Background Cancer remains a major public health issue globally, with a growing burden due to population aging and lifestyle changes. This study provides the estimates of cancer burden in China for 2024. Methods Cancer data of year 2019 from 919 population-based cancer registries across China submitted to the National Cancer Center were selected, with 106 registries providing continuous data from 2010 to 2019 being used to predict the burden of cancer in 2024. The Segi’s world standard population was used to estimate the age-standardized rates. Joinpoint regression analysis was used to evaluate the trends from 2000 to 2019 by calculating the annual percentage changes (APC) and average annual percentage changes (AAPC). Results In 2024, an estimated 5,150,000 new cancer cases and 2,580,000 cancer deaths occurred in China. The age-standardized incidence rate (ASIR) was 207.70 per 100,000 population and the age-standardized mortality rate (ASMR) was 90.90 per 100,000 population. Lung cancer was the most diagnosed cancer, followed by thyroid, colorectal, breast, and liver cancers. Collectively these top five cancers accounted for 59.13 % of all new cases. The leading cause of cancer death was lung cancer, followed by liver cancer, colorectal cancer, stomach cancer, and esophageal cancer, which together comprised of 66.75 % of all cancer deaths. The age-specific incidence rates increased with age for most cancer sites in men, but for cancers of breast, thyroid, ovarian, and cervix in women, the rates increased significantly in young and middle ages. The age-specific mortality rate increased with age and showed a higher level in men than in women. From 2000 to 2019, the ASIR for all cancers combined increased significantly (AAPC = 1.6 %), while the ASMR decreased (AAPC = −1.4 %). Cancers of the esophagus, stomach, and liver showed declining incidence and mortality trends, whereas thyroid, prostate, and cervical cancers exhibited significant increases in incidence. Conclusions The cancer burden in China continued to be substantial, characterized by a coexistence of cancer patterns of both developing and developed countries. The results highlight the necessity for targeted policies within the “Healthy China 2030" initiative to address sex and age disparities, as well as evolving cancer patterns.

e23138 Background: While multi-cancer early detection (MCED)—a promising approach using one blood sample to detect multiple cancers—could supplement or replace standard-of-care (SOC) screening, its optimal position in population-based screening paradigm remains uncertain. This study aimed to evaluate the effectiveness and cost-effectiveness of integrating MCED at various phases of the screening process. Methods: We recalibrated the National Cancer Center (NCC) modeling framework to align with the latest population-based empirical data. The calibrated model was then used to simulate the natural history of the five highest-mortality cancers in China (lung, liver, colorectal, esophageal, and stomach) over a lifetime horizon for the entire Chinese population, with screening targeted at ages 50–74.The evaluated screening scenarios included no screening, risk-based SOC screening, and four screening strategies incorporating MCED: MCED used as a risk-assessment method (S1), MCED used as a clinical screening method (S2), MCED interception followed by SOC triage for MCED-negative individuals (S3), and MCED used as a supplemental screening for questionnaire non-high-risk individuals and SOC non-compliers (S4). The primary outcome was the 5% discounted incremental cost-effectiveness ratio (ICER), with a willingness-to-pay (WTP) threshold of three times per-capita GDP ($42,857 per quality-adjusted life-year [QALY] gained). Secondary outcomes included stage III-IV cancer diagnoses, cancer deaths, number needed to screen (NNS) to prevent one death. Sensitivity analyses were performed to assess the probability of cost-effective. Results: Compared with no screening, discounted ICERs for risk-based SOC and MCED strategies S1 to S4 were $1,808, $52,195, $26,726, $26,876, and $16,595 per QALY, respectively. Versus risk-based SOC, the ICERs for S4 and S3 were $33,809/QALY and $39,761/QALY. When using risk-based SOC as reference, S3 reduced stage III–IV cancer diagnoses by 6.9% and cancer mortality by 4.3%, while also improving screening efficiency by reducing the NNS from 240 to 81. S4 provided intermediate benefits with a 1.8% reduction in mortality, whereas S1 and S2 yielded smaller mortality reductions (<1.2%). Probabilistic sensitivity analysis indicated that S3 had the highest probability of being cost-effective at the WTP threshold (43.9%). Conclusions: Using MCED interception followed by SOC triage for MCED-negative individuals (S3) likely represents the most appropriate position for MCED in the cancer screening paradigm. In contrast, using MCED as a supplemental screening for questionnaire non-high-risk individuals and SOC non-compliers (S4) offers a lower-cost but suboptimal alternative.

