Colon cancer survival differs from right side to left side and lymph node harvest number matter

Background

Right-sided colorectal cancer (CRC) has worse survival than does left-sided CRC. The objective of this study was to further assess the impact of right-side location on survival and the role of the extent of lymphadenectomy.

Methods

All CRCs diagnosed between 2000 and 2012 in Emilia-Romagna Region, Italy, were included. Data for stage, grade, histology, screening history, and number of removed lymph nodes (LN) were collected. Multivariable Cox regression models were used to estimate hazard ratios (HR), with relative 95% confidence intervals (95%CI), of right vs. left colon and of removing < 12, 12–21 or > 21 lymph nodes by cancer site.

Results

During the study period, 29,358 patients were registered (8828 right colon, 18,852 left colon, 1678 transverse). Patients with right cancer were more often older, females, with advanced stage and high grade, and higher number of removed LNs. Five-year survival was lower in the right than in the left colon (55.2% vs 59.7%). In multivariable analysis, right colon showed a lower survival when adjusting for age, sex, and screening status (HR 1.12, 95%CI 1.04–1.21). Stratification by number of lymph nodes removed (12–21 or > 21) was associated with better survival in right colon (HR 0.54, 95%CI 0.40–0.72 and HR 0.40, 95%CI 0.30–0.55, respectively) compared to left colon (HR 0.89, 95%CI 0.76–1.06 and HR 0.83, 95%CI 0.69–1.01, respectively).

Conclusions

This study confirms that right CRC has worse survival; the association is not due to screening status. An adequate removal of lymph nodes is associated with better survival, although the direction of the association in terms of causal links is not clear.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10746-4.

A virtual reality interface for the immersive manipulation of live microscopic systems

For more than three centuries we have been watching and studying microscopic phenomena behind a microscope. We discovered that cells live in a physical environment whose predominant factors are no longer those of our scale and for which we lack a direct experience and consequently a deep intuition. Here we demonstrate a new instrument which, by integrating holographic and virtual reality technologies, allows the user to be completely immersed in a dynamic virtual world which is a simultaneous replica of a real system under the microscope. We use holographic microscopy for fast 3D imaging and real-time rendering on a virtual reality headset. At the same time, hand tracking data is used to dynamically generate holographic optical traps that can be used as virtual projections of the user hands to interactively grab and manipulate ensembles of microparticles or living motile cells.

Online group psychotherapy for patients with binge eating disorder during COVID-19 emergency

Introduction

On March 13th 2020, in execution of the Law Decree 14/2020 regarding the reorganization of National Health Care related to COVID-19 emergency, all non-urgent outpatient healthcare services were suspended in Italy. The present work describes remote support and online group psychotherapy set in motion during COVID-19 emergency for outpatients with Binge Eating Disorder.

Objectives

Aim of the present work is to describe and evaluate online support and group psychotherapy for outpatients with Binge Eating Disorder during lockdown due to COVID-19 emergency. Outcomes were evaluated by remote administration of questionnaires.

Methods

20 outpatients with Binge Eating Disorder, treated by psychotherapists of Hospital Psychology Unit in Psychiatry Day Hospital of an Italian General Hospital, received remote support by phone calls and online group psychotherapy from march to may 2020. During the first two weeks, patients were supported via phone calls. From the third week on, they took part to online group psychotherapy sessions, held every week at the same day and time. Pre-post remote administration of Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and the Questionnaire of Eating Behaviours (Scheda dei Comportamenti Alimentari, SCA) was used to evaluate outcomes. Data were analyzed by Student’s t-test.

Results

No significant difference was found, thus indicating stability of symptomatology.

Conclusions

Lockdown was a highly stressful period, in which many people lost control on eating behaviours and those with Binge Eating Disorder were expected to have an exacerbation of symptoms. Remote support and online group psychotherapy proved effective in protecting patients from a possible aggravation of their condition.

