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Huang G, Wang Y, Qin B, Zeng J, Tan H, Zhang D, Wang Q. Global, regional and national burdens of Nasopharynx cancer in the adolescents and young adults from 1990 to 2019 and its predictions. BMC Cancer 2024; 24:720. [PMID: 38862937 PMCID: PMC11167860 DOI: 10.1186/s12885-024-12480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/05/2024] [Indexed: 06/13/2024] Open
Abstract
PURPOSE To use data from the Global Burden of Disease (GBD) Study 2019 to report the global, regional and national rates and trends of deaths incidence, prevalence, disability-adjusted life years (DALYs) for Nasopharynx cancer (NPC) in adolescents and young adults (AYAs). METHODS Data from the GBD 2019 were used to analyze deaths incidence, prevalence and DALYs due to NPC at global, regional, and national levels. Joinpoint regression analysis was used to calculate the average annual percentage changes (AAPC). The association between incidence, prevalence and DALYs and socioeconomic development was analyzed using the GBD Socio-demographic Index (SDI). Finally, projections were made until 2030 and calculated in Nordpred. RESULTS The incidence, prevalence, death and DALYs rates (95%UI) due to NPC 0.96 (0.85-1.09, 6.31 (5.54-7.20),0.20 (0.19-0.22), and 12.23(11.27-13.29) in 2019, respectively. From 1990 to 2019, the incidence and prevalence rates increased by 1.79 (95% CI 1.03 to 2.55) and 2.97(95% CI 2.13 to 3.82) respectively while the deaths and DALYs rates declined by 1.64(95%CI 1.78 to 1.49) and 1.6(95%CI 1.75 to 1.4) respectively. Deaths and DALYs rates in South Asia, East Asia, North Africa and Middle East decreased with SDI. Incidence and prevalence rates in East Asia increased with SDI. At the national level, the incidence and prevalence rates are high in China, Taiwan(China), Singapore, Malaysia, Brunel Darussalam, Algeria, Tunisia, Libya and Malta. Meanwhile, the deaths and DALYs rates are still high in Malaysia, Brunel Darussalam, Greenland and Taiwan(Province of China). The deaths and DALYs rates are low in Honduras, Finland and Norway. From the 2020 to 2030, ASIR、ASPR and ASDR in most regions are predicted to stable, but DALYs tends to decline. CONCLUSION NPC in AYAs is a significant global public problem. The incidence, prevalence, and DALYs rates vary widely by region and country. Therefore different regions and countries should be targeted to improve the disease burden of NPC.
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Affiliation(s)
- Guoxin Huang
- Department of Evidence-Based Medicine Center, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China
| | - Yaojie Wang
- Department of Otolaryngology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, 15 Jiefang Road, Fancheng District, Xiangyang, 441000, Hubei, China
| | - Bingqing Qin
- Center Laboratory for Translational Medicine, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Jing Zeng
- Department of Paediatrician, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Huazhang Tan
- Department of Otolaryngology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, 15 Jiefang Road, Fancheng District, Xiangyang, 441000, Hubei, China
| | - Dongdong Zhang
- Department of Oncology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, China.
| | - Qiuyang Wang
- Department of Otolaryngology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, 15 Jiefang Road, Fancheng District, Xiangyang, 441000, Hubei, China.
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Bin Sumaida A, Shanbhag NM, Aby Ali HA, Jaafar N, AlKaabi K, Balaraj K. An Evaluation of Treatment Outcomes and Associated Factors in Nasopharyngeal Cancer Patients at a Tertiary Cancer Center in the United Arab Emirates. Cureus 2024; 16:e54344. [PMID: 38371438 PMCID: PMC10873819 DOI: 10.7759/cureus.54344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 02/20/2024] Open
Abstract
Background and objective Nasopharyngeal carcinoma (NPC) presents a complex epidemiological pattern influenced by demographic characteristics, risk factors such as Epstein-Barr virus (EBV) infection, and smoking. Understanding the clinical profile and optimizing treatment strategies for NPC requires comprehensive analyses of these factors. In light of this, this study aimed to analyze the epidemiological patterns, histological characteristics, and treatment outcomes of NPC patients diagnosed and treated at a single center from 2016 to 2023. Materials and methods This retrospective study was conducted at Tawam Hospital in the United Arab Emirates (UAE), focusing on patients diagnosed with NPC. It involved the analysis of patient age distribution to identify epidemiological patterns, histological examination to classify NPC types according to WHO guidelines, and evaluation of treatment outcomes based on induction chemotherapy regimens and concurrent chemoradiotherapy protocols. The effectiveness of various chemotherapy combinations, particularly cisplatin and 5-fluorouracil (Cis+5FU), was assessed alongside the integration of advanced radiotherapy techniques like intensity-modulated radiotherapy (IMRT). Results In this study of 41 NPC patients, the age distribution varied widely, ranging from 10 to 74 years, with a mean age of >40 years. There was a significant male predominance (82.93%). Most patients were non-smokers (68.29%) and did not consume alcohol (92.68%), and there was a high prevalence of EBV positivity (100%). At diagnosis, 80.49% had no metastases. The primary treatment was chemotherapy induction, with a 73.17% uptake and a 92.68% completion rate, leading to a 65.85% complete response (CR) rate. No significant association was found between smoking status and treatment response (p=0.7657). Pathologically, non-keratinizing undifferentiated squamous carcinoma was the most common variant (75.61%). The Cis+5FU regimen was the most frequently employed method (56.67%), associated with a 76.47% CR rate. Concurrent chemotherapy was administered to 87.80% of patients, with the weekly Cis regimen being the most used one (56.09%), resulting in a significant CR rate. Combining radiation therapy with concurrent and induction chemotherapy yielded high CR rates (RT+cCT: 66.66%, RT+cCT+iCT: 80%). Survival analysis revealed the highest 36-month survival rate (46.43%) in the RT+cCT+iCT group, suggesting a potential benefit from incorporating induction chemotherapy into the treatment regimen. Conclusions This study illustrates the impact of demographic variables, EBV infection, and smoking on the development and treatment outcomes of NPC. It points to the success of customized chemotherapy and advanced radiotherapy strategies. Yet, it is limited by its retrospective nature and single-center focus, and hence we recommend multicentric studies to broaden the applicability of the results and improve NPC treatment approaches for varied patient groups.
