Clinical and Descriptive Epidemiology Unit

Firenze, Italy

Clinical and Descriptive Epidemiology Unit

Firenze, Italy

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Mangone L.,Quality and Clinical Studies Unit | Minicozzi P.,Fondazione IRCCS Instituto Nazionale dei Tumori | Vicentini M.,Epidemiology and Local Health Unit | Giacomin A.,Epidemiology Unit | And 4 more authors.
Cancer Epidemiology | Year: 2013

Aim: Lung cancer is a major cause of cancer death worldwide. The aims of this study were to analyze presentation, treatment and survival for lung cancer in northern Italy, and identify factors influencing survival. Methods: A total of 1180 lung cancer cases diagnosed in four north Italian cancer registries (Biella, Modena, Reggio Emilia, Romagna) in 2003-2005 were analyzed. Information on morphology, stage, diagnostic examinations, chemotherapy, radiotherapy, and surgical treatment was collected from clinical records. Three-year relative survival and relative excess risks of death were estimated. Results: Overall, 10% of cases were stage I, 50% stage IV, and 12% stage unknown. Romagna - where sophisticated diagnostic examinations were performed more often - had proportionately more microscopically verified cases and resected cases than Biella. Romagna had also high proportions of cases given chemotherapy and radiotherapy. Three-year survival was 14%, range 10% (Biella) to 19% (Romagna); 69% for stage I, 3% for stage IV. Stage I survival was higher in Romagna (82%) than Reggio Emilia and Biella (60-61%) but for operated stage I cases, survival was similar (88%) in Romagna and Biella. The fully adjusted model showed a higher risk of death in Biella (1.23, 95%CI 1.02-1.48) than Modena (reference). Conclusions: Stage and surgery are key factors influencing survival. Centralizing lung cancer treatment to improve diagnostic work-up may improve outcomes. © 2013 Elsevier Ltd.


Neppl-Huber C.,German Cancer Research Center | Zappa M.,Clinical and Descriptive Epidemiology Unit | Coebergh J.W.,Erasmus University Rotterdam | Rapiti E.,Geneva Cancer Registry | And 16 more authors.
Annals of Oncology | Year: 2012

Background: We describe changes in prostate cancer incidence, survival and mortality and the resulting impact in additional diagnoses and avoided deaths in European areas and the United States. Methods: Using data from 12 European cancer registries and the Surveillance, Epidemiology and End Results program, we describe changes in prostate cancer epidemiology between the beginning of the PSA era (USA: 1985-1989, Europe: 1990-1994) and 2002-2006 among patients aged 40-64, 65-74, and 75+. Additionally, we examine changes in yearly numbers of diagnoses and deaths and variation in male life expectancy. Results: Incidence and survival, particularly among patients aged <75, increased dramatically, yet both remain (with few exceptions in incidence) lower in Europe than in the United States. Mortality reductions, ongoing since the mid/late 1990s, were more consistent in the United States, had a distressingly small absolute impact among patients aged 40-64 and the largest absolute impact among those aged 75+. Overall ratios of additional diagnoses/avoided deaths varied between 3.6 and 27.6, suggesting large differences in the actual impact of prostate cancer incidence and mortality changes. Ten years of remaining life expectancy was reached between 68 and 76 years. Conclusion: Policies reflecting variation in population life expectancy, testing preferences, decision aids and guidelines for surveillance-based management are urgently needed. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Crocetti E.,Clinical and Descriptive Epidemiology Unit | Trama A.,Predictive Medicine Fondazione IRCCS Instituto Nazionale dei Tumori | Stiller C.,University of Oxford | Caldarella A.,Clinical and Descriptive Epidemiology Unit | And 6 more authors.
European Journal of Cancer | Year: 2012