Socioeconomic status and skin cancer incidence: a population-based, cohort study in the province of Ferrara, northern Italy

To assess the impact of socioeconomic status (SES) on the occurrence of skin cancer in the population living in the province of Ferrara, Italy, a retrospective cohort of patients with squamous cell carcinoma (SCC), basal cell carcinoma (BCC) or malignant melanoma (MM), provided by the local cancer registry, was investigated. The SES was expressed through an ecological-based deprivation index. During the 8-year study period (2006-2013, total person-years 2 859 137), 6051 carcinomas (1535 SCCs, 4365 BCCs) and 459 MMs were diagnosed. Both crude and standardized (on the European population) rates and the standardized incidence ratio showed a direct correlation between BCC and SES. Multivariate analysis confirmed these results for BCC and also for MM, while it showed an excess of SCC incidence in the lowest SES subgroup. This study shows, for the first time, to our knowledge, opposite effects of SES on SCC and BCC occurrence. A role of environmental factors conditioned by SES may be hypothesized.

Association of Sarcopenia and Body Composition With Short-term Outcomes After Liver Resection for Malignant Tumors

Importance

Previous retrospective studies have shown that sarcopenia substantially alters the postoperative and oncological outcomes after liver resection for malignant tumors. However, the evidence is limited to small retrospective studies with heterogeneous results and the lack of standardized measurements of sarcopenia.

Objective

To investigate the role of sarcopenia as a risk factor associated with 90-day morbidity after liver resection for malignant tumors.

Design, Setting, and Participants

This cohort study included 234 consecutive patients undergoing liver resection for malignant tumors at San Camillo Forlanini Hospital, Rome, Italy, between June 1, 2018, and December 15, 2019. Muscle mass and strength were assessed using the skeletal muscle index (SMI) on preoperative computed tomographic scans and the handgrip strength test, respectively. Patients were then divided into the following 4 groups: group A (normal muscle mass and strength), group B (reduced muscle strength), group C (reduced muscle mass), and group D (reduced muscle mass and strength).

Main Outcomes and Measures

The primary outcome of the study was 90-day morbidity. The following secondary outcomes were investigated: 90-day mortality, hospital stay, and readmission rate.

Results

Sixty-four major and 170 minor hepatectomies were performed in 234 patients (median age, 66.50 [interquartile range, 58.00-74.25] years; 158 men [67.5%]). The median SMI of the entire population was 46.22 (interquartile range, 38.60-58.20) cm/m2. The median handgrip strength was 30.80 (interquartile range, 22.30-36.90) kg. Patients in group D had a statistically significantly higher rate of 90-day morbidity than patients in the other groups (51.5% [35 of 68] vs 38.7% [29 of 75] in group C, 23.1% [3 of 13] in group B, and 6.4% [5 of 78] in group A; P < .001). Compared with patients in the other groups, those in group D had a longer hospital stay (10 days vs 8 days in group C, 9 days in group B, and 6 days in group A; P < .001), and more patients in this group were readmitted to the hospital (8.8% [6 of 68] vs 5.3% [4 of 75] in group C, 7.7% [1 of 13] in group B, and 0% [0 of 78] in group A; P = .02). Sarcopenia, portal hypertension, liver cirrhosis, and biliary reconstruction were independent risk factors associated with 90-day morbidity.

Conclusions and Relevance

Sarcopenia appears to be associated with adverse outcomes after liver resection for malignant tumors. Both muscle mass measurements on computed tomographic scans and muscle strength assessments with the handgrip strength test should be performed at the first clinical encounter to better classify patients and to minimize the risk of morbidity.

Telephone consultation during Coronavirus outbreak in a Pediatric Emergency Department: methodological approach of a tertiary care center in a COVID-19 hospital setting

OBJECTIVE

A computerized system of telephone consultation has been experimented at the Pediatric Emergency Department (ED) of Policlinico Gemelli Hospital in Rome during the outbreak of Coronavirus Disease 2019 (COVID-19).

MATERIALS AND METHODS

Twenty monothematic items with a series of questions to evaluate child's clinical conditions have been set up in order to evaluate the different situations according to their severity. All items were highlighted according to conventional scores corresponding to the different answers (yes/no) given by the child's parents. This system has been implemented with large diffusion of computer programs and applications by the availability of a computer station in every ED room.

RESULTS

The system allows healthcare workers to establish the medical check-up urgency which may be immediate, within the next 24 hours or scheduled in the pediatric ward. Therefore, it has been implemented a telephone triage consultation with a standardized method.

