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Classic myeloproliferative neoplasms in Singapore: A population-based study on incidence, trends, and survival from
Htet Lin Htun1, Weixiang Lian1, Joshua Wong1
1Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore.
Background:
Current descriptive epidemiological information on classic myeloproliferative neoplasms (MPNs) is incomplete. Published data among Asian population are particularly sparse.
Methods:
We conducted a large population-based study to determine the incidence rates and survival patterns of MPN reported to the Singapore Cancer Registry during the period 1968-2017. Age-standardised incidence rates(ASR), overall survival, 5-/10-year relative survival ratio (RSR) were estimated. Joinpoint regression was used to evaluate quinquennial percent change (QPC) in incidence.
Results:
We identified 2557 individuals diagnosed with MPN including 1031 chronic myeloid leukaemia (CML), 424 polycythaemia vera (PV), 389 essential thrombocythaemia (ET), 134 primary myelofibrosis (PMF) and 579 MPN unclassifiable (MPN-U). The overall respective ASRs per 100,000 for CML, PV, ET, PMF and MPN-U were 1.24, 1.15, 1.07, 0.43, and 0.80 in 2013-2017. Males had higher ASR than females in all MPNs. A gradual rise in incidence trends of CML was observed between 1968 and 2017 (QPC 2.1%, 95% CI -0.9, 5.3). The overall incidence trends of non-CML MPNs including PV (QPC 62.9%, 95% CI 19.3, 122.6), ET (QPC 54.2%, 95% CI 23.5, 92.3) and PMF (QPC 103.5%, 95% CI 19.1, 247.6) increased sharply during 1993-2017. Survival was lower in MPNs compared with expected survival in general population: 5-year RSRs were 0.82 (95% CI 0.78, 0.86), 0.96 (95% CI 0.91, 1.01), 0.96 (95% CI 0.92, 1.01), 0.53 (95% CI 0.43, 0.65), and 0.74 (95% CI 0.68, 0.80) for CML, PV, ET, PMF and MPN-U respectively.
Conclusion:
CML incidence has increased marginally, whereas non-CML MPNs incidences have sharply increased. MPN patients have a lower relative survival compared to the general population, and patients with PV and ET have the most favourable relative survival. Median survival for CML patients has increased dramatically over the last 50 years.
Insights
Incidence of myeloproliferative neoplasms (MPNs) in Asia is rising, particularly for non-chronic myeloid leukemia types. While survival for MPN patients is lower than the general population, outcomes for polycythemia vera and essential thrombocythemia are more favorable.
Area of Science:
- Hematology
- Epidemiology
- Oncology
Background:
- Epidemiological data on classic myeloproliferative neoplasms (MPNs) are limited, especially within Asian populations.
- Understanding MPN incidence and survival patterns is crucial for public health and clinical management.
Purpose of the Study:
- To determine the incidence rates and survival patterns of MPNs in Singapore from 1968 to 2017.
- To analyze trends in MPN incidence over five decades.
- To compare MPN patient survival with the general population.
Main Methods:
- A population-based study utilizing data from the Singapore Cancer Registry (1968-2017).
- Estimation of age-standardized incidence rates (ASR) and 5-/10-year relative survival ratios (RSR).
- Joinpoint regression analysis to assess quinquennial percent change (QPC) in incidence trends.
Main Results:
- Identified 2557 MPN cases: chronic myeloid leukemia (CML), polycythemia vera (PV), essential thrombocythemia (ET), primary myelofibrosis (PMF), and MPN unclassifiable (MPN-U).
- Incidence of CML showed a gradual rise (QPC 2.1%), while non-CML MPNs (PV, ET, PMF) exhibited sharp increases (QPC 62.9%, 54.2%, 103.5% respectively) between 1993-2017.
- MPN patients had lower relative survival than the general population; 5-year RSRs ranged from 0.53 (PMF) to 0.96 (PV, ET).
Conclusions:
- MPN incidence is increasing, with a particularly sharp rise in non-CML types.
- MPN patients face reduced survival rates, though PV and ET patients have more favorable prognoses.
- Median survival for CML patients has significantly improved over the past 50 years.