Background and study aim: Upper gastrointestinal cancer (UGIC) imposes a heavy burden in China, where endoscopic screening has been proven effective in rural areas, evidence from urban Chinese populations and risk-stratified subgroups remains limited. This study aims to evaluate the effectiveness of one-time endoscopic screening on UGIC incidence and mortality across risk-stratified subgroups in an urban Chinese population. Methods: A multicenter population-based prospective cohort study was conducted in seven Chinese cities from 2014 to 2021. A total of 39,991 high-risk participants aged 40-69 were stratified into six subgroups using a validated risk assessment system. Inverse probability of treatment weighting (IPTW) and Poisson regression models were used to address baseline confounding and estimate incidence rate ratios (IRRs) between screened and non-screened groups. Results: Over a median follow-up of 6.8 years, 243 UGIC cases and 74 deaths were recorded. While the screened group showed a higher initial incidence due to detection bias, mortality was significantly lower across all risk subgroups (weighted IRR for any high-risk = 0.39, 95% CI: 0.19-0.82), representing a 61% reduction in death risk. The dual high-risk subgroup (both esophageal and gastric cancer) derived the greatest benefit, showing the highest incidence (113.68/100,000 person-years) and significant mortality reduction (weighted IRR = 0.38, 95% CI: 0.15-0.98). Conclusions: One-time endoscopic screening significantly reduces UGIC mortality in urban Chinese high-risk populations. Risk stratification identifies dual high-risk individuals as a priority "high-burden, high-benefit" group, supporting individualized, risk-based precision screening strategies to optimize resource allocation.

The clinical landscape of early stage nonsmall cell lung cancer is at transformative crossroads. Driven by the widespread adoption of low-dose computed tomography screening, the frequent detection of ground-glass opacities, and a rising incidence among never-smokers, the diagnostic center of gravity has shifted toward earlier, potentially curable disease. This shift has been accompanied by equally important therapeutic advances, including parenchyma-sparing surgical techniques, minimally invasive platforms enhanced by digital navigation, and the transformative integration of perioperative immunotherapy and targeted agents. Concurrently, noninvasive monitoring approaches, such as liquid biopsy, have emerged as powerful tools to guide precision management. Despite this progress, substantial barriers to achieving a universal cure persist. Clinicians continue to face uncertainty in the management of ground-glass opacities, the anatomy-based TNM staging system fails to capture the biologic heterogeneity of early tumors, and global disparities in access to innovation remain unresolved. To address these challenges, the authors propose a shift toward a risk-adaptive management paradigm that harnesses artificial intelligence-driven analytics and multi-omics profiling to tailor treatment intensity according to each patient's biologic risk. Such an approach would enable appropriate escalation for high-risk individuals while permitting safe de-escalation for those at low risk. This holistic, lifespan-oriented strategy must be embraced to deliver equitable and durable cures for patients with early stage nonsmall cell lung cancer.

OBJECTIVE:Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related mortality worldwide. This study was aimed at estimating regional and national variations in lifetime CRC risk worldwide. METHODS:CRC data were extracted from GLOBOCAN 2022, including 185 countries, and population and all-cause mortality data were sourced from the United Nations. The world was divided into 20 geographical regions and categorized by Human Development Index (HDI). Lifetime CRC risk was estimated with the life table method, adjusted for multiple primary cancers. RESULTS:In 2022, the lifetime risks of developing and dying from CRC were 2.69% [95% confidence interval (CI): 2.68-2.70] and 1.39% (95% CI: 1.39-1.40), respectively. Men had a higher risk of colon cancer than rectal cancer, and higher CRC risk than women. Lifetime risk varied by region and HDI: regions with very high, high, moderate, and low HDI had incidence risks of 5.17%, 2.75%, 0.72%, and 0.57%, respectively, and mortality risks of 2.48%, 1.50%, 0.44%, and 0.41%, respectively. Australia/New Zealand had the highest incidence risk (7.41%, 95% CI: 7.30-7.52), and Northern Europe the highest mortality risk (3.28%, 95% CI: 3.24-3.32). Risks were stable before 40 years of age, peaked in middle age, and declined after 70 years of age. Temporally, Thailand had the highest increasing trend in lifetime risk, whereas the United States and Austria showed a decreasing trend. CONCLUSIONS:Lifetime CRC risk differs by subtype, sex, HDI, and geography, and residual risk gradually decreases with age. Targeted primary prevention strategies should be implemented in various countries and regions to mitigate CRC burden.

