for buccal, 2.68 (2.20‐3.28) for floor of mouth, 2.96 (2.52‐3.47) for hard palate, 6.04 (5.17‐7.05) for gingiva, and 10.83 (9.20‐12.74) for oropharynx. The estimated hazard ratios (95% CI) for oral cancer death increased from 1.48 (1.31‐1.67) in buccal, 1.61 (1.43‐1.82) in tongue, 1.68 (1.41‐1.99) in floor of mouth, 1.79 (1.57‐2.05) in gingiva, 1.97 (1.71‐2.26) in hard palate, and 2.15 (1.89‐2.45) in oropharynx.ConclusionDifferent anatomic sites had variations in advanced stage of and death from oral cancer and need vigilant surveillance.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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