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Affiliation(s)
| | - Nandan M Shanbhag
- Oncology/Palliative Care, Tawam Hospital, Al Ain, ARE
- Oncology/Radiation Oncology, Tawam Hospital, Al Ain, ARE
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
| | | | - Noor Jaafar
- Radiotherapy Technology, Tawam Hospital, Al Ain, ARE
| | | | - Khalid Balaraj
- Oncology/Radiation Oncology, Tawam Hospital, Al Ain, ARE
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Melouli H, Khenchouche A, Taibi-Zidouni F, Salma D, Aoudia N, Djennaoui D, Sahraoui T, Benyahia S, El Kebir FZ. A Distinct Anti-EBV DNase Profile in Patients with Undifferentiated Nasopharyngeal Carcinoma Compared to Classical Antigens. Viruses 2023; 15:2158. [PMID: 38005835 PMCID: PMC10675439 DOI: 10.3390/v15112158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/17/2023] [Accepted: 10/08/2023] [Indexed: 11/26/2023] Open
Abstract
Nasopharyngeal cancer (NPC) is a prevalent type of cancer that often takes the form of undifferentiated carcinoma in the Maghreb region. It affects people of all ages. NPC diagnosis, mainly based on detecting Epstein-Barr virus (EBV), has not been well evaluated in North Africa. We compared the classical EBV serological tests using indirect immunofluorescence to the detection of EBV DNase antibodies by immunoblot in Algerian NPC patients. Significant variations were observed among different age groups of patients regarding the presence of VCA-IgA antibodies (0-14 and ≥30 years old, p < 0.0001; 15-19 and ≥30 years old, p < 0.01) and EA-IgA (0-14 and ≥30 years old, p < 0.01; 15-29 and ≥30 years old, p < 0.05). Differences were also noted in the titers of IgA anti-VCA and anti-EA antibodies across the three age groups. Some patients under the age of 30 with detectable IgG anti-VCA antibodies had undetectable IgA anti-VCA antibodies. These patients had a strong anti-DNase IgA response. However, older individuals had a higher level of anti-DNase IgG. Before treatment, children had strong DNase reactivity as indicated by specific IgA antibodies. Young adults had high IgA anti-DNase response, but the elderly (90.9%) had a lower response for these antibodies. Following therapy, the children retained high levels of IgA anti-DNase antibodies, and 66% of the young adults demonstrated robust antibody reactivity against DNase. In contrast, IgG responses to anti-DNase were low in children. This study demonstrated the utility of anti-DNase responses in the diagnosis and prognosis of NPC.
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Affiliation(s)
- Hamid Melouli
- Viral Oncogenesis Laboratory, Pasteur Institute of Algeria, Algiers 16000, Algeria; (H.M.)
| | - Abdelhalim Khenchouche
- Laboratory of Applied Biochemistry, Ferhat Abbas, Setif 1 University, Setif 19000, Algeria
| | - Fouzia Taibi-Zidouni
- Viral Oncogenesis Laboratory, Pasteur Institute of Algeria, Algiers 16000, Algeria; (H.M.)
| | - Dahmani Salma
- Viral Oncogenesis Laboratory, Pasteur Institute of Algeria, Algiers 16000, Algeria; (H.M.)
| | - Nassim Aoudia
- Viral Oncogenesis Laboratory, Pasteur Institute of Algeria, Algiers 16000, Algeria; (H.M.)