CONCLUSIONS

Telephone consultation during outbreaks, considering the risks of contagion, allows healthcare workers to decrease the concern of families and to reduce indiscriminate access to ED. The remote approach will not solve logistic and setting problems related to COVID-19 outbreak17, but it would be a valid tool to improve medical evaluation without deep change in infrastructure and clinical organization.

Mid-term trends and recent birth-cohort-dependent changes in incidence rates of cutaneous malignant melanoma in Italy

In Oceania, North America and north-western Europe, after decades of increase, cutaneous malignant melanoma (CMM) rates began to stabilise or decline before 2000. Anecdotal evidence suggests that the reversal of the incidence trend is extending to southern Europe. To obtain a formal confirmation, this nationwide study from Italy investigated the incidence trends by birth cohort. Twenty-one local cancer registries covering a population of 15 814 455 provided incidence data for primary CMM registered between 1994 and 2013. Trends in age-standardised rates were analysed using joinpoint regression models and age-period-cohort models. Age-standardised incidence showed a consistent increase throughout the period (estimated annual percent change, 3.6 [95% confidence interval, 3.2-4.0] among men and 2.5 [2.0-3.1] among women). This pattern was confirmed by a sensitivity analysis with removal of low-risk populations of southern Italy. The rates, however, showed a stabilisation or a decrease in men and women aged below 35. Using the cohort of 1949-the median cohort with respect to the number of cases for both genders-as a reference, the incidence rate ratio increased for successive cohorts born until 1973 (women) and 1975 (men), and subsequently tended to decline. For the most recent cohorts in both genders, the risk of disease returned to the level of the cohort of 1949. The changes observed in the latest generations can be interpreted as the earliest manifestations of a birth-cohort-dependent incidence decrease. Our study adds to previous data indicating that the reversal of the long-term upward incidence trend of CMM is extending to southern Europe.

Incidence of interval breast cancer among women aged 45-49 in an organised mammography screening setting

OBJECTIVE

To estimate the proportional incidence (PI) of first- and second-year interval breast cancer among women aged 45-49.

METHODS

In the Emilia-Romagna Region (northern Italy), women aged 45-49 are invited to mammography screening annually, and women aged 50-74 biennially. For younger ones, the proportional incidence of interval cancer in the first and unique interval year was calculated using standard methods. For the second, hypothetical year, it was estimated using two different estimates of the ratio between the second- and the first-year proportional incidence observed among women aged 50-54. Overall, 567,151 negative mammography records were used.

RESULTS

In the first interval year, the observed proportional incidence of interval cancer among women aged 45-49 was 0.27 (95% confidence interval (CI), 0.22-0.33), within the European limit considered desirable for women aged 50-69 (<0.30). In the second, hypothetical interval year, the estimated proportional incidence ranged from 0.61 (95% CI, 0.43-0.86) to 0.48 (95% CI, 0.31-0.76) depending on whether the estimate was based on data from the pre-digital or digital era, respectively.

CONCLUSION

The more up-to-date estimate of 0.48, slightly below the maximum limit considered acceptable for women aged 50-69 (<0.50), suggests that a screening interval of two years may also be an acceptable option for women aged 45-49.

Incidence trends of vulvar squamous cell carcinoma in Italy from 1990 to 2015

OBJECTIVE

The incidence of vulvar squamous cell carcinoma has increased for decades in most Western countries - a trend virtually restricted to women aged <50 or 60 years. In southern Europe, conversely, the trends have been insufficiently studied. This article reports a study from Italy.

METHOD

Thirty-eight local cancer registries, currently covering 15,274,070 women, equivalent to 49.2% of the Italian national female population, participated. Invasive cancers registered between 1990 and 2015 with an International Classification of Diseases for Oncology, 3rd revision, topography code C51 and morphology codes compatible with vulvar squamous cell carcinoma (n = 6294) were eligible. Incidence trends were analysed using joinpoint regression models, with calculation of the estimated annual percent change (EAPC), and age-period-cohort models.

