Pan And Agl Kyriakou Childrens Hospital

Athens, Greece

Pan And Agl Kyriakou Childrens Hospital

Athens, Greece
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Petridou E.T.,National and Kapodistrian University of Athens | Dimitrova N.,National Oncology Hospital | Eser S.,Izmir Public Health Institute | Karakilinc H.,Antalya Cancer Registry | And 11 more authors.
Cancer Causes and Control | Year: 2013

Purpose Within Europe, incidence and mortality rates of childhood leukemia and lymphoma are rather heterogeneous. The present study comprising data from five Southern and Eastern European Cancer Registries aims to compare time trends and examine whether sociodemographic variables, clinical parameters, and proxies of efficient care affect survival. Methods Data spanning 1996-2010 were obtained for a total of 3,041 newly diagnosed childhood leukemia and 1,183 lymphoma cases reported by the Greek Nationwide Registry for Childhood Hematological Malignancies, Bulgarian National Cancer Registry, Moscow Region and Turkey (Antalya and Izmir) Cancer Registries. Poisson modeling for the evaluation of time trends and multivariate Cox regression analysis for the assessment of prognostic factors were performed. Results The incidence of leukemia was increasing in all cases, with Bulgaria and Greece presenting statistically significant annual changes (?3.5, and ?1.7 %, respectively), followed by marginally increasing trends in Izmir and Moscow; by contrast, there was a remarkable, statistically significant, decreasing mortality trend for leukemia. Rates for lymphoma remained flat. Greece experienced almost twofold better survival rates for both leukemia and lymphoma, probably due to its higher socioeconomic status during the study period. Overall, patients with leukemia living in rural areas had a 28 % lower prognosis (RR: 1.28, 95 % CI 1.03-1.59), pointing to effects of remoteness, when the most privileged country (Greece) was excluded from the analysis. Conclusions The favorable mortality trends highlight the progress in Southern-Eastern European countries along their trajectory to converge with Northern-Western EU counterpart states. Socioeconomic status may act as a multipotent factor underlying the study findings. © 2013 Springer Science+Business Media Dordrecht.


Antonopoulos C.N.,National and Kapodistrian University of Athens | Sergentanis T.N.,National and Kapodistrian University of Athens | Papadopoulou C.,National and Kapodistrian University of Athens | Andrie E.,National and Kapodistrian University of Athens | And 9 more authors.
International Journal of Cancer | Year: 2011

Results from epidemiological studies exploring the association between childhood lymphoma and maternal smoking during pregnancy have been contradictory. This meta-analysis included all published cohort (n = 2) and case-control (n = 10) articles; among the latter, the data of the Greek Nationwide Registry for Childhood Hematological Malignancies study were updated to include all recently available cases (-2008). Odds ratios (ORs), relative risks and hazard ratios were appropriately pooled in three separate analyses concerning non-Hodgkin lymphoma (NHL, n = 1,072 cases), Hodgkin lymphoma (HL, n = 538 cases) and any lymphoma (n = 1,591 cases), according to data availability in the included studies. An additional metaregression analysis was conducted to explore dose-response relationships. A statistically significant association between maternal smoking (any vs. no) during pregnancy and risk for childhood NHL was observed (OR = 1.22, 95% confidence interval, CI: 1.03-1.45, fixed effects model), whereas the risk for childhood HL was not statistically significant (OR = 0.90, 95% CI: 0.66-1.21, fixed effects model). The analysis on any lymphoma did not reach statistical significance (OR = 1.10, 95% CI = 0.96-1.27, fixed effects model), possibly because of the case-mix of NHL to HL. No dose-response association was revealed in the metaregression analysis. In conclusion, this meta-analysis points to a modest increase in the risk for childhood NHL, but not HL, among children born by mothers smoking during pregnancy. Further investigation of dose-response phenomena in the NHL association, however, warrants accumulation of additional data. Copyright © 2011 UICC.