| | - Djamel Djennaoui
- Otorhinolaryngology Department, Mustapha Pacha Hospital, Algiers 16000, Algeria
| | - Tewfik Sahraoui
- Laboratory of Developmental Biology and Differentiation, Es-Sénia University, Oran 31000, Algeria
| | - Samir Benyahia
- Otorhinolaryngology Department, Mustapha Pacha Hospital, Algiers 16000, Algeria
| | - Fatima Zohra El Kebir
- Laboratory of Developmental Biology and Differentiation, Es-Sénia University, Oran 31000, Algeria
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Lou PJ, Jacky Lam W, Hsu WL, Pfeiffer RM, Yu KJ, Chan CM, Lee VC, Chen TC, Terng SD, Tsou YA, Leu YS, Liao LJ, Chang YL, Chien YC, Wang CP, Lin CY, Hua CH, Lee JC, Yang TL, Hsiao CH, Wu MS, Tsai MH, Cheng HC, Hildesheim A, Chen CJ, Chan KA, Liu Z. Performance and Operational Feasibility of Epstein-Barr Virus-Based Screening for Detection of Nasopharyngeal Carcinoma: Direct Comparison of Two Alternative Approaches. J Clin Oncol 2023; 41:4257-4266. [PMID: 37478397 PMCID: PMC10852390 DOI: 10.1200/jco.22.01979] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/21/2023] [Accepted: 06/05/2023] [Indexed: 07/23/2023] Open
Abstract
PURPOSE Two Epstein-Barr virus (EBV)-based testing approaches have shown promise for early detection of nasopharyngeal carcinoma (NPC). Neither has been independently validated nor their performance compared. We compared their diagnostic performance in an independent population. METHODS We tested blood samples from 819 incident Taiwanese NPC cases (213 early-stage, American Joint Committee on Cancer version 7 stages I and II) diagnosed from 2010 to 2014 and from 1,768 controls from the same region, frequency matched to cases on age and sex. We compared an EBV antibody score using immunoglobulin A antibodies measured by enzyme-linked immunosorbent assay (EBV antibody score) and plasma EBV DNA load measured by real-time PCR followed by next-generation sequencing (NGS) among EBV DNA-positive individuals (EBV DNA algorithm). RESULTS EBV antibodies and DNA load were measured for 2,522 (802 cases; 1,720 controls) and 2,542 (797 cases; 1,745 controls) individuals, respectively. Of the 898 individuals positive for plasma EBV DNA and therefore eligible for NGS, we selected 442 (49%) for NGS testing. The EBV antibody score had a sensitivity of 88.4% (95% CI, 86.1 to 90.6) and a specificity of 94.9% (95% CI, 93.8 to 96.0) for NPC. The EBV DNA algorithm yielded significantly higher sensitivity (93.2%; 95% CI, 91.3 to 94.9; P = 1.33 × 10-4) and specificity (98.1%; 95% CI, 97.3 to 98.8; P = 3.53 × 10-7). For early-stage NPC, the sensitivities were 87.1% (95% CI, 82.7 to 92.4) for the EBV antibody score and 87.0% (95% CI, 81.9 to 91.5) for the EBV DNA algorithm (P = .514). For regions with a NPC incidence of 20-100/100,000 person-years (eg, residents in southern China and Hong Kong), these two approaches yielded similar numbers needed to screen (EBV antibody score: 5,656-1,131; EBV DNA algorithm: 5,365-1,073); positive predictive values ranged from 0.4% to 1.7% and 1.0% to 4.7%, respectively. CONCLUSION We demonstrated high sensitivity and specificity of EBV antibody and plasma EBV DNA for NPC detection, with slightly inferior performance of the EBV antibody score. Cost-effectiveness studies are needed to guide screening implementation.
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Affiliation(s)
- Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - W.K. Jacky Lam
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, Hong Kong SAR, China
| | - Wan-Lun Hsu
- Data Science Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Master Program of Big Data Analysis in Biomedicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Kelly J. Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Charles M.L. Chan
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Vicky C.T. Lee
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Tseng-Cheng Chen
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shyuang-Der Terng
- Division of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Yung-An Tsou
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Shing Leu
- Department of Otolaryngology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yen-Liang Chang
- Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan
| | - Yin-Chu Chien
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Cheng-Ping Wang
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Yuan Lin
- Division of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chun-Hung Hua
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan
| | - Jehn-Chuan Lee
- Department of Otolaryngology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chu-Hsing Hsiao
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Hsui Tsai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Chun Cheng
- Division of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - K.C. Allen Chan
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, Hong Kong SAR, China
| | - Zhiwei Liu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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Ge XY, Xie SH, Wang H, Ye X, Chen W, Zhou HN, Li X, Lin AH, Cao SM. Associations between serum trace elements and the risk of nasopharyngeal carcinoma: a multi-center case-control study in Guangdong Province, southern China. Front Nutr 2023; 10:1142861. [PMID: 37465140 PMCID: PMC10351973 DOI: 10.3389/fnut.2023.1142861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/05/2023] [Indexed: 07/20/2023] Open
Abstract
Background Associations between trace elements and nasopharyngeal carcinoma (NPC) have been speculated but not thoroughly examined. Methods This study registered a total of 225 newly diagnosed patients with NPC and 225 healthy controls matched by sex and age from three municipal hospitals in Guangdong Province, southern China between 2011 and 2015. Information was collected by questionnaire on the demographic characteristics and other possibly confounding lifestyle factors. Eight trace elements and the level of Epstein-Barr virus (EBV) antibody were measured in casual (spot) serum specimens by inductively coupled plasma-mass spectrometry (ICP-MS) and enzyme-linked immunosorbent assay (ELISA), respectively. Restricted cubic splines and conditional logistic regression were applied to assess the relationship between trace elements and NPC risk through single-and multiple-elements models. Results Serum levels of chromium (Cr), cobalt (Co), nickel (Ni), arsenic (As), strontium (Sr) and molybdenum (Mo) were not associated with NPC risk. Manganese (Mn) and cadmium (Cd) were positively associated with NPC risk in both single-and multiple-element models, with ORs of the highest tertile compared with the reference categories 3.90 (95% CI, 1.27 to 7.34) for Mn and 2.30 (95% CI, 1.26 to 3.38) for Cd. Restricted cubic splines showed that there was a linear increasing trend between Mn and NPC risk, while for Cd there was a J-type correlation. Conclusion Serum levels of Cd and Mn was positively related with NPC risk. Prospective researches on the associations of the two trace elements with NPC ought to be taken into account within the future.