RESULTS

Total incidence showed a regular and significant decreasing trend (EAPC, -0.96; 95% confidence interval (CI), -1.43 to -0.48). This was entirely accounted for by women aged ≥60 years (EAPC, -1.34; 95% CI, -1.86 to -0.81). For younger women, the EAPC between 1990 and 2012 was 1.20 (95% CI, 0.34 to 2.06) with a non-significant acceleration thereafter. This pattern did not vary substantially in a sensitivity analysis for the effect of geographic area and duration of the registry. The age-period-cohort analysis revealed a risk decrease in cohorts born between 1905 and 1940 and a new increase in cohorts born since 1945.

CONCLUSIONS

The decreasing trend observed among older women and the resulting decrease in total rate are at variance with reports from most Western countries. Age-period-cohort analysis confirmed a decreasing trend for earliest birth cohorts and an opposite one for recent ones.

Proportional incidence of interval colorectal cancer in a large population-based faecal immunochemical test screening programme

BACKGROUND

The European guidelines for quality assurance in colorectal cancer (CRC) screening recommend that interval cancer rate be expressed as a proportion of background incidence rate.

AIM

To determine the crude and adjusted proportional incidence of interval CRC in an Italian regional two-yearly faecal immunochemical test (FIT) screening programme.

METHODS

The programme (year of implementation, 2005) is targeted at over 1,000,000 people aged 50-69 years. The test is a one-sample OC-Sensor (Eiken Chemical Co., Tokyo, Japan). The study covered one-third of the regional area. Excerpts of 434,295 eligible negative FIT records dated 2005-2012 from 193,193 subjects were retrieved from the regional CRC screening data warehouse. By 31 December 2013, the cohort accumulated 198,302 man-years and 235,370 woman-years. Interval CRCs were identified by record-linkage with the local population-based cancer registry. Their number was divided by the expected number, estimated with age-period-cohort models, to obtain the proportional incidence.

RESULTS

The proportional incidence of interval CRC for men and women was, respectively, 0.06 (95% confidence interval (CI), 0.04-0.09) and 0.17 (95% CI, 0.13-0.23) in the first interval year, and 0.21 (95% CI, 0.16-0.26) and 0.28 (95% CI, 0.22-0.36) in the second year.

CONCLUSIONS

The results were acceptable and in line with previous studies.

A regional population-based hereditary breast cancer screening tool in Italy: First 5-year results

Background

Up to 10% of individuals with breast cancer (BC) belong to families with hereditary syndromes. The aim of this study was to develop an instrument to identify individuals/families at high‐hereditary risk for BC and offer dedicated surveillance programs according to different risks.

Methods

The instrument consisted of a primary questionnaire collecting history of BC and ovarian cancer (OC). This questionnaire was applied to women enrolled in the Emilia‐Romagna Breast Cancer Screening Program. General practitioners (GPs) and specialists could propose the same questionnaire too. Women with a score of ≥ 2, were invited to complete an oncogenetic counseling. According to the Tyrer‐Cuzick evaluation, women considered at high risk were invited to involve the most representative alive individual of the family affected with BC/OC for BRCA1/2 genetic testing.

Results

Since January 2012 and December 2016, 660 040 women were evaluated by the regional screening program, of which 22 289 (3.5%) were invited to the Spoke evaluation, but only 5615 accepted (25.2%). Totally, also considering women sent by GPs and specialists, 11 667 were assessed and 5554 were sent to the Hub evaluation. Finally, 2342 (42.8%) women fulfilled the criteria for genetic testing, and 544 (23.2%) resulted BRCA1/2 mutation carriers.

Conclusions

To our knowledge, this is the first regional population‐based multistep model that is aimed to identify individuals with BRCA1/2 mutations and to offer an intensive surveillance program for hereditary‐high risk women. This tool is feasible and effective, even if more efforts must be performed to increase the acceptance of multiple assessments by the study population.

Changes in the incidence of cervical tumours by disease stage in a cytology-based screening programme

OBJECTIVES

To report changes in incidence of cervical tumours by disease stage, following the introduction of an organized cytology-based screening programme.