Background The “Healthy China 2030” outline aims to reduce premature mortality from major non-communicable diseases by 30% by 2030 compared to the levels in 2015. In China, approximately 2.57 million cancer-related deaths occurred in 2022. Population-based cancer registries are crucial for assessing cancer burdens and guiding policy. The National Cancer Center (NCC) of China regularly collects cancer registry data, ensures quality control and reports the nationwide statistics on cancer mortality in China. Methods Data from 1073 cancer registries in China were submitted to the NCC in 2019. Quality control was conducted based on Chinese and international guidelines. Temporal trends in premature mortality rates from 2010 to 2019 were analyzed using data from 106 continuous cancer registries representing 8.85% of the Chinese population. Descriptive analysis, standardized mortality rates, and Joinpoint Regression were used to examine cancer-related deaths stratified by sex and area. Results In 2019, the premature mortality rate from cancer in China was 6.67%. Lung cancer had the highest premature mortality rate (1.87%), followed by liver cancer (1.15%). In South China, liver cancer had the highest premature mortality rate, while lung cancer led in other regions. Nasopharyngeal cancer had a higher premature mortality rate in South China. From 2010 to 2019, a significant decreasing trend of 1.9% per year was observed in premature cancer mortality, primarily due to declines in esophageal, stomach, and liver cancers. Conclusions Premature cancer mortality remains a significant issue in China, with lung cancer being the leading cause. Traditionally high-incidence digestive tract cancers in China still carried a substantial burden of premature mortality. Throughout the history of cancer prevention and control, there has been a notable decline in overall premature cancer mortality, particularly for cancers of the digestive tract. In the future, it is imperative to develop tailored screening, early diagnosis, and early treatment strategies for different cancers in order to achieve the goal of reducing premature cancer mortality and enhancing the health of the population.

Background:Gastric cancer remains a leading cause of cancer-related mortality worldwide, frequently diagnosed at advanced stages due to the limitations of current diagnostic approaches. While cell-free DNA (cfDNA)-based epigenetic profiling has emerged as a promising avenue for early cancer detection, comprehensive investigations into the epigenetic landscape of cfDNA in gastric cancer remain scarce. To address this gap, we aimed to develop and validate a multimodal epigenetic blood test for the non-invasive detection of gastric cancer. Methods:We developed GastroAlert, a multimodal epigenetic blood test that integrates cfDNA methylation, nucleosome footprinting, and fragmentation features into a single diagnostic approach for gastric cancer detection. A custom-designed capture probe panel was utilized to target gastric cancer-associated differentially methylated CpG sites and functionally relevant genes. Targeted enzymatic methylation sequencing was then performed on a discovery dataset consisting of 136 participants, including 53 gastric cancer patients, 55 individuals with benign gastric conditions, and 28 healthy controls. Subsequently, the diagnostic performance of GastroAlert was rigorously validated in an independent external dataset of 149 participants, comprising 79 gastric cancer cases and 70 non-cancer controls. Results:In cross-validation of the discovery dataset, GastroAlert achieved an area under the receiver operating characteristic curve (AUC) of 0.950 [95% confidence interval (CI) 0.874-0.995], with observed AUCs for conventional protein biomarkers ranging from 0.507 to 0.687. Notably, the locked GastroAlert model exhibited robust and reproducible performance in the independent validation dataset, yielding an AUC of 0.965 (95% CI 0.940-0.989) for distinguishing gastric cancer patients from non-cancer controls. For the clinically critical subset of early-stage gastric cancer cases, the model still maintained high diagnostic efficacy with an AUC of 0.921 (95% CI 0.862-0.980) in the discovery dataset and 0.948 (95% CI 0.910-0.985) in the validation dataset. Among all 79 gastric cancer cases in the validation dataset, the model attained an overall sensitivity of 0.898 (95% CI 0.813-0.948) at a specificity of 0.900 in the validation dataset. Conclusions:The findings demonstrate that multimodal epigenetic analysis of cfDNA provides a robust, non-invasive strategy for early gastric cancer detection, with potential clinical utility to improve patient outcomes.