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Affiliation(s)
- Xin-Yu Ge
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shang-Hang Xie
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hao Wang
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin Ye
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wenjie Chen
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hang-Ning Zhou
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xueqi Li
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ai-Hua Lin
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Su-Mei Cao
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
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Cherkos K, Jember G, Mihret T, Fentanew M. Prevalence and Associated Factors of Cognitive Impairment Among Stroke Survivors at Comprehensive Specialized Hospitals in Northwest Ethiopia: Multi-Centered Cross-Sectional Study. Vasc Health Risk Manag 2023; 19:265-277. [PMID: 37138791 PMCID: PMC10150733 DOI: 10.2147/vhrm.s405357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/22/2023] [Indexed: 05/05/2023] Open
Abstract
Background Deficit in cognitive impairment is the most serious of the stroke sequelae. Post-stroke cognitive impairment is associated with impaired daily living activities and decreased capacity for independent living and functional performance. As a result, the purpose of this study was to determine the prevalence and associated factors of cognitive impairment among stroke survivors at comprehensive specialized hospitals in Ethiopia's Amhara region by 2022. Methods A multi-centered cross-sectional study was designed at an institution. During the study period. Data was gathered by conducting structured questionnaire interviews with participants and reviewing medical charts with trained data collectors. The participants were chosen using a systematic random sampling technique. The Montreal cognitive assessment basic was used to assess cognitive impairment. Descriptive statistics, binary and multivariate logistic regression methods were used to analyze the data. The Hosmer-Lemeshow goodness-of-fit test was used to assess the fitness of the model. The AOR with a P value of 0.05 at 95% CI was reported, and variables were considered statistically significant. Results This study enrolled 422 stroke survivors. Overall, 58.3% of stroke survivors had cognitive impairment (95% CI 53.4-63.0%). The study participants' age with AOR; 7.12 (4.40-11.45), being hypertensive with AOR; 7.52 (3.46-16.35), arriving at the hospital after 24 hours with AOR; 4.33 (1.49-12.05), less than three months after stroke with AOR; 4.83 (3.95-12.19), dominant hemisphere lesion with AOR; 4.83 (3.95-12.19) and being illiterate with AOR; 5.26 (4.43-18.64) were found significant factors. Conclusion Cognitive impairment was discovered to be relatively common among stroke survivors in this study. More than half of stroke survivors who attended comprehensive specialized hospitals during the study period were found to have cognitive impairment. Age, hypertension, arriving at the hospital after 24 hours, less than three months after stroke, dominant hemisphere lesion, and illiterate educational status were all significant factors in cognitive impairment.
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Affiliation(s)
- Kassahun Cherkos
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Jember
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Mihret
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Molla Fentanew
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Molla Fentanew, University of Gondar, P.O. Box. 196, Gondar, Ethiopia, Tel +251935686860, Email
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Li W, Yang C, Zhao F, Li J, Li Z, Ouyang P, Yuan X, Wu S, Yuan Y, Cui L, Feng H, Lin D, Chen Z, Lu J, Peng X, Chen J. Combination of smoking and Epstein-Barr virus DNA is a predictor of poor prognosis for nasopharyngeal carcinoma: a long-term follow-up retrospective study. BMC Cancer 2022; 22:1262. [PMID: 36471255 PMCID: PMC9720998 DOI: 10.1186/s12885-022-10297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This retrospective study was performed to determine the prognostic potential of smoking and its combination with pre-treatment plasma Epstein-Barr virus (EBV) DNA levels in patients with nasopharyngeal carcinoma (NPC). METHODS Medical records of 1080 non-metastatic NPC patients who received intensity-modulated radiotherapy were reviewed. Male patients were categorized as never and ever smokers, and the smoking amount, duration, and cumulative consumption were used to evaluate dose-dependent effects. Survival outcomes were assessed using Kaplan-Meier survival analysis and the multivariate Cox regression analysis. Propensity score matching (PSM) was constructed. RESULTS The 5-year overall survival (OS) was worse for ever smokers than never smokers, and significantly decreased with the increase of smoking amount, duration, and cumulative consumption. Compared with never smokers, the multivariate-adjusted hazard ratio (HR) of death was higher in ever smokers (HR = 1.361, P = 0.049), those smoked ≥20 cigarettes/day (HR = 1.473, P = 0.017), those smoked for ≥30 years (HR = 1.523, P = 0.023), and those cumulative smoked for ≥30 pack-years (HR = 1.649, P = 0.005). The poor prognostic effects of smoking was also confirmed in the PSM analysis. The combination of cumulative smoking consumption and pre-treatment EBV DNA levels was proven to be an independent poor prognostic factor for male NPC, and the risk of death, progression, and distant metastases gradually increased with both factors (P < 0.001). CONCLUSIONS Combination of smoking and pre-treatment EBV DNA levels as a predictor of poor prognosis could further improve the risk stratification and prognostication for NPC.