METHODS

An intention-to-screen study of a cytology-based screening programme targeting 1,219,000 women aged 25-64 in northern Italy was carried out. Based on the previously reported trend in total incidence of cervical cancer, the study period 1995-2014 was divided into 1995-1996 (pre-screening, or reference, years), 1997-1998 (screening implementation phase), 1999-2006 (transition phase, when incidence decreased), and 2007-2014 (steady-state phase, when incidence stabilized again). Tumour stage was categorized as preinvasive (cervical intraepithelial neoplasia grade 3 (CIN3) and adenocarcinoma in situ), early (pT1a), advanced (pT1b or greater, ypT), and unknown (pT1 not otherwise specified, pTx, missing information). Average annual incidence rates observed in each phase were compared with the expected (reference) rates, using the incidence rate ratio, calculated with a Poisson regression model.

RESULTS

In the steady-state phase, incidence rate ratios were: CIN3, 1.55 (95% confidence interval, 1.41-1.70); early-stage squamous carcinoma, 0.49 (0.36-0.67); advanced-stage squamous carcinoma, 0.44 (0.33-0.57); unknown-stage squamous carcinoma, 0.69 (0.48-0.99); adenocarcinoma in situ, 1.44 (0.72-2.88); early-stage adenocarcinoma, 2.65 (0.82-8.53); advanced-stage adenocarcinoma, 1.03 (0.56-1.91); and unknown-stage adenocarcinoma, 0.46 (0.23-0.92).

CONCLUSIONS

After stabilization, changes in incidence by tumour stage included a 55% increase for CIN3 and a 50-55% decrease both for early- and advanced-stage squamous carcinoma, but no significant changes for glandular tumours. These data will serve to quantify the incremental impact of the implementation of human papillomavirus-based screening, introduced in 2015.

Self-reported health conditions among refugees and asylum-seekers (AS) in Italian hosting centres

Key messages

Migrants’ health in hosting centres is good; AS by sea, married and with higher education are more at risk, especially as regards mental health; depression warning signs must not go unnoticed. AS in hosting centres represent a heterogeneous population: they may benefit from a more tailored assistance, considering differences in travel conditions, cultural background and life expectations.

The burden of HPV-related diseases in Italy, 2001-12

Background

Human papillomavirus (HPV) infection is the main cause of cervical cancer and plays a relevant role in the development of genital warts and of the cancer of penis and anus, head/neck, oropharynx and genitourinary system. The aim of this study is the evaluation of hospitalizations due to HPV-related pathologies in 2001-12 in Italy.

Methods

The national hospital discharge forms were provided by the Ministry of Health. The HPV-related hospitalizations were identified using specific diagnostic codes, accordingly to the ICD-9-CM coding system. The proportion of hospitalizations of potentially HPV-related pathologies, obtained from the literature, was evaluated as well as the hospitalization rates (hr) and their trend over time.

Results

Uterine cervical cancer and CIN III accounted for 40% of hospitalizations (hr: 15.6/100 000 and 17.6/100 000, respectively). Head/neck and oropharynx pathologies accounted for 24.5% of cases (hr: 16/100 000 and 3.9/100 000, in males and females, respectively), followed by genital warts (17.3% of hospitalizations; hr: 7.5/100 000 in males and 8.52/100 000 in females), anal (8.1% of hospitalizations), genitourinary (7.7%) and penis cancers (2.2%).

Conclusions

The study, even if limited to the evaluation of hospitalizations, points out how HPV-related pathologies continue to be a relevant public health issue in Italy with a high impact on population.

National Estimates of Cancer Patients Survival in Italy: A Model-Based Method

Aims and background

To provide model-based estimates of all cancers patient survival in Italy and in Italian large geographical areas (North-West, North-East, Center, South), where only partial coverage of cancer registries data is available, and to describe them in terms of time trends. Moreover, to measure the degree of representativeness of cancer patient survival obtained from Italian cancer registries data.

Methods

Relative survival in the four main Italian geographical areas was estimated by a parametric mixture model belonging to the class of “cure” survival models. Data used are from Italian cancer registries, stratified by sex, period of diagnosis and age. The Italian national survival was obtained as a weighted average of these area-specific estimates, with weights proportional to the number of estimated incident cases in every area. The model takes into account also differences in survival temporal trends between the areas.