Petridou E.T.,National and Kapodistrian University of Athens | Sergentanis T.N.,National and Kapodistrian University of Athens | Perlepe C.,National and Kapodistrian University of Athens | Papathoma P.,National and Kapodistrian University of Athens | And 14 more authors.
Annals of Oncology | Year: 2015

Background: Despite advancements in the treatment of childhood leukemia, socioeconomic status (SES) may potentially affect disease prognosis. This study aims to evaluate whether SES is associated with survival from childhood leukemia. Methods: The US National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) 1973-2010 data were analyzed; thereafter, results were meta-analyzed along with those from survival (cohort) studies examining the association between SES indices and survival from childhood leukemia (end-of-search date: 31 March 2014). Randomeffects models were used to calculate pooled effect estimates (relative risks, RRs); meta-regression was also used. Results: We included 29 studies yielding 28 804 acute lymphoblastic leukemia (ALL), 3208 acute myeloblastic leukemia (AML) and 27 650 'any' leukemia (denoting joint reporting of all subtypes) cases. According to individual-level composite SES indices, children from low SES suffered from nearly twofold higher death rates from ALL (pooled RR: 1.83, 95% confidence interval 1.00-3.34, based on four study arms); likewise, death RRs derived from an array of lower area-level SES indices ranged between 1.17 and 1.33 (based on 11 study arms). Importantly, the survival gap between higher and lower SES seemed wider in the United States, with considerably (by 20%-82%) increased RRs for death from ALL in lower SES. Regarding AML, poorer survival was evident only when area-level SES indices were used. Lastly, remoteness indices were not associated with survival from childhood leukemia. Conclusion: Children with lower SES suffering childhood leukemia do not seem to equally enjoy the impressive recent survival gains. Special health policy strategies and increased awareness of health providers might minimize the effects of socioeconomic disparities. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology.


Petridou E.Th.,National and Kapodistrian University of Athens | Dessypris N.,National and Kapodistrian University of Athens | Panagopoulou P.,National and Kapodistrian University of Athens | Sergentanis T.N.,National and Kapodistrian University of Athens | And 6 more authors.
Pediatric Blood and Cancer | Year: 2010

This case-control study aims to explore the association of serum adiponectin/leptin with childhood Hodgkin lymphoma (HL). Study participants were 75 children with histologically confirmed HL, registered in the Nationwide Registry for Childhood Haematological Malignancies and 75 age- and gender-matched controls. Multiple conditional logistic regression analyses were performed, adjusting for sociodemographic and lifestyle parameters. Adiponectin levels were consistently higher among cases in all models with ORs >1.25; 95% CIs ranging from 0.9 to 1.8 and P-values from 0.09 to 0.20. By contrast, there was no association of serum leptin with HL. In conclusion, elevated serum adiponectin might be a risk factor for childhood HL. © 2009 Wiley-Liss, Inc.


Petridou E.T.,National and Kapodistrian University of Athens | Sergentanis T.N.,National and Kapodistrian University of Athens | Panagopoulou P.,National and Kapodistrian University of Athens | Moschovi M.,National and Kapodistrian University of Athens | And 15 more authors.
Pediatric Blood and Cancer | Year: 2012

Background: Cancer risk in children born after in vitro fertilization (IVF) remains largely unknown. We aimed to investigate risk of leukemia and lymphoma following IVF using two nationwide datasets. Methods: The hospital-based case-control study in Greece derived from the National Registry for Childhood Hematological Malignancies (1996-2008, 814 leukemia and 277 lymphoma incident cases with their 1:1 matched controls). The Swedish case-control study was nested in the Swedish Medical Birth Register (MBR) (1995-2007, 520 leukemia and 71 lymphoma cases with their 5,200 and 710 matched controls) with ascertainment of incident cancer cases in the National Cancer Register. Study-specific and combined odds ratios (OR) were estimated using conditional logistic regression, with adjustment for possible risk factors. Results: Nationwide studies pointed to similar size excess risk of leukemia following IVF, but to a null association between IVF and lymphoma. The proportion of leukemia cases conceived through IVF was 3% in Greece and 2.7% in Sweden; prevalence of IVF in matched controls was 1.8% and 1.6%, respectively. In combined multivariable analyses, the increased risk of leukemia was confined to age below 3.8 years (OR=2.21; 95% confidence interval, CI: 1.27-3.85) and to acute lymphoblastic leukemia (ALL) (OR=1.77; 95% CI: 1.06-2.95) with no sufficient evidence of excess risk for other leukemias (OR=1.34; 95% CI: 0.38-4.69). Following IVF, OR for ALL was 2.58 (95% CI: 1.37-4.84) before age 3.8 and 4.29 (95% CI: 1.49-12.37) before age 2 years. Conclusions: IVF seems to be associated with increased risk of early onset ALL in the offspring. © 2011 Wiley Periodicals, Inc.


