Oesophageal cancer is a significant health concern worldwide, with high incidence and mortality rates. In China, the disease burden is particularly high, accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.

To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type, out-of-pocket ratio, and the joint effects of insurance type and out-of-pocket ratio.

The χ² test was used to analyze patients’ demographic and clinical characteristics. Multivariate logistic regression, the Cox proportional hazard model, and the competitive risk model were used to calculate the cumulative hazard ratios (HRs) of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.

Compared with patients covered by basic medical insurance for urban and rural residents, patients covered by urban employee basic medical insurance for urban workers (UEBMI) had a 23.30% increased risk of oesophageal cancer-specific death [HR = 1.233, 95% confidence interval (CI): 1.093-1.391, P < 0.005]. Compared with patients in the low out-of-pocket ratio group, patients in the high out-of-pocket ratio group had a 25.80% reduction in the risk of oesophageal cancer-specific death (HR = 0.742, 95%CI: 0.6555-0.84, P < 0.005). With each 10% increase in the out-of-pocket ratio, the risk of oesophageal cancer-specific death decreased by 10.10% in patients covered by UEBMI. However, the risk of oesophageal cancer-specific death increased by 26.90% in patients in the high out-of-pocket ratio group.

This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects. This study provides practical suggestions and guidance for the formulation of relevant policies in this area.

• Oesophageal cancer
• Public health
• Insurance
• Prognosis
• Mortality risk

• Cancer costs
• China
• Cost-of-illness
• Treatment phases

• Humans
• China/epidemiology
• Cross-Sectional Studies
• Male
• Female
• Middle Aged
• Cost of Illness
• Neoplasms/economics
• Neoplasms/therapy
• Aged
• Adult
• Health Care Costs/statistics & numerical data
• Health Expenditures/statistics & numerical data

• NA China National Cancer Center

• DALYs
• esophageal cancer
• mortality rate
• trend

• Camrelizumab
• Cost-effectiveness
• Esophageal squamous cell carcinoma
• Immune checkpoint inhibitors
• Network meta-analysis
• Nivolumab
• Pembrolizumab
• Sintilimab
• Tislelizumab

• Humans
• Cost-Benefit Analysis
• Immune Checkpoint Inhibitors/therapeutic use
• Immune Checkpoint Inhibitors/economics
• Esophageal Squamous Cell Carcinoma/drug therapy
• Esophageal Squamous Cell Carcinoma/mortality
• Esophageal Squamous Cell Carcinoma/economics
• Esophageal Neoplasms/drug therapy
• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/economics
• Network Meta-Analysis
• Quality-Adjusted Life Years
• Antibodies, Monoclonal, Humanized/therapeutic use
• Antibodies, Monoclonal, Humanized/economics
• Markov Chains
• Nivolumab/therapeutic use
• Nivolumab/economics
• Cost-Effectiveness Analysis

• 2022KY585 the Research Program for Medicine and Health Science and Technology of Zhejiang Province
• 2020zyy22 Zhejiang Pharmaceutical Association Foundation Project
• LGC21H160005 the Public welfare Program of the Science and Technology Department of Zhejiang Province
• YS2022-3-009 Zhejiang Medical Doctors Association Foundation Project

• U22A20320, 82125028, 31871319, 91953114, 81761128015, and 81861130370 National Natural Science Foundation of China (National Science Foundation of China)
• 2020YFA0112300, 2020YFA0803600 Ministry of Science and Technology of the People's Republic of China (Chinese Ministry of Science and Technology)

• China
• developing country
• esophageal cancer
• gastrointestinal cancer
• research

• DNMT1
• Esophageal cancer
• Folic acid
• Kazakh nationality
• VitB12

• Humans
• Carcinoma, Squamous Cell/epidemiology
• Nutritional Status
• Risk Factors
• Case-Control Studies
• Esophageal Neoplasms/epidemiology
• Esophageal Neoplasms/etiology
• Feeding Behavior
• Folic Acid

• Afghanistan
• Cancer Health Services
• cancer
• out-of-pocket

• Breast Cancer
• China
• Cost Containment
• Healthcare Expenditure
• Medical Service Utilization

• Humans
• Female
• Breast Neoplasms/therapy
• Inpatients
• Health Care Costs
• Ambulatory Care
• Health Expenditures
• China/epidemiology

Esophageal cancer (EC) is the sixth leading cause of tumor-related deaths worldwide. Estimates of the EC burden are necessary and could offer evidence-based suggestions for local cancer control.

The aim of this study was to predict the disease burden of EC in China through the estimation of disability-adjusted life years (DALYs) and direct medical expenditure by sex from 2013 to 2030.