Background Upper gastrointestinal (GI) cancers, comprising esophageal cancer (EC) and gastric cancer (GC), remain a significant global health burden with disproportionate geographic distribution of incidence and mortality. A comprehensive assessment of global and regional patterns and trends of upper GI cancer burden is essential to inform targeted prevention strategies. Methods Data were sourced from the Global Burden of Disease (GBD) study 2021. We examined the incidence, mortality, and life expectancy (LE) impacts of upper GI cancers from 1990 to 2021 across 21 GBD world regions. Trends were assessed using age-standardized rates and average annual percentage change (AAPC). Non-modifiable demographic factors and modifiable risk-attributable burdens were analyzed. A three-step decomposition method was applied to quantify the contribution of upper GI cancer to changes in LE. Results In 2021, upper GI cancers accounted for 1.80 million new cases and 1.49 million deaths globally, with Asia contributing over 70% of the burden. Global age-standardized incidence and mortality rates for upper GI cancers declined from 1990 to 2021, with AAPC of -1.53% and -1.87%, respectively, although absolute incidence and deaths increased due to population growth and ageing, contributing to 1.13 million deaths for upper GI cancers. Population expansion and ageing drove increases in age-related deaths during the study period and were offset by reduced incidence and case fatality. Risk-attributable deaths declined for most modifiable factors, with tobacco remaining the leading risk, responsible for 21.9% of all deaths. A total of 0.24 year of LE gained was attributable to upper GI cancers from 1990 to 2021. Regionally, high-income Asia Pacific achieved the greatest gains in LE (0.67 years). GC predominantly contributed to the most gains, whereas EC mostly contributed to LE changes in Central and East Asia (0.27 years and 0.19 years, respectively). Conclusions Although the burden of upper GI cancers has declined, progress is uneven, and the absolute burden remains high in Asia. Continued region-specific prevention, risk factor control, and equitable access to early detection and treatment are essential to further reduce the disease burden and close global disparities.

Objective Although liver cancer mortality in China has declined overall, long-term trends in geographic and demographic disparities remain poorly understood. This study aimed to evaluate temporal trends and evolving patterns in liver cancer mortality, focusing on subnational disparities and shifts in disease burden. Methods Mortality data were obtained from two sources: the World Health Organization (WHO) Mortality Database (1987–2000), which provided nationally representative vital registration data stratified by urban–rural residence; and the Chinese Disease Surveillance Points (DSP) system (2004–2021), a population-based sampling network that gradually expanded to 605 surveillance sites across all 31 provinces by 2013, with continuous stratification by urban–rural and eastern–central–western regions. To assess subnational disparities, we calculated the overall and subgroup-specific temporal trends and compared regional age-standardized mortality rates (ASMRs) with the national level as reference. Age-period-cohort (APC) model was applied to decompose age, period, and birth cohort effects. Poisson models were applied to estimate the period-specific rate ratios of mortality aligning with key phases. Results Liver cancer mortality increased modestly until around 2004 and then declined overall through 2021 (average annual percentage change –1.09% [95% CI: –1.25%, –0.93%]), with more pronounced reductions in urban and eastern areas, and slower declines in rural and western areas. Eastern and central regions contributed over 80% of the overall national decline. Males consistently had higher mortality than females, with widening sex disparities observed in rural and western areas. Younger age groups experienced greater declines, while older adults showed slower reductions or even increasing trends. APC analysis showed increased mortality risk with age, while period and cohort effects showed marked improvements, particularly among younger individuals, females, and those in eastern urban areas. In contrast, declines were limited in older age groups and western rural populations. Regional disparities in mortality widened over time, with growing rural–urban and western–eastern gaps observed in recent years. Conclusions Liver cancer mortality in China remains geographically and demographically unequal, with burden shifting towards western rural regions, and persistent disparities by sex and age. These findings highlight the urgent need for region-specific and population-targeted prevention strategies, particularly for older adults and underdeveloped regions.