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Affiliation(s)
- Wanxia Li
- grid.284723.80000 0000 8877 7471Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China ,grid.284723.80000 0000 8877 7471Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Chao Yang
- grid.284723.80000 0000 8877 7471Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Feipeng Zhao
- grid.440164.30000 0004 1757 8829Department of Otolaryngology-Head and Neck Surgery, Chengdu Second People’s Hospital, Chengdu, 610000 Sichuan China
| | - Junzheng Li
- grid.284723.80000 0000 8877 7471Department of Otolaryngology-Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510220 Guangdong China
| | - Zonghua Li
- Department of Otolaryngology, 942 Hospital of the Chinese People’s Liberation Army, Yinchuan, 750001 Ningxia China
| | - Ping Ouyang
- grid.284723.80000 0000 8877 7471Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Xiaofei Yuan
- grid.284723.80000 0000 8877 7471Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Shuting Wu
- grid.284723.80000 0000 8877 7471Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Yue Yuan
- grid.284723.80000 0000 8877 7471Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Linchong Cui
- grid.284723.80000 0000 8877 7471Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Huiru Feng
- grid.284723.80000 0000 8877 7471Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Danfan Lin
- grid.284723.80000 0000 8877 7471Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Zilu Chen
- grid.284723.80000 0000 8877 7471Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Juan Lu
- grid.284723.80000 0000 8877 7471Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Xiaohong Peng
- grid.284723.80000 0000 8877 7471Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Jing Chen
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515 Guangdong China
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8
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Chen Y, Chang ET, Liu Q, Cai Y, Zhang Z, Chen G, Huang QH, Xie SH, Cao SM, Jia WH, Zheng Y, Li Y, Lin L, Ernberg I, Huang G, Zeng YX, Adami HO, Ye W. Environmental factors for Epstein-Barr virus reactivation in a high-risk area of nasopharyngeal carcinoma: a population-based study. Open Forum Infect Dis 2022; 9:ofac128. [PMID: 35450082 PMCID: PMC9017372 DOI: 10.1093/ofid/ofac128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/14/2022] [Indexed: 11/14/2022] Open
Abstract
Background Epstein-Barr virus (EBV) reactivation from latent to lytic infection has been considered as a key step in nasopharyngeal carcinoma oncogenesis. However, epidemiological evidence regarding environmental risk factors for EBV reactivation on a population level remains largely lacking. Methods We enrolled 1916 randomly selected adults from the general population of Guangdong and Guangxi, China, from 2010 to 2014. Information on environmental factors was collected via a structured interview. Serum immunoglobulin A antibodies against EBV viral capsid antigen and nuclear antigen 1 were measured by enzyme-linked immunosorbent assay to evaluate EBV reactivation status. We used logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for the associations of EBV reactivation with various environmental factors. Results No associations were observed between EBV reactivation and extensive environmental factors, including alcohol or tea drinking, a history of chronic ear/nose/throat diseases, use of medications or herbs, consumption of salted fish or preserved foods, oral hygiene, sibship structure, and various residential and occupational exposures. Only cigarette smoking was associated with EBV reactivation (current smokers vs never smokers; OR = 1.37; 95% CI = 1.02–1.83), with positive exposure-response trends with increasing intensity, duration, and pack-years of smoking. Conclusions Consistent with previous studies, we found an association between cigarette smoking and EBV reactivation. Other examined exposures were not associated with EBV reactivation. These null results could suggest either more complex interactions between exposures and EBV reactivation or a predominant role of host and/or viral genetic variation.
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Affiliation(s)
- Yufeng Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ellen T Chang
- Exponent, Inc., Center for Health Sciences, Menlo Park, CA, USA
| | - Qing Liu
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center for Cancer Medicine & Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yonglin Cai
- Department of Clinical Laboratory, Wuzhou Red Cross Hospital, Wuzhou, China
- Wuzhou Health System Key Laboratory for Nasopharyngeal Carcinoma Etiology and Molecular Mechanism, Wuzhou, China
| | - Zhe Zhang
- Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of High-Incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education, Nanning, China
| | - Guomin Chen
- State Key Laboratory for Infectious Diseases Prevention and Control, Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Shang-Hang Xie
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center for Cancer Medicine & Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Su-Mei Cao
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center for Cancer Medicine & Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Wei-Hua Jia
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center for Cancer Medicine & Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yuming Zheng
- Department of Clinical Laboratory, Wuzhou Red Cross Hospital, Wuzhou, China
- Wuzhou Health System Key Laboratory for Nasopharyngeal Carcinoma Etiology and Molecular Mechanism, Wuzhou, China
| | - Yancheng Li
- Cangwu Institute for Nasopharyngeal Carcinoma Control and Prevention, Wuzhou, China
| | - Longde Lin
- Key Laboratory of High-Incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education, Nanning, China
| | - Ingemar Ernberg
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Guangwu Huang
- Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of High-Incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education, Nanning, China
| | - Yi-Xin Zeng
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center for Cancer Medicine & Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Beijing Hospital, Beijing, China
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
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9
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Coghill AE, Fang J, Liu Z, Chen CJ, Jarrett RF, Hjalgrim H, Proietti C, Yu KJ, Hsu WL, Lou PJ, Wang CP, Zhao Y, Doolan DL, Hildesheim A. Identifying Epstein-Barr virus peptide sequences associated with differential IgG antibody response. Int J Infect Dis 2022; 114:65-71. [PMID: 34728343 PMCID: PMC8724419 DOI: 10.1016/j.ijid.2021.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Epstein-Barr virus (EBV) infection contributes to cancers in a fraction of seropositive individuals, but much remains to be learned about variation in EBV-directed humoral immunity in cancer-free adults. METHODS A protein microarray was used to probe serum from 175 Taiwanese and 141 Northern European adults for immunoglobulin G (IgG) antibody responses to 115 different peptide sequences, representing protein segments or protein variants, from 45 EBV proteins. It was posited that this antibody-based approach could identify EBV peptide sequences representing immunodominant regions relevant for B-cell immunity. RESULTS Analyses of 45 EBV proteins with multiple protein segments or variants printed on the array identified eight EBV peptide sequences that appear to play a role in immunogenicity. This included: (1) three proteins with segments/regions associated with IgG reactivity (BALF5, LMP1, LMP2A); and (2) five proteins with sequence variants/amino acid changes associated with IgG reactivity (BDLF4, EBNA3A, EBNA3B, EBNA-LP, LF1). CONCLUSION This examination of IgG antibody responses against 115 EBV peptide sequences in 316 cancer-free adults represents an important step toward identifying specific EBV protein sequences that play a role in generating B-cell immunity in humans.