A dynamic cohort Markov model was developed to simulate EC prevalence, DALYs, and direct medical expenditure by sex. Input data were collected from the China Statistical Yearbooks, Statistical Report of China Children’s Development, World Population Prospects 2019, and published papers. The JoinPoint Regression Program was used to calculate the average annual percentage change (AAPC) of DALY rates, whereas the average annual growth rate (AAGR) was applied to analyze the changing direct medical expenditure trend over time.

From 2013 to 2030, the predicted EC prevalence is projected to increase from 61.0 to 64.5 per 100,000 people, with annual EC cases increasing by 11.5% (from 835,600 to 931,800). The DALYs will increase by 21.3% (from 30,034,000 to 36,444,000), and the years of life lost (YLL) will account for over 90% of the DALYs. The DALY rates per 100,000 people will increase from 219.2 to 252.3; however, there was a difference between sexes, with an increase from 302.9 to 384.3 in males and a decline from 131.2 to 115.9 in females. The AAPC was 0.8% (95% CI 0.8% to 0.9%), 1.4% (95% CI 1.3% to 1.5%), and –0.7% (95% CI –0.8% to –0.7%) for both sexes, males, and females, respectively. The direct medical expenditure will increase by 128.7% (from US $33.4 to US $76.4 billion), with an AAGR of 5.0%. The direct medical expenditure is 2-3 times higher in males than in females.

EC still causes severe disease and economic burdens. YLL are responsible for the majority of DALYs, which highlights an urgent need to establish a beneficial policy to reduce the EC burden.

Out‐of‐pocket costs (OOPC) associated with treatment have significant implications on quality of life and survival in cancer patients. Head and neck cancer patients face unique treatment‐related challenges, but to date OOPC have been understudied in this population.

This study aims to identify and measure OOPC for patients with head and neck cancer (HNC) in Ontario.

HNC patients between 2015 and 2018 at Princess Margaret Cancer Centre in Toronto were recruited. Participants completed OOPC questionnaires and lost income questions during radiation, post‐surgery, and 3, 6, 12, and 24 months after completion of treatment. Associations between OOPC and treatment modality and disease site were tested with multivariable hurdle regression.

A total of 1545 questionnaires were completed by 657 patients. Median estimated OOPC for the total duration of treatment for participants undergoing chemoradiation was $1452 [$0–14 616], for surgery with adjuvant radiation or chemoradiation (C/RT) was $1626, for radiation therapy alone was $635, and for surgery alone was $360. The major expenses for participants at the mid‐treatment time‐point was travel (mean $424, standard error of the mean [SEM] $34) and meals, parking, and accommodations (mean $617, SEM $67). In multivariable analysis, chemoradiation, surgery with C/RT, and radiation were associated with significantly higher OOPC than surgery alone during treatment (791% higher, p < .001; 539% higher, p < .001; 370% higher, p < .001 respectively) among patients with non‐zero OOPC. Participants with non‐zero OOPC in the laryngeal cancer group paid 49% lower OOPC than those with oropharyngeal cancers in adjusted analysis (p = .025).

Patients undergoing treatment for HNC pay significant OOPC. These costs are highest during treatment and gradually decrease over time. OOPC vary by patient demographics, clinical factors, and, in particular, treatment modality.

• chemotherapy
• head and neck cancer
• out-of-pocket costs
• quality of life
• radiation
• surgery

• China
• Cost
• Lung cancer
• Medical expenditure

• 2017YFC1308700 National Key research and development plan of China
• 2017YFC1308705 National Key research and development plan of China
• 71673071 National Nature Science Foundation of China
• 71503063 National Nature Science Foundation of China
• Cancer Screening Program in Urban China(CanSPUC))

• Advanced/metastatic esophageal squamous cell carcinoma (advanced/metastatic ESCC)
• camrelizumab
• cost-effectiveness analysis
• second-line treatment

Esophageal cancer is the eighth most prevalent malignancy in the world and China has a high incidence of esophageal cancer. Previous studies have identified that LINC00488 is an oncogene; however, its role in esophageal cancer remains unclear. The present study detected the expression and biological functions of LINC00488 in the progression of esophageal cancer. LINC00488 levels in 45 esophageal cancer and matched paracancerous tissues were detected. The association between LINC00488 level, clinical indexes and overall survival rate of patients with esophageal cancer was analyzed. Using Cell Counting Kit-8, Transwell and wound healing assays, the influence of LINC00488 on the biological functions of OE19 and OE33 cells were assessed. The target gene of LINC00488, microRNA-485-5p (miRNA-485-5p), was predicted using bioinformatics databases. In addition, the role of miRNA-485-5p in the progression of esophageal cancer was evaluated using rescue experiments. LINC00488 was upregulated in esophageal cancer tissues and cell lines. A high level of LINC00488 was associated with lymphatic and distant metastasis and poor prognosis in patients with esophageal cancer. Silencing LINC00488 attenuated the viability, migration and wound healing of OE19 and OE33 cells. miRNA-485-5p was downregulated in esophageal cancer and low expression levels predicted a poor prognosis in these patients. In addition, miRNA-485-5p level was negatively correlated with that of LINC00488. Rescue experiments showed that knockdown of miRNA-485-5p reversed the attenuated proliferation and migration of esophageal cancer cells with LINC00488-knockdown. In conclusion, LINC00488 aggravated the malignant progression of esophageal cancer by targeting miRNA-485-5p.