To the central nervous system (CNS) belong a heterogeneous group of glial and non glial rare cancers. The aim of the present study was to estimate the burden (incidence, prevalence, survival and proportion of cured) for the principal CNS cancers in Europe (EU27) and in European regions using population-based data from cancer registries participating in the RARECARE project. We analysed 44,947 rare CNS cancers diagnosed from 1995 to 2002 (with follow up at 31st December 2003): 86.0% astrocytic (24% low grade, 63% high grade and 13% glioma NOS), 6.4% oligodendroglial (74% low grade), 3.6% ependymal (85% low grade), 4.1% Embryonal tumours and 0.1% choroid plexus carcinoma. Incidence rates vary widely across European regions especially for astrocytic tumours ranging from 3/100,000 in Eastern Europe to 5/100,000 in United Kingdom and Ireland. Overall, about 27,700 new rare CNS cancers were estimated every year in EU27, for an annual incidence rate of 4.8 per 100,000 for astrocytic, 0.4 for oligodendroglial, 0.2 for ependymal and embryonal tumours and less than 0.1 for choroid plexus carcinoma. More than 154,000 persons with rare CNS were estimated alive (prevalent cases) in the EU at the beginning of 2008. Five-year relative survival was 14.5% for astrocytic tumours (42.6% for low grade, 4.9% for high grade and 17.5% for glioma NOS), 54.5% for oligodendroglial (64.9% high grade and 29.6% low grade), 74.2% for ependymal (80.4% low grade and 36.6% high grade), 62.8% for choroid plexus carcinomas and 56.8% for embryonal tumours. Survival rates for astrocytic tumours were relatively higher in Northern and Central Europe than in Eastern Europe and in UK and Ireland. The different availability of diagnostic imaging techniques and/or radiation therapy equipment across Europe may contribute to explain the reported survival differences. The estimated proportion of cured patients was 7.9% for the 'glial' group to which belong astrocytic tumours. Overall results are strongly influenced by astrocytic tumours that are the most common type. This is the first study to delineate the rare CNS cancer burden in Europe by age, sex and European region. © 2011 Elsevier Ltd. All rights reserved.


Bella F.,Fondazione IRCCS Instituto Nazionale Dei Tumori | Minicozzi P.,Fondazione IRCCS Instituto Nazionale Dei Tumori | Giacomin A.,Epidemiology Unit | Crocetti E.,Clinical and Descriptive Epidemiology Unit | And 8 more authors.
Journal of Cancer Research and Clinical Oncology | Year: 2013

Purpose: Diabetes is associated with increased risk of developing colorectal cancer (CRC), but its effect on overall and cancer-specific mortality in CRC patients has been little investigated. The aim of this study was to assess the influence of diabetes on overall and cancer-specific mortality in Italian CRC patients. Methods: Cases of adult (≥15 years) CRC, diagnosed in 2003-2005, most followed-up to the end of 2008, were randomly selected from the Italian Cancer Registries database. Diabetic status, sex, age, tumor stage, subsite, treatment, morphology, and grade were obtained by consultation of patient clinical records. Poisson multivariable regression models, adjusted for potential confounding variables, were used to estimate hazard ratios (HRs) for all-cause and CRC-specific mortality, according to diabetic status. Results: A total of 1,039 CRC cases with known fasting glucose or diabetic status, archived in 7 cancer registries, was analyzed. Compared to non-diabetics, diabetics (specific diagnosis or glucose ≥126 mg/dl) were older and less likely to receive adjuvant therapy. Diabetics were at higher risk of all-cause death [HR 1.41; 95 % confidence interval (CI) 1.18-1.70] and CRC death (HR 1.36; 95 % CI 1.11-1.67), with no differences by sex or subsite. Conclusions: Diabetes was significantly associated with increased overall and CRC-specific mortality. Our findings indicate that diabetes is a negative prognostic factor for CRC and suggest that in patients with CRC, diabetes prevention and treatments that stabilize the condition and control its complications might reduce mortality. Further studies are required to ascertain the mechanisms linking diabetes to greater mortality in CRC patients. © 2013 Springer-Verlag Berlin Heidelberg.