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Affiliation(s)
- Anna E. Coghill
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA,Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Jianwen Fang
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland, USA
| | - Zhiwei Liu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Chien-Jen Chen
- Genomics Research Center, Academica Sinica, Taipei, Taiwan
| | - Ruth F. Jarrett
- MRC-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Henrik Hjalgrim
- Statens Serum Institut, Copenhagen, Denmark,Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - Carla Proietti
- Australian Institute of Tropical Health & Medicine, James Cook University, Cairns, Australia
| | - Kelly J. Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Wan-Lun Hsu
- Genomics Research Center, Academica Sinica, Taipei, Taiwan,College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital & College of Medicine, Taipei, Taiwan
| | - Chen-Ping Wang
- Department of Otolaryngology, National Taiwan University Hospital & College of Medicine, Taipei, Taiwan
| | - Yingdong Zhao
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland, USA
| | - Denise L. Doolan
- Australian Institute of Tropical Health & Medicine, James Cook University, Cairns, Australia
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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10
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Wang L, Mai ZM, Ngan RKC, Ng WT, Lin JH, Kwong DLW, Chiang SC, Yuen KT, Ng AWY, Ip DKM, Chan YH, Lee AWM, Lung ML, Ho SY, Lam TH. Dose-Response Reduction in Risk of Nasopharyngeal Carcinoma From Smoking Cessation: A Multicenter Case-Control Study in Hong Kong, China. Front Oncol 2021; 11:699241. [PMID: 34646762 PMCID: PMC8503184 DOI: 10.3389/fonc.2021.699241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cigarette smoking is associated with nasopharyngeal cancer (NPC) risk. Whether quitting reduces the risk is unclear. We investigated the associations of NPC with duration of and age at quitting in an endemic region. METHODS We investigated the associations between NPC and quitting in a multicenter case-control study in Hong Kong with 676 newly diagnosed NPC cases and 1,285 hospital controls between 2014 and 2017, using a computer-assisted self-administered questionnaire. Multivariable unconditional logistic regression yielded adjusted odds ratios (AORs) of NPC by quitting status, duration and age of quitting, combinations of duration and age of quitting, and quitting to smoking duration ratio, compared with current smoking. RESULTS Quitting (AOR: 0.72; 95% CI: 0.53-0.98) and never smoking (0.73, 0.56-0.95) were associated with lower NPC risk. NPC risk decreased with (i) longer quitting duration (p < 0.01), reaching significance after 11-20 (0.62, 0.39-0.99) and 21+ years (0.54, 0.31-0.92) of quitting; (ii) younger quitting age (p = 0.01), reaching significance for quitting at <25 years (0.49, 0.24-0.97); and (iii) higher quitting to smoking duration ratio (p < 0.01), reaching significance when the ratio reached 1 (0.60, 0.39-0.93). Quitting younger (age <25) appeared to confer larger reductions (49% for ≤10 years of quitting, 50% for 11+ years) in NPC risk than quitting at older ages (25+) regardless of quitting duration (16% for ≤10 years, 39% for 11+ years). CONCLUSIONS We have shown longer duration and younger age of quitting were associated with lower NPC risk, with dose-response relations. Our findings support including smoking as a cause of NPC. Stronger tobacco control measures and quitting services are needed to prevent NPC.