• LINC00488
• esophageal cancer
• malignant progression
• microRNA-485-5p

• Adenocarcinoma
• Epidemiology
• Esophageal cancer
• Mortality
• Squamous cell carcinoma

RACGAP1 has significant involvement in tumorigenesis of cancers, including liver cancer, stomach cancer, and colon cancer. However, the role and the exact mechanism of RACGAP1 in esophageal squamous cell carcinoma (ESCC) has not been explored.

QPCR and Western blots analysis was performed to analyze the expression of RACGAP1 in ESCC. MTT assays and colony formation assays were performed to explore the functional role of RACGAP1 in ESCC. Cell cycle analysis and immunofluorescence assays were used to investigate the function of RACGAP1 involvement in mitotic catastrophe. At last, we conducted the public datasets mining to explore the expression status and prognosis value of RACGAP1 as well as the correlation between RACGAP1 and E2F3 in various cancers.

The high abnormal expression of RACGAP1 is observed in ESCC and associated with worse clinical outcomes of patients with ESCC. RACGAP1, a novel cell cycle associated gene regulated by E2F3, acts as an oncogenic driver in ESCC cell lines. Notably, for the first time, RACGAP1 depletion induced severe mitotic catastrophe, followed by massive cell death.

Our findings showed the essential role of RACGAP1 in ESCC cancer cell survival and the therapeutic potential of RACGAP1 as a molecular target for ESCC.

• E2F3
• Esophageal squamous cell carcinoma (ESCC)
• RACGAP1
• mitotic catastrophe

China has a heavy cancer burden. We aimed to quantitatively estimate the secular trend of cancer mortality and incidence in China.

We extracted numbers, age-specific and age-standardized rates of 29 cancer groups (from 1990 to 2017) from the Global Burden of Disease (GBD) study in 2017. We estimated rates of major cancer types for annual percent change by Joinpoint regression, and for age, period, and cohort effect by an age–period–cohort model.

In 2017, breast cancer had the highest incidence rate in females. Lung cancer had the highest mortality and incidence rates in males. Although the age-standardized incidence rate of prostate cancer ranked second highest in males, it increased by 112% from 1990 to 2017. Individuals aged over 50 years were at high risk of developing cancer, and the number of deaths at this age accounted for over 89% of all cancers in all age groups. When compared with the global average level, the age-standardized mortality and incidence rates of both liver and esophageal cancers were 2.1 times higher in China, and stomach, lung and nasopharyngeal cancers in China also had high levels (more than 1.5 times higher). During 1990–2017, most of the 29 cancers exhibited an increasing incidence trend, and Joinpoint regression demonstrated increasing mortality of some major cancers. The period effect indicated that the risk of mortality and incidence due to the main cancers generally increased during 1992–2017.

Trend analysis provided information on the effects of prevention strategies and targeted interventions on the occurrence of different cancers. Etiological studies need to be conducted on some major cancers in the Chinese population.

• Chinese burden of cancer
• Joinpoint analysis
• age–period–cohort analysis
• mortality and incidence
• trend

• Eca 109
• Kyse 150
• esophageal cancer
• long non-coding RNA
• matrix metalloproteinase 9
• myocardial infarction-associated transcript

• EORTC QLQ-OES 18
• Esophageal cancer
• Mongolian Mind–Body Interactive Psychotherapy
• QLICP-OES
• Quality of life

This study constructs, calibrates, and verifies a mathematical simulation model designed to project the natural history of ESCC and is intended to serve as a platform for testing the benefits and cost-effectiveness of primary and secondary ESCC prevention alternatives.

The mathematical model illustrates the natural history of ESCC as a sequence of transitions among health states, including the primary health states (e.g., normal mucosa, precancerous lesions, and undetected and detected cancer). Using established calibration approaches, the parameter sets related to progression rates between health states were optimized to lead the model outputs to match the observed data (specifically, the prevalence of precancerous lesions and incidence of ESCC from the published literature in Chinese high-risk regions). As illustrative examples of clinical and policy application, the calibrated and validated model retrospectively simulate the potential benefit of two reported ESCC screening programs.

Nearly 1,000 good-fitting parameter sets were identified from 1,000,000 simulated sets. Model outcomes had sufficient calibration fit to the calibration targets. Additionally, the verification analyses showed reasonable external consistency between the model-predicted effectiveness of ESCC screening and the reported data from clinical trials.