Results

Relative survival for all cancers combined in Italian patients diagnosed in 1990-1994 was estimated to be higher in women (53%) than in men (38%) at 5 years from the diagnosis. The survival trend is increasing by period and decreasing creasing by age, both for men and women. The greatest gain in terms of survival was obtained by the elderly, with annual mean growth rates in the period 1978-1994 equal to 3.5% and 3.2% for men and women, respectively. More than 50% of the youngest cancer patients were “cured”, whereas for the elderly this proportion dropped to 15% and 25% for men and women, respectively. The South of Italy had the lowest survival and the North the most pronounced increase.

Conclusions

The obtained national survival estimates are similar, but not identical, to previously published estimates, in which Italian registries’ data were pooled without any adjustment for geographical representativeness. The four Italian areas have different survival levels and trends, showing variability within the country. The differences in survival between men and women may be explained by the different proportion of lethal cancers. Among males, most cases had a poor prognosis (lung and stomach cancers), whereas among females the largest proportion was made up of curable and less lethal cancers (breast cancer).

Changes in life expectancy for cancer patients over time since diagnosis

•

Research question: how cancer impacts on LE changes during patients’ entire life

•

LE increased in patients surviving the first years and decreasing thereafter.

•

Patients’ LE in the long-term approached but seldom reached the general population’s LE.

•

This method describes when cancer survivors’ excess risk of death became negligible.

•

Life expectancy indicator is easy to be understood and interpreted by patients.

The aims of this study were to provide life expectancy (LE) estimates of cancer patients at diagnosis and LE changes over time since diagnosis to describe the impact of cancer during patients' entire lives. Cancer patients' LE was calculated by standard period life table methodology using the relative survival of Italian patients diagnosed in population-based cancer registries in 1985–2011 with follow-up to 2013. Data were smoothed using a polynomial model and years of life lost (YLL) were calculated as the difference between patients' LE and that of the age- and sex-matched general population. The YLL at diagnosis was highest at the youngest age at diagnosis, steadily decreasing thereafter. For patients diagnosed at age 45 years, the YLL was above 20 for lung and ovarian cancers and below 6 for thyroid cancer in women and melanoma in men. LE progressively increased in patients surviving the first years, decreasing thereafter, to approach that of the general population. YLL in the long run mainly depends on attained age. Providing quantitative data is essential to better define clinical follow-up and plan health care resource allocation. These results help assess when the excess risk of death from tumour becomes negligible in cancer survivors.

Second primary malignancies in patients with non-melanoma skin cancer: Results from a cancer registry-based study in Emilia Romagna, north-east Italy

BACKGROUND

previous research on the risk of subsequent, primary non-cutaneous malignancies among patients with non-melanoma skin cancers (NMSCs) led to conflicting results. We aimed to investigate a possible link between NMSC and second primary malignancies by using the population-based data available in cancer registries.

METHODS

this observational study retrospectively assessed the risk of occurrence of both synchronous and methachronous second primary tumours in a cohort of cancer patients whose first diagnosis was NMSC. The cohort came from the network of general cancer registries of the Emilia-Romagna Region, northeast Italy, in the period between 1978 and 2012, and was compared with the general population living in the same area. Two main indexes were used: i) Standardized Incidence Ratio (SIR), calculated as the ratio between the observed and the expected number of second cancers and ii) Excess Absolute Risk (EAR), expressing the absolute excess or deficit of second cancer incidence.

RESULTS

in the period analysed (1978-2012, 72,503,157 person/years, PYs), 89,912 primary NMSC were found in 76,414 patients. Among them, 14,195 developed a second primary cancer in the subsequent 501,763 follow-up PYs. NMSC patients showed an overall SIR of 1.22 (CI 95% 1.20-1,24) and an EAR of 5.11 cases/1000 PYs (CI 95% 4.48-5.74).

CONCLUSIONS

the study results showed that NMSC patients had an increase in relative risk and, at least for some tumours, in absolute risk of developing a second cancer when compared with the general population. Genetic, environmental and personal risk factors may influence this finding.

First report of the invasive mosquito Aedes koreicus (Diptera: Culicidae) and of its establishment in Liguria, northwest Italy

BACKGROUND

Invasive mosquito species (IMS) of the genus Aedes are a cause of increasing concern in Europe owing to their ability to vector important human viral diseases. Entomological surveillance to early detect alien mosquito and flavivirus circulation in Liguria, northwest Italy, has been carried out since 2011.