BACKGROUND:Optimal uptake rates of mammography or ultrasound are essential for breast cancer screening. This study aimed to identify the individual and structural factors affecting breast cancer screening in China, with quantitative adjustment of structural factors to increase individual uptake rates. METHODS:A multicenter prospective cohort study was conducted in 19 provinces across China, recruiting women aged 40-74 years. Logistic regression models identified individual factors affecting screening uptake, whereas linear regression models explored structural factors across 332 randomly selected communities. Adjusted structural approaches were used to improve individual uptake rates. RESULTS:During 2013-2018, uptake rates among 343,244 high-risk women were 40.9% for ultrasound, 36.8% for mammography, and 34.9% for combined screening. Eleven individual-level factors affected ultrasound uptake, with ten for mammography and nine for combined screening. Taking mammography as an example, higher education level (OR [95% CI]: high vs. low: 1.25 [1.21, 1.28]), smoking (OR [95% CI]: yes vs. no: 1.07 [1.05, 1.1]), passive smoking (OR [95% CI]: ≥40 years vs. 0 years: 1.39 [1.35, 1.44]), occupational exposure to hazardous substances (OR [95% CI]: yes vs. no: 1.19 [1.17, 1.22]), metabolic syndrome components (OR [95% CI]: 3 vs. 0: 1.08 [1.05, 1.12]), benign breast disease (OR [95% CI]: yes vs. no: 1.71 [1.66, 1.75]), delivery history (OR [95% CI]: yes vs. no: 1.60 [1.55, 1.66]), and family breast cancer history (OR [95% CI]: yes vs. no: 1.31 [1.29, 1.33]) might increase the likelihood of screening. Two structural-level factors consistently impacted all three screening modalities. Taking mammography as an example, shorter risk assessment-to-screening intervals (β [95% CI]: ≥60 days vs. <7 days: -24.37 [-33.48, -15.25]) and 30- to 60-day reminders for nonattenders (β [95% CI]: 30-60 days vs. 0-14 days: 8.71 [3.18, 14.24]) increased community mammography uptake. Individual-level uptake rates were 1.95 times higher with <7-day vs. ≥60-day assessment-screening intervals, peaking at 50.14% with 30- to 60-day reminder intervals for nonattenders. CONCLUSIONS:This study identified factors associated with breast cancer screening uptake and proposed quantitative adjustments to structural approaches to maximize uptake rates with minimal resources.

BACKGROUND:The management and outcomes of liver cancer in China have not been well studied. This study aimed to evaluate the management and prognosis of patients with liver cancer in China through a comprehensive multicenter analysis and to compare these findings with data from the United States (US). METHODS:We conducted a retrospective cohort study using data from 13 hospitals across 10 provinces in China, covering patients diagnosed with primary liver cancer between January 2016 and December 2017. We collected data on sociodemographic characteristics, lifestyle factors, stage at diagnosis, and first-line treatment. Patients' survival outcomes were tracked using active and passive follow-up methods until December 2023. Multivariable Cox regression was used to identify prognostic factors. We further compared treatment patterns and prognoses of liver cancer patients between 13 hospitals in China and the Surveillance, Epidemiology, and End Results (SEER) cohort in the US. RESULTS:A total of 4951 patients with liver cancer from China and 18,365 from the Surveillance, Epidemiology, and End Results cohort were analyzed. In the Chinese cohort, commonly used treatments, ranked from highest to lowest, were surgery (37.3%, 1821/4879), interventional therapy (32.1%, 1570/4898), chemotherapy (17.4%, 850/4877), radiofrequency ablation (6.9%, 337/4872), radiotherapy (3.7%, 182/4890), and targeted therapy (2.6%, 127/4875). Surgery rates for patients with liver cancer in stages I to IV were 59.2% (309/522), 58.8% (443/753), 39.0% (328/841), and 18.6% (141/760), respectively. According to the stage at diagnosis, 5-year survival rates for patients in stages I to IV were 48.1% (95% confidence interval [CI]: 44.0-52.6%), 37.8% (95% CI: 34.5-41.4%), 24.0% (95% CI: 21.3-27.0%), and 8.0% (95% CI: 6.2-10.1%), respectively. Compared with the US, China had higher surgery rates and stage-specific survival for patients with liver cancer across all stages. Data from both countries indicated a poor prognosis for liver cancer, with the stage at diagnosis and surgical intervention being key prognostic factors in both China and the US. CONCLUSION:The present findings underscore the urgent need for early diagnosis and curative treatment interventions such as surgery to enhance survival outcomes for patients with liver cancer.