Sergentanis T.,National and Kapodistrian University of Athens | Dessypris N.,National and Kapodistrian University of Athens | Kanavidis P.,National and Kapodistrian University of Athens | Skalkidis I.,National and Kapodistrian University of Athens | And 7 more authors.
European Journal of Cancer Prevention | Year: 2013

The aim of the present nationwide Greek study is to assess whether survival from acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) is modified by socioeconomic status (SES) and area remoteness. Detailed precoded information derived from a personal interview conducted by specially trained health personnel with the child guardians was available for 883 ALL and 111 AML incident childhood cases registered in the Nationwide Registry for Childhood Hematological Malignancies during the period 1996-2010. Parental socioprofessional category was recorded on the basis of ISCO68 and ISCO88 codes; the exact traveling distance between residence and the treating hospital was ad hoc calculated. Multivariate Cox's proportional hazards models were applied to examine the mutually adjusted associations between survival and potential predictors. Children from a lower parental socioprofessional category experienced 40% worse survival (P=0.02) independent of age, sex, and ALL subtype, whereas those whose parents were married had better outcomes (rate ratio: 0.47, P=0.01). Urbanization of residence at diagnosis or 'residence to treating hospital' distance was not nominally associated with survival from ALL. By contrast, no noteworthy associations implicating SES were found for AML survival, probably because of the burden of the disease and small numbers. Lower SES indicators and a single-parenthood family milieu seem to be independently associated with unfavorable outcomes from childhood ALL. Area remoteness might not be a significant outcome predictor during recent years, following considerable improvements in the motorway infrastructures and care delivery patterns. This study may provide a valuable snapshot capturing the impact of socioeconomic covariates before the burst of the Greek financial crisis. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Thomopoulos T.P.,National and Kapodistrian University of Athens | Skalkidou A.,Uppsala University | Dessypris N.,National and Kapodistrian University of Athens | Chrousos G.,National and Kapodistrian University of Athens | And 11 more authors.
European Journal of Cancer Prevention | Year: 2016

The long-term impact of cesarean delivery (CD) on the health of the offspring is being explored methodically. We sought to investigate the effect of birth by (a) prelabor and (b) during-labor CD on the risk of early-onset (≤3 years) acute lymphoblastic leukemia (ALL), specifically of its prevailing precursor B (B-ALL) subtype. A total of 1099 incident cases of ALL (957 B-ALL), 131 of acute myeloid leukemia (AML), and their 1: 1 age-matched and sex-matched controls, derived from the Nationwide Registry for Childhood Hematological Malignancies (1996-2013), were analyzed using multivariate regression models. A null association was found between prelabor and/or during labor CD and either ALL (B-ALL) or AML in the 0-14 age range. By contrast, birth by CD increased significantly the risk of early-onset ALL [odds ratio CD (OR CD)=1.57, 95% confidence interval (CI): 1.10-2.24] mainly on account of prelabor CD (OR prelaborCD =1.66, 95% CI: 1.13-2.43). The respective figures were even higher for the early-onset precursor B-ALL (OR CD =1.66, 95% CI: 1.15-2.40 and OR prelaborCD =1.79, 95% CI: 1.21-2.66), whereas no association emerged for early-onset AML. Prelabor CD, which deprives exposure of the fetus/infant to the presumably beneficial effect of stress hormones released in both vaginal labor and during labor CD, was associated exclusively with an increased risk of early-onset ALL, particularly the precursor B-ALL subtype. If confirmed, these adverse long-term outcomes of CD may point to re-evaluation of prelabor CD practices and prompt scientific discussion on the best ways to simulate the effects of vaginal delivery, such as a precesarean induction of labor. © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Thomopoulos T.P.,National and Kapodistrian University of Athens | Ntouvelis E.,National and Kapodistrian University of Athens | Diamantaras A.-A.,Charité - Medical University of Berlin | Tzanoudaki M.,Aghia Sofia Childrens Hospital | And 9 more authors.
Cancer Epidemiology | Year: 2015