This parameterized mathematical model offers a tool for future research investigating benefits, costs, and cost-effectiveness related to ESCC prevention and treatment.

Cancer is a major public health issue worldwide. The cost of cancer care imposes a substantial economic burden on society and patient, but it has not been thoroughly studied in China. This study aimed to describe direct cost and cost elements of all cancer types by different beneficial characteristics.

The research was a retrospective observational study based on inpatient and outpatient records with a primary diagnosis of cancer from 31 hospitals in 2016. Total cost and cost per time were analyzed by cancer type, sources (prescription medicines, consumables fee for diagnosis and surgery, and other health services), and beneficial characteristics (gender and age).

A total of 30 224 eligible inpatient admissions and 485 391 outpatient visits were identified during the study period. Inpatient care costs account for 58.6% cancer treatment costs. Nearly 70% of the total expenditure is spent on patients aged 50‐79 years. Lung cancer had the highest economic cost (15% of overall cancer costs), followed by breast cancer (12%), and colorectal cancer (10%). Anticancer drug cost accounted a large proportion in both inpatient (37.7%) and outpatient care (64.6%). The average cost per inpatient admission was estimated to be $4590.1 (5621.9), ranging from $1157.7 (1349.8) for testis cancer to $7975 (7343.9) for stomach cancer. The regression analyses revealed that length of hospital stay, cancer type, age, payment type, and hospital level were highly correlated with the expenditure per admission (P < 0.001).

The cancer care cost is substantial and varies with cancer type. Our findings provide important information for health service planning, allowing more efficient allocation of health resources for the care of people with cancer.

• China
• cancer
• cost analysis
• healthcare utilization
• real world data

• Clinicopathological features
• Epidemiology
• Overall survival
• Primary small gGIST
• Prognosis

Accumulating evidence demonstrates that circRNAs regulate diverse cellular processes and cancer progression. However, it remains unclear whether circRNAs play any functional role in esophageal squamous cell carcinoma (ESCC).

The significance of circRNA_100876 in ESCC was analyzed by studying circRNA_100876 expression in ESCC tissues and the association between circRNA_100876 expression and clinicopathologic parameters. The biological effects of circRNA_100876 knockdown by lentivirus-mediated siRNAs on cell proliferation, cell cycle, apoptosis, and migration were investigated in vitro and in vivo.

CircRNA_100876 expression was upregulated (P<0.05) and was negatively correlated with survival outcome (P<0.05) in ESCC. Inhibition of proliferation, migration, invasion, and epithelial–mesenchymal transition progression was confirmed after circRNA_100876 depletion.

Dysregulation of circRNA_100876 expression leads to poor prognosis in ESCC by accelerating cell proliferation and metastasis.

• circRNA_100876
• epithelial—mesenchymal transition
• esophageal squamous cell carcinoma
• metastasis

• TAB1
• TAK1
• esophageal cancer
• prognosis
• recurrence

• health policy
• public health

• Antineoplastic Agents/economics
• Antineoplastic Agents/supply & distribution
• China
• Costs and Cost Analysis
• Drug Costs
• Drug Industry/economics
• Drug Industry/trends
• Drugs, Generic/economics
• Drugs, Generic/supply & distribution
• Economic Competition
• Humans
• Interrupted Time Series Analysis

Stomach and esophageal cancer are imposing huge threats to the health of Chinese people whereas there were few studies on the financial burden of the two cancers.

Costs per hospitalization of all patients with stomach or esophageal cancer discharged between September 2015 and August 2016 in seven cities/counties in China were collected, together with their demographic information and clinical details. Former patients in the same hospitals were sampled to collect information on annual direct non-medical cost, indirect costs and annual number of hospitalization. Annual direct medical cost was obtained by multiplying cost per hospitalization by annual number of hospitalization. Annual cost of illness (ACI) was obtained by adding the average value of annual direct medical cost, direct non-medical cost and indirect cost, stratified by sex, age, clinical stage, therapy and pathologic type in urban and rural areas. Costs per hospitalization were itemized into eight parts to calculate the proportion of each part. All costs were converted to 2016 US dollars (1 USD=6.6423 RMB).

Totally 19,986 cases were included, predominately male. Mean ages of stomach cancer and urban patients were lower than that of esophageal cancer and rural patients. ACI of stomach and esophageal cancer patients were $10,449 and $13,029 in urban areas, and $2,927 and $3,504 in rural areas, respectively. Greater ACI was associated with male, non-elderly patients as well as those who were in stage I and underwent surgeries. Western medicine fee took the largest proportion of cost per hospitalization.

The ACI of stomach and esophageal cancer was tremendous and varied substantially among the population in China. Preferential policies of medical insurance should be designed to tackle with this burden and further reduce the health care inequalities.

• China
• Cost of illness
• esophageal neoplasms
• stomach neoplasms