Cancer has become the second leading cause of death, the global cancer burden is rapidly increasing, and there are marked disparities between and within countries worldwide. Population-based cancer registries systematically collect data on cancer patients in defined populations, which play a crucial role in planning and assessing cancer prevention and control strategies. While the development of cancer registration has been marked by increasing standardization of definitions and methods and the electronic processing of data, the advent of artificial intelligence (AI) offers opportunities to further reduce the labor-intensive nature of registry operations, particularly where registry resources are scarce. These include enabling the processing of large datasets, extracting complex or unstructured data patterns to support cancer registration data abstraction, and facilitating data quality and control. The analysis and dissemination of registry data are also increasingly integrating AI methodologies. This paper provides a comprehensive overview of the application of AI in cancer registration. We investigate the challenges associated with integrating AI into existing cancer registry structures, with a particular emphasis on network and computational constraints, uneven resource allocation, and potential biases and limitations within AI systems. We propose a forward-looking AI-enhanced framework for cancer registration, highlighting AI’s potential to optimize efficiency in cancer registration and the use of registry data for cancer control and cancer research.

Background: Helicobacter pylori infection is the leading cause of gastric cancer (GC) and peptic ulcer disease (PUD), with China having the largest affected population. Our study aimed to reconstruct age-specific force of infection (FOI) and prevalence of H. pylori in China from 1990 to 2023 and to quantify H. pylori-attributable burden of GC and PUD. Methods: We performed a systematic review of studies reporting H. pylori prevalence in China and extracted age-specific data on current infection, seropositivity, and ever infection. Random-effects meta-analyses were conducted to identify age-period and age-birth cohort prevalence patterns. We then fitted a Bayesian catalytic model to estimate FOI and prevalence across age and calendar time, while accounting for study uncertainty and diagnostic differences. Finally, we combined modelled prevalence estimates with published relative risks and case data to calculate the population attributable fraction (PAF) and the number of GC (cardia and non-cardia) and PUD cases attributable to H. pylori. Findings: A total of 181 studies were included in Bayesian model fitting, covering all ages. Cohorts born after 1980 experienced substantially lower childhood FOI than earlier cohorts. Despite this decline in childhood acquisition, overall population prevalence changed modestly over time, from 43·1% (95% credible interval 39·1, 47·4) in 1990 to 36·3% (33·2, 39·6) in 2023. In 2023, the PAF was 70·1% (95% uncertainty interval 51·4, 82·4) for non-cardia GC, 49·4% (20·5, 70·7) for cardia GC. H. pylori was associated with 340 000–370 000 GC cases and about 160 000–210 000 PUD cases. Interpretation: The findings suggest that the burden attributable to H. pylori remains high and support more active H. pylori control strategies in China, including H. pylori infection screen-and-treat approaches.

Abstract Background: A comprehensive understanding of the associations between multiple risk factors and cancer incidence is crucial for evidence-based cancer control. While many studies have examined specific risk-cancer pairs, none have yet estimated the entire network of risks across cancer types. This study aims to quantity the associations between 144 cancer-related risk factors and the incidence of 39 cancer types. Methods: Using risk records from CanRisk-DB, a well-established repository that employs graph-based retrieval-augmented generation large language model agents within the PICOS-PRISMA framework, we synthesized relative risks (RRs) or hazard ratios (HRs) of cancer incidence from cohort studied between 1980 and 2024. We meta-analyzed the effect sizes using harmonized definitions and both graph-based and inverse variance approaches. The reliability of this artificial intelligence (AI)-driven meta-analysis was validated by comparing our estimated effects with those from published meta-analyses. Results: A total of 2,388 combinations between 144 risk factors and 39 cancer types were identified from CanRisk-DB. Among these, 131 and 120 risk factors were linked to 36 and 33 cancer types in females and males, respectively. Of 144 risk factors, 92.4% were modifiable. 67 factors were identified as causal risk factors only, such as family history of cancer, immunosuppressive agents, non-alcoholic fatty liver disease, and nitrogen dioxide pollution. However, 77 risk factors showed either causal and protective roles across cancer types, such as tobacco use, alcohol consumption, and type 2 diabetes. For instance, alcohol consumption was positively associated with several cancers (e.g., liver [RR = 1.46; 95% CI, 1.27-1.69], breast [RR = 1.09; 95% CI, 1.06-1.12], and colorectal [RR = 1.08; 95% CI, 1.02-1.13]) but inversely with kidney cancer (RR = 0.81; 95% CI, 0.76-0.87). The cancers with the greatest number of associated risk factors were lung (73 factors), colorectal (57), and liver (53). Overall, the majority of cancer types were associated with multiple modifiable risk factors: 34 cancers (87.2%) with at least 5 risks, 28 cancers (71.8%) with at least 10 risks, and 20 cancers (51.3%) with at least 15 risks. The effect sizes in our analysis are highly consistent with those reported in published meta-analyses (Spearman’s ρ = 0.93). Conclusion: AI-driven systematic reviews and meta-analyses accurately captured the complex network of associations between cancers and risk factors. Mapping these relationships facilitated a better understanding of the attributable risk of cancer, thereby informing strategies for cancer prevention and control. Citation Format: Changfa Xia, Shiyuan Tong, Yongjie Xu, Hui Yu, Fang Liu, Shiqing Chen, Fei Zhao, Junyi Ye, Jing Liu, Baoliang Zhu, Xiaohui Wu, Sibo Zhu, Wanqing Chen. Mapping the associations of 144 incidence risk factors with 39 cancers: An AI-driven systematic review and meta-analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 2337.