PubMed | Ferrara Cancer Registry, IRCCS Instituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Clinical and Descriptive Epidemiology Unit, Quality and Clinical Studies Unit and 6 more.
Type: Journal Article | Journal: Cancer epidemiology | Year: 2015

Our study aim was to investigate the degree of adherence to international recommendations for cutaneous melanoma pathology reports at the population level by a EUROCARE high resolution study.The availability of nine characteristics - predominant cell type, tumour-infiltrating lymphocytes, mitotic index, histological subtype, growth phase, Clark level, Breslow thickness, ulceration, and sentinel-node biopsy - was examined on pathology reports of a random sample of 636 cases diagnosed in 2003-2005 in seven Italian cancer registries: Biella, Ferrara, Firenze, Latina, Ragusa, Reggio Emilia, Romagna. The odds of having (versus not having) information for all four core characteristics (last four listed above) were estimated.Sentinel node biopsy was available most often, followed by Clark level, Breslow thickness, histological subtype and ulceration. Information on all nine characteristics was more often available in Biella and Ferrara (northern Italy) than elsewhere. Information on all four core items was available for 78% of cases. Odds of four-core-item availability were higher (than mean) in Biella and lower in Latina (centre) and Ragusa (south).The availability of information important for staging and management was good overall on pathology reports, but varied with geography. It is likely to be improved by wider dissemination of reporting guidelines and adoption of a standardised synoptic reporting system.


De Giorgi V.,University of Florence | Savarese I.,University of Florence | Rossari S.,University of Florence | Gori A.,University of Florence | And 5 more authors.
Melanoma Research | Year: 2012

The use of dermoscopy is known to increase the sensitivity and specificity in the clinical diagnosis of cutaneous pigmented melanocytic lesions compared with naked-eye examinations. However, small pigmented melanocytic lesions with maximum clinical diameters of 6 mm remain the most significant diagnostic challenge to the clinician, particularly in the diagnosis of small melanoma, both in naked-eye and in dermatoscopic examinations. The aim of the present study was to analyze the clinical and dermatoscopic features of small pigmented melanocytic lesions, focusing on more frequently occurring features in small melanoma to identify them earlier. A total of 103 pigmented melanocytic lesions with diameters less than 6 mm were analyzed. On histopathological examination, 34 of these lesions were diagnosed as melanomas and the remaining lesions (n=69) were diagnosed as benign, melanocytic lesions. Images of cases were independently and blindly administered to three dermatologist experts in dermoscopy, who were asked to examine the clinical and dermatoscopic images of melanocytic skin lesions separately and to fill out a printed questionnaire to rate the images according to the ABCD clinical criteria and according to typical dermoscopic pattern analyses. The results of the questionnaires were then analyzed and crossed in order to rate the clinical and dermoscopic features of small pigmented lesions. Our study proved that the clinical criteria for diagnosing melanoma are not as reliable in the diagnosis of pigmented lesions of less than 6 mm diameter. However, the use of dermoscopy, even if not nullifying, allows a better classification of small, melanocytic lesions through pattern analysis. Copyright © Lippincott Williams & Wilkins.


De Giorgi V.,University of Florence | Rossari S.,University of Florence | Gori A.,University of Florence | Grazzini M.,University of Florence | And 4 more authors.
Melanoma Research | Year: 2012

Cutaneous melanoma is a malignant neoplasia with several demographic and histopathological prognostic factors. Many studies stress that the head and neck region has a worse prognosis compared with other localizations, but the reasons for this worse prognosis are unclear. Therefore, the aim of our study is to analyse the poor prognosis of head and neck melanoma (HNM) with respect to the other anatomical sites, considering the face and neck (F&N) and the scalp separately. We carried out a retrospective analysis of 757 melanoma patients. In particular, we studied the prognostic impact of different melanoma skin localizations (head and neck, trunk, upper extremities and lower extremities). Afterwards, we divided HNM into two subgroups, F&N and scalp, to evaluate their impact in the HNM prognosis. Data showed a significantly lower 5-year overall survival probability for HNM (78.9 versus 93.1% for other body sites; P=0.05). Moreover, on analysing the two anatomical areas considered among HNM, we observed a 5-year overall survival of 81.8% for F&N and 66.7% for scalp. HNM has different and worse prognostic features with respect to other sites, but this trend is not only because of scalp melanoma but is also determined by F&N melanoma, which we believe to be underestimated until now. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