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Affiliation(s)
- Lijun Wang
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Zhi-Ming Mai
- School of Public Health, University of Hong Kong, Hong Kong, China
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
| | - Roger Kai-Cheong Ngan
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Wai-Tong Ng
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, the University of Hong Kong, Hong Kong, China
| | - Jia-Huang Lin
- School of Public Health, University of Hong Kong, Hong Kong, China
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Dora Lai-Wan Kwong
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Shing-Chun Chiang
- School of Public Health, University of Hong Kong, Hong Kong, China
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
| | - Kam-Tong Yuen
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Alice Wan-Ying Ng
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Dennis Kai-Ming Ip
- School of Public Health, University of Hong Kong, Hong Kong, China
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
| | - Yap-Hang Chan
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Anne Wing-Mui Lee
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Maria Li Lung
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Tai-Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
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11
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Lin JH, Wen CP, Jiang CQ, Yuan JM, Chen CJ, Ho SY, Gao W, Zhang W, Wang R, Chien YC, Xu L, Wu X, Jin YL, Koh WP, Hsu WL, Zhu F, Wen C, Zhu T, Lee JH, Mai ZM, Lung ML, Lam TH. Smoking and nasopharyngeal cancer: individual data meta-analysis of six prospective studies on 334 935 men. Int J Epidemiol 2021; 50:975-986. [PMID: 33787881 PMCID: PMC8271191 DOI: 10.1093/ije/dyab060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The role of smoking in nasopharyngeal carcinoma (NPC) remains uncertain, especially in endemic regions. We conducted an individual participant data (IPD) meta-analysis of prospective cohort studies to investigate the associations between smoking exposure and risk of NPC. METHODS We obtained individual participant data of 334 935 male participants from six eligible population-based cohorts in NPC-endemic regions, including two each in Guangzhou and Taiwan, and one each in Hong Kong and Singapore. We used one- and two-stage approaches IPD meta-analysis and Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of NPC for smoking exposure adjusting for age and drinking status. RESULTS During 2 961 315 person-years of follow-up, 399 NPC evens were ascertained. Risks of NPC were higher in ever versus never smokers (HRone-stage = 1.32, 95% CI = 1.07-1.63, P = 0.0088; HRtwo-stage = 1.27, 1.01-1.60, 0.04). These positive associations appeared to be stronger in ever smokers who consumed 16+ cigarettes/day (HRone-stage = 1.67, 95% CI = 1.29-2.16, P = 0.0001), and in those who started smoking at age younger than 16 (2.16, 1.33-3.50, 0.0103), with dose-response relationships (P-values for trend = 0.0028 and 0.0103, respectively). Quitting (versus daily smoking) showed a small reduced risk (stopped for 5+ years: HRone-stage = 0.91, 95% CI = 0.60-1.39, P = 0.66; for former smokers: HRtwo-stage = 0.84, 0.61-1.14, 0.26). CONCLUSIONS This first IPD meta-analysis from six prospective cohorts in endemic regions has provided robust observational evidence that smoking increased NPC risk in men. NPC should be added to the 12-16 cancer sites known to be tobacco-related cancers. Strong tobacco control policies, preventing young individuals from smoking, would reduce NPC risk in endemic regions.
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Affiliation(s)
- Jia Huang Lin
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, University of Hong Kong, Hong Kong
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Chi Pang Wen
- Institute of Population Health Sciences, National Health Institutes, Zhunan, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | | | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Centre, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chien Jen Chen
- Genomics Research Centre, Academia Sinica, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sai Yin Ho
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Wayne Gao
- Master's Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | | | - Renwei Wang
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Centre, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yin-Chu Chien
- Genomics Research Centre, Academia Sinica, Taipei, Taiwan
| | - Lin Xu
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xifeng Wu
- Centre for Biostatistics Bioinformatics and Big Data, School of Public Health, National Institute for Data Science in Health and Medicine, Zhejiang University, Hangzhou, China
| | - Ya Li Jin
- Guangzhou No.12 Hospital, Guangzhou, China
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wan-Lun Hsu
- Genomics Research Centre, Academia Sinica, Taipei, Taiwan
| | - Feng Zhu
- Guangzhou No.12 Hospital, Guangzhou, China
| | - Christopher Wen
- Department of Radiology, Long Beach Veterans Administration Hospital, University of California at Irvine, Irvine, CA, USA
| | - Tong Zhu
- Guangzhou No.12 Hospital, Guangzhou, China
| | - June Han Lee
- Institute of Population Health Sciences, National Health Institutes, Zhunan, Taiwan
| | - Zhi-Ming Mai
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, University of Hong Kong, Hong Kong
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Corresponding author. School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong Patrick Manson Building (North Wing), 7 Sassoon Road, Pok Fu Lam, Hong Kong, China. E-mail:
| | - Maria Li Lung
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, University of Hong Kong, Hong Kong
- Department of Clinical Oncology and Centre for Cancer Research, University of Hong Kong, Hong Kong
| | - Tai-Hing Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, University of Hong Kong, Hong Kong
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12
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Aguayo F, Boccardo E, Corvalán A, Calaf GM, Blanco R. Interplay between Epstein-Barr virus infection and environmental xenobiotic exposure in cancer. Infect Agent Cancer 2021; 16:50. [PMID: 34193233 PMCID: PMC8243497 DOI: 10.1186/s13027-021-00391-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022] Open
Abstract
Epstein-Barr virus (EBV) is a herpesvirus associated with lymphoid and epithelial malignancies. Both B cells and epithelial cells are susceptible and permissive to EBV infection. However, considering that 90% of the human population is persistently EBV-infected, with a minority of them developing cancer, additional factors are necessary for tumor development. Xenobiotics such as tobacco smoke (TS) components, pollutants, pesticides, and food chemicals have been suggested as cofactors involved in EBV-associated cancers. In this review, the suggested mechanisms by which xenobiotics cooperate with EBV for carcinogenesis are discussed. Additionally, a model is proposed in which xenobiotics, which promote oxidative stress (OS) and DNA damage, regulate EBV replication, promoting either the maintenance of viral genomes or lytic activation, ultimately leading to cancer. Interactions between EBV and xenobiotics represent an opportunity to identify mechanisms by which this virus is involved in carcinogenesis and may, in turn, suggest both prevention and control strategies for EBV-associated cancers.