Multi-cancer early detection (MCED) via blood tests expands single-cancer screening. Artificial intelligence (AI) can enhance MCED across the screening lifecycle, from test development to real-world implementation. Key challenges include algorithmic bias, generalizability, overdiagnosis, and governance. Emerging AI paradigms, digital twins, and personal health agents may support dynamic learning health systems. We argue AI should be viewed not merely as a performance booster but as foundational infrastructure for precise cancer screening.

Background:A cancer diagnosis is usually associated with a substantial loss of life years. However, few studies have quantified life expectancy (LE) and years of life lost (YLL) among cancer patients, particularly in China. This study aims to estimate LE and YLL by cancer type, sex, age at diagnosis, and attained age (i.e., the age a cancer survivor has reached at a given time) for cancer patients in China. Methods:This is a comparative assessment based on population-based cancer registration and death surveillance in China. Data on all-cause deaths, cancer cases, and relative survival in 2021 were obtained from publicly available reports released by the National Cancer Center and the Chinese Center for Disease Control and Prevention. Life tables for the general population were constructed using age-specific all-cause mortality rates, whereas relative survival rates and parameterized long-term excess hazard functions were used to construct life tables for cancer patients. We used the standard period life table method to estimate LE of both the general population and cancer patients, assuming that mortality probabilities remained constant over time. The YLL was the LE difference between cancer patients and the sex- and age-matched general population. Results:For cancer patients diagnosed at the median age of 64 years, the LE is 8.8 years [95% confidence interval (CI) 8.7-9.0], corresponding to a YLL of 9.2 years (95% CI 9.0-9.3). Male patients have an LE and YLL of 6.7 years (95% CI 6.6-6.8) and 9.8 years (95% CI 9.7-9.9), respectively, while females have 11.2 years (95% CI 11.1-11.4) and 8.4 years (95% CI 8.3-8.6). Thyroid cancer had the highest LE [31.9 years (95% CI 31.5-32.0)], while pancreatic cancer had the lowest [2.6 years (95% CI 2.4-2.8)]. Female patients had better LEs than males across 20 cancer types that affect both sexes. Younger patients experienced greater YLL, except in cases of thyroid cancer, oropharyngeal cancer, ovarian cancer, and male bladder cancer. LE gradually increased in patients who survived the first three years; thereafter, the decline depended on attained age, approaching that of the general population. Conclusions:LE of cancer patients in China varied by sex, cancer type, age at diagnosis, and attained age. Cancer patients, healthcare providers, and policymakers may incorporate these estimates into their decision-making.

China accounts for nearly 17% of the global population yet contributes approximately 25% of the global cancer burden with >5 million new cancers diagnosed every year; this evolving landscape is reshaping the global pattern of cancer burden. Over the past decades, cancer epidemiology trends have substantially shifted in China. Driven by a rapidly ageing population and an expanded diagnostic capacity, the number of newly diagnosed cancers in China is rising rapidly and particularly of those that are most common in high-income countries, such as lung, colorectal, prostate, thyroid, female breast and cervical cancers. Conversely, the incidence of cancers historically prevalent in China, including oesophageal, gastric and liver cancers, has been declining substantially. In response to this escalating and evolving cancer burden, China has implemented a series of national cancer control initiatives starting in 1986. In this Review, we provide a comprehensive overview of the epidemiology and temporal trends of cancer burden in China, both overall and for the major cancer types, and analyse the key contributors to this landscape, including risk factors, screening programmes and cancer care provision. In the context of national cancer control policies and targets, we further assess progress and discuss the remaining challenges in prevention, screening and cancer treatment, as well as the implications for global cancer control in the coming decades.