De Giorgi V.,University of Florence | Rossari S.,University of Florence | Papi F.,University of Florence | Gori A.,University of Florence | And 6 more authors.
British Journal of Dermatology | Year: 2010

Summary Background Patients with melanoma are especially encouraged to have regular follow-up visits with their dermatologist and to perform total-body skin examination on a routine basis to identify new pigmented lesions or detect significant changes in existing naevi. Objectives To identify main risk factors (sex, age, number of common and atypical naevi, family history, phototype) associated with multiple primary melanomas (MPM) and to investigate the association between regular follow up and tumour thickness of a second primary melanoma. Methods We performed a retrospective analysis of patients with MPM in order to evaluate risk factors for developing a second primary melanoma. Medical records of patients with melanoma who developed a second primary melanoma were selected from a database of all patients with histopathologically confirmed melanoma treated at the dermatology clinic of the University of Florence, Italy, from 2000 to 2004. Medical data culled from the patient records were as follows: medical history, number of typical naevi, presence of atypical naevi, Breslow thickness, Clark level and histotype of the melanomas, site of the melanomas and patient adherence to 6-month follow-up examinations. Results The presence of atypical naevi was associated with a higher risk of developing MPM (adjusted odds ratio 3·28, 95% confidence interval 1·35- 7·44). Moreover, in the subjects who did not attend follow up, we noted that the thickness of the second melanoma was significantly higher, with a mean thickness of 1·22 mm, in comparison with patients with a careful adherence to follow up in whom the mean thickness was 0·36 mm (P = 0·0189). Conclusions For the first time, the validity of this clinical approach has been supported by real comparison of thickness levels of second melanoma in patients with or without periodical follow up. Results obtained from this analysis show that follow up is an effective method for early detection of melanoma. © 2010 British Association of Dermatologists.


De Giorgi V.,ISPO | Grazzini M.,ISPO | Gori A.,ISPO | Alfaioli B.,ISPO | And 4 more authors.
European Journal of Cancer Prevention | Year: 2011

Although, for several decades, the role of ABO blood group antigens has been suspected in the development of cancer, to our knowledge, the association between ABO blood group and the risk of malignant melanoma has not been evaluated yet. We, therefore, examined the relationship between ABO blood group and risk of developing cutaneous malignant melanoma. We retrospectively reviewed 445 patients with a histological diagnosis of malignant melanoma. Blood groups were obtained from medical records. The control group was represented by 38 321 patients. We evaluated the data by investigation with statistical analysis to show a statistically significant increased risk of developing a malignant melanoma in the O Rh-negative group (odds ratio=1.4). We suggest focus on the melanoma cases belonging to the blood groups O Rh-negative in future studies, because all the clues of this study seem to show a correlation between blood groups and the risk of malignant melanoma among these groups. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Puliti D.,Clinical and Descriptive Epidemiology Unit | Miccinesi G.,Clinical and Descriptive Epidemiology Unit | Paci E.,Clinical and Descriptive Epidemiology Unit
Preventive Medicine | Year: 2011

Objectives: In recent years observational epidemiological studies have been used to estimate overdiagnosis in breast cancer screening. These estimates vary widely. In this paper we present some of the methodological issues which explain the large variability of the reported findings. Methods: Different types of observational studies were identified according to study design, definition of the population, adjustment for breast cancer risk and adjustment for lead time. Results: The majority of observational studies that have estimated breast cancer overdiagnosis have analyzed temporal trends or geographical differences in breast cancer incidence. Estimates of overdiagnosis in a dynamic population vary widely, from 4% to 52%. Only a few studies have used the cohort approach and they found estimates varying from 1% to 5%. Conclusions: The cohort approach is preferable to the analysis of a dynamic population because it allows the follow-up of a group of women who have had the opportunity for screening and evaluates if there is sufficient follow-up after the last screen. © 2011.

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