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Affiliation(s)
| | - Enrique Boccardo
- Laboratory of Oncovirology, Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Alejandro Corvalán
- Advanced Center for Chronic Diseases (ACCDiS), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gloria M Calaf
- Instituto de Alta Investigación, Universidad de Tarapacá, 1000000, Arica, Chile.,Center for Radiological Research, Columbia University Medical Center, New York, NY, 10032, USA
| | - Rancés Blanco
- Laboratorio de Oncovirología, Programa de Virología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago, Chile
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13
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Chang ET, Ye W, Zeng YX, Adami HO. The Evolving Epidemiology of Nasopharyngeal Carcinoma. Cancer Epidemiol Biomarkers Prev 2021; 30:1035-1047. [PMID: 33849968 DOI: 10.1158/1055-9965.epi-20-1702] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/15/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The epidemiology of nasopharyngeal carcinoma (NPC) has long been a source of fascination due to the malignancy's striking geographic distribution, the involvement of the oncogenic Epstein-Barr virus (EBV), the unique association with intake of Chinese-style salt-preserved fish, and etiologic heterogeneity by histologic subtype. METHODS This review summarizes the current epidemiologic literature on NPC, highlighting recent results from our population-based case-control study in southern China. RESULTS Findings from our case-control study provide new insight into the epidemiology of NPC, including a diminished role of Chinese-style salt-preserved fish, a profound impact of EBV genetic sequence variation, modest positive associations with passive smoking and household air pollution, and possible effects of oral health and the oral microbiome. Recent findings from other studies include a protective association with infectious mononucleosis, suggesting a causal role of early EBV infection; familial risk conferred by shared genetic variation in the host antibody-mediated immune response to EBV infection; and an unclear association with occupational exposure to formaldehyde. CONCLUSIONS To shed further light on the interplay of environmental, genetic, and viral causes of NPC, large pooled studies must accumulate sufficient cases with detailed exposure data. IMPACT New epidemiologic findings have reshaped the causal model for NPC.
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Affiliation(s)
- Ellen T Chang
- Center for Health Sciences, Exponent, Inc., Menlo Park, California.
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yi-Xin Zeng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Beijing Hospital, Beijing, P.R. China
| | - Hans-Olov Adami
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway
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14
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Hsu WL, Chien YC, Huang YT, Yu KJ, Ko JY, Lin CY, Tsou YA, Leu YS, Liao LJ, Chang YL, Su JY, Liu Z, Wang CP, Terng SD, Hua CH, Lee JC, Yang TL, Kate Hsiao CH, Wu MS, Tsai MH, Liu MJ, Lou PJ, Hildesheim A, Chen CJ. Cigarette smoking increases the risk of nasopharyngeal carcinoma through the elevated level of IgA antibody against Epstein-Barr virus capsid antigen: A mediation analysis. Cancer Med 2020; 9:1867-1876. [PMID: 31925935 PMCID: PMC7050088 DOI: 10.1002/cam4.2832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/16/2019] [Accepted: 12/26/2019] [Indexed: 12/21/2022] Open
Abstract
Background The study aims are to evaluate the associations between nasopharyngeal carcinoma (NPC) risk and cigarette smoking and to explore the effects of cigarette smoking on Epstein‐Barr virus (EBV) infection for NPC risk. Methods 1235 male NPC cases and 1262 hospital‐based male controls matched to cases were recruited across six collaborative hospitals between 2010 and 2014. Using a standardized questionnaire, information on cigarette smoking and other potential risk factors for NPC was obtained. Blood was collected and used for anti‐EBV VCA IgA and anti‐EBV EA‐EBNA1 IgA testing using standard methods. Unconditional logistic regression analysis was used to estimate odds ratio (OR) with 95% confidence interval (CI) for each risk factor after adjusting for confounders. Results 63.6% of cases and 44.0% of controls reported ever smoking cigarettes. After full adjustment, current smokers had a significant 1.60‐fold (95% CI = 1.30‐1.97) and former smokers a borderline significant 1.27‐fold (95% CI = 1.00‐1.60) increased NPC risk compared to never smokers. NPC risk increased with increasing duration, intensity, and pack‐years of cigarette smoking but not with age at smoking initiation. Among controls, anti‐EBV VCA IgA seropositivity rate was higher in current smokers than never smokers (14.0% vs 8.4%; OR = 1.82; 95% CI = 1.19‐2.79). Mediation analyses showed that more than 90% of the cigarette smoking effect on NPC risk is mediated through anti‐EBV VCA IgA. Conclusion This study confirms the association between long‐term cigarette smoking and NPC and demonstrates that current smoking is associated with seropositivity of anti‐EBV VCA IgA antibodies.
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Affiliation(s)
- Wan-Lun Hsu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Yin-Chu Chien
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Yen-Tsung Huang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Kelly J Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Yuan Lin
- Department of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Yung-An Tsou
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Shing Leu
- Department of Otolaryngology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yen-Liang Chang
- Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan
| | - Jia-Ying Su
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Zhiwei Liu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Cheng-Ping Wang
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shyuang-Der Terng
- Department of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chun-Hung Hua
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan
| | - Jehn-Chuan Lee
- Department of Otolaryngology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chu-Hsing Kate Hsiao
- Graduate Institute of Epidemiology and Preventative Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Hsui Tsai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Jiung Liu
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
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