Objective: To systematically review studies and meta-analyze the literature on the association of maternal and/or index child's coffee, tea, and cola consumption with subsequent development of childhood leukemia and its major subtypes. Methods: Eligible studies were identified through a detailed algorithm and hand-search of eligible articles' references; thereafter, summary-effect estimates were calculated by leukemia subtype and dose-response meta-analyses were performed. Results: Twelve case-control studies, comprising a total of 3649 cases and 5705 controls, were included. High maternal coffee consumption was positively associated with acute lymphoblastic leukemia (ALL; OR: 1.43, 95%CI: 1.22-1.68) and acute myeloid leukemia (AML; OR: 2.52, 95%CI: 1.59-3.57). Any or low to moderate maternal cola consumption was also positively associated with overall leukemia (AL) and ALL, A linear trend between coffee and cola consumption and childhood leukemia was observed in the dose-response analyses. On the contrary, low to moderate tea consumption was inversely associated with AL (OR: 0.85, 95%CI: 0.75-0.97), although the trend was non-significant. A null association between offspring's cola consumption and leukemia was noted. Conclusions: Our findings confirm the detrimental association between maternal coffee consumption and childhood leukemia risk and provide indications for a similar role of maternal cola intake. In contrast, an inverse association with tea was found, implying that other micronutrients contained in this beverage could potentially counterbalance the deleterious effects of caffeine. Further research should focus on the intake of specific micronutrients, different types of coffee and tea, specific immunophenotypes of the disease, and the modifying effect of genetic polymorphisms. © 2015.


Diamantaras A.-A.,National and Kapodistrian University of Athens | Dessypris N.,National and Kapodistrian University of Athens | Sergentanis T.N.,National and Kapodistrian University of Athens | Ntouvelis E.,National and Kapodistrian University of Athens | And 8 more authors.
Cancer Causes and Control | Year: 2013

Purpose: There is a paucity of findings concerning the role of diet in childhood leukemogenesis, whereas the results are equivocal and the studies heterogeneous with regard to food items examined. This case-control study investigates the association of childhood leukemia with food groups, macronutrient consumption, total energy intake and adherence to Mediterranean diet among children aged 5-14 years in Greece. Methods: A total of 139 consecutive, incident leukemia cases out of which 121 were acute lymphoblastic leukemia were derived from the Nationwide Registry for Childhood Hematological Malignancies along with one: one age- and gender-matched hospital controls. Information on socio-demographic, maternal and child variables and dietary habits was obtained through in-person interviews with the guardians/children. Multiple logistic regression was performed with adjustment for birth weight and possible confounding variables. Results: Higher consumption of added lipids was associated with an increased risk of childhood leukemia, whereas consumption of milk and dairy products with reduced risk. From the macronutrient analysis, a borderline trend linking high protein intake with reduced childhood leukemia risk was observed. Conclusion: Consumption of milk and dairy products in the first year of life may protect against childhood leukemia possibly through vitamin D actions, while added lipids may increase the risk through various mechanisms. These results offer a holistic evaluation of children's nutrition and suggest that dietary habits in the early years of life may contribute to the prevention of childhood leukemia. © 2012 Springer Science+Business Media Dordrecht.


Klimentopoulou A.,National and Kapodistrian University of Athens | Antonopoulos C.N.,National and Kapodistrian University of Athens | Papadopoulou C.,National and Kapodistrian University of Athens | Kanavidis P.,National and Kapodistrian University of Athens | And 8 more authors.
Pediatric Blood and Cancer | Year: 2012

Background: Maternal smoking during pregnancy has been often implicated in the development of childhood leukemia with ambiguous results. Hence, we conducted a meta-analysis aiming to summarize current evidence and quantify any tentative impact. Procedure: We retrieved one cohort (553 leukemias compared to 1,440,542 children), 20 case-control studies and also analyzed the updated Greek case-control dataset with unpublished data, yielding in total 11,092 cases and 25,221 controls. Results: Odds ratios reported in the studies included ranged from 0.70 to 2.20 for acute lymphocytic (ALL) and from 0.60 to 2.17 for acute myelocytic leukemia (AML). The combined effect regarding the association of maternal smoking (any vs. no) and leukemia risk was 1.03 for ALL (95% CI=0.95-1.12, random effects model) and 0.99 for AML (95% CI=0.90-1.09, fixed effects model). The results remained unchanged when sensitivity analyses were undertaken of studies reporting same maternal smoking periods, those focusing only on childhood leukemia deaths or investigations which did not clearly define AML subtype. Conclusions: The findings of the meta-analysis challenge the limits of traditional epidemiology to provide sound inferences when point estimates of constituent studies range around the null. In particular, this study provides no support to a hypothesis linking maternal smoking during pregnancy with subsequent development of main childhood leukemia subtypes. Further investigations employing molecular and genetic epidemiology, however, might be needed in the hope to reveal even minimal risks pertaining individuals with specific susceptibility to tobacco compounds who sustain high environmental exposures prenatally or postnatally. © 2011 Wiley Periodicals, Inc.

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