Objective:The prognosis of patients with hepatocellular carcinoma (HCC) is often poor, making prediction of prognosis and risk stratification highly significant. However, existing indicators are insufficient for accurately predicting the prognosis of patients with HCC. This study aimed to systematically summarize the value of circulating tumor DNA (ctDNA) as a prognostic biomarker for HCC patients. Methods:PubMed, Web of Science, Embase, Cochrane Library, Scopus, and clinical trials.gov databases were searched to collect observational studies and randomized clinical trials from January 2016 to November 2024. Studies focusing on ctDNA status or ctDNA methylation and prognostic outcomes in HCC patients were included. Pooled hazard ratios (HRs) were calculated for the primary outcomes: relapse-free survival (RFS) and overall survival (OS). Random-effects models were applied considering the potential heterogeneity. Results:A total of 25 studies involving 2490 HCC patients were included. Positive ctDNA status both before and after surgery were significantly associated with shorter RFS (before surgery: HR = 3.88, 95% confidence interval [CI]: 1.46-10.33, P = 0.007; after surgery: HR = 5.08, 95% CI: 3.35-7.72, P < 0.001). Compared with ctDNA-negative groups, ctDNA-positive before and after surgery groups both exhibited shorter OS (before surgery: HR = 6.59, 95% CI: 2.47-17.55, P < 0.001; after surgery: HR = 7.01, 95% CI: 2.21-22.27, P = 0.001). Sensitivity analyses yielded results similar to the main analysis. Additionally, ctDNA may detect recurrence 2-5 months earlier than radiographic imaging. Conclusions:ctDNA detection was significantly associated with poorer prognosis in HCC patients. The potential applications of ctDNA in prognostic prediction are promising, and the predictive value of ctDNA dynamic change warrants further exploration.

Objective To provide an updated global assessment of esophageal and gastric cancers incidence by histological subtype and anatomical subsite. Methods We utilized data from GLOBOCAN 2022 and Cancer Incidence in Five Continents Vol. XII (2013-2017) to estimate the incidence of esophageal cancer subtypes (squamous cell carcinoma [ESCC] and adenocarcinoma [EAC]) and gastric cancer subsites (cardia [CGC] and non-cardia [NCGC]). Age-standardized incidence rates (ASIRs) were calculated by sex for each country, world region, and Human Development Index (HDI) category. Spearman correlation analysis was conducted to evaluate the association between ASIRs and HDI. Results In 2022, an estimated 511,000 new esophageal cancer cases occurred globally (83% ESCC [ASIR 4.1 per 100,000 person-years], 16% EAC [ASIR 0.8]), with Eastern Asia accounting for 53% of global ESCC and 25% of EAC cases. Among 968,000 gastric cancer cases, 13% were CGC (ASIR 1.2 per 100,000 person-years) and 87% were NCGC (ASIR 8.0), with Eastern Asia contributing 44% and 55% of CGC and NCGC cases, respectively. Notably, age-stratified analyses revealed a distinct burden of early-onset disease (<50 years) in South-Central Asia, which accounted for 57% of global early-onset ESCC and 35% of early-onset EAC cases. Generally, EAC incidence exceeded that of ESCC in Northern and Western Europe, Northern America, and Oceania. More than 50% of global EAC cases occurred in countries with very high HDI. Incidence rates were consistently higher among males than females, with particularly elevated male-to-female ASIR ratios for EAC (up to 7.0) and CGC (up to 4.7). Conclusions ESCC and NCGC represent the most prevalent upper gastrointestinal cancer subtypes globally, with Eastern Asia accounting for the highest burden. Crucially, South-Central Asia has emerged as a key region for early-onset esophageal cancer (<50 years). The region-, sex-, and age-specific variations in incidence underscore the necessity for targeted prevention strategies to reduce the global burden of these cancers.