RESULTS

The invasive species Aedes koreicus was first detected in Genoa in September 2015, when a male specimen was caught near the international airport; species identity was confirmed by genetic analysis. Over the next three years, 86 more adult specimens were trapped at sites throughout the city, accounting for 0.50% of all mosquitoes and 1.04% of Aedes sp. mosquitoes trapped in Genova in the four-year period 2015-2018. So far, no other monitored sites in Liguria have revealed the presence of this species. Ovitraps at two sites became positive for the species in July-August 2017. All female Ae. koreicus pools analysed were negative in biomolecular assays for Flavivirus.

CONCLUSIONS

Our findings of Ae. koreicus in Genoa constitute, to the best of our knowledge, the first report of the species in northwest Italy and in a Mediterranean port city. The species appears to be established; trapping and climatic data support survival of Ae. koreicus in the area through three consecutive winters. Monitoring of adult mosquitoes detected the species two years before its discovery with ovitraps; trapping for adult specimens appears to be a more effective tool for the early detection of IMS. The airport (located near the commercial port area) and the flower market are the most probable sites of introduction; however, the exact time and place of arrival of this IMS in Liguria remain unknown. Based on morphological and genetic data, a common origin for most of the Ae. koreicus populations established in Europe is suspected. So far, no control measures have been adopted in Genoa and the species will probably colonize an even wider area in the next few years.

Prognosis and cure of long-term cancer survivors: A population-based estimation

Background

Increasing evidence of cure for some neoplasms has emerged in recent years. The study aimed to estimate population‐based indicators of cancer cure.

Methods

Information on more than half a million cancer patients aged 15‐74 years collected by population‐based Italian cancer registries and mixture cure models were used to estimate the life expectancy of fatal tumors (LEFT), proportions of patients with similar death rates of the general population (cure fraction), and time to reach 5‐year conditional relative survival (CRS) >90% or 95% (time to cure).

Results

Between 1990 and 2000, the median LEFT increased >1 year for breast (from 8.1 to 9.4 years) and prostate cancers (from 5.2 to 7.4 years). Median LEFT in 1990 was >5 years for testicular cancers (5.8) and Hodgkin lymphoma (6.3) below 45 years of age. In both sexes, it was ≤0.5 years for pancreatic cancers and NHL in 1990 and in 2000. The cure fraction showed a 10% increase between 1990 and 2000. It was 95% for thyroid cancer in women, 94% for testis, 75% for prostate, 67% for breast cancers, and <20% for liver, lung, and pancreatic cancers. Time to 5‐year CRS >95% was <10 years for testis, thyroid, colon cancers, and melanoma. For breast and prostate cancers, the 5‐year CRS >90% was reached in <10 years but a small excess remained for >15 years.

Conclusions

The study findings confirmed that several cancer types are curable. Became aware of the possibility of cancer cure has relevant clinical and social impacts.

Estimating the impact of an organised screening programme on cervical cancer incidence: A 26-year study from northern Italy

The impact of the organised cervical cancer (CC) screening programmes implemented in Europe since the 1990s has been insufficiently evaluated. We investigated the changes in CC incidence following the introduction of a screening programme in the Emilia-Romagna Region (northern Italy). The study period was 1988-2013. The programme, targeting women aged 25-64 years (1,219,000 in 2018), started in 1998. The annual incidence rates that would be expected in 1998-2013 in the absence of screening were estimated, first, by analysing the annual rates in 1988-1997 with a log-linear model and, second, by analysing the annual rates in 1988-2013 with an age-period model in which the period effect was enforced to be linear. Cervical adenocarcinoma incidence trend over the entire period was used to validate both estimates. Observed annual rates were compared to the two series of expected ones with the incidence rate ratio (IRR). Incidence remained stable during 1988-1997, peaked in 1998 and then decreased until 2007, when it stabilised. The two series of expected rates were virtually coincident and their trends roughly paralleled the stable adenocarcinoma incidence trend. After 2007, the median IRR was 0.60 (95% confidence interval, 0.45-0.81) based on the log-linear model and 0.58 (95% confidence interval, 0.34-0.97) based on the age-period model. Thirty-six to seventy-five CC cases were prevented annually for an average annual frequency of 6.5 per 100,000 women in the target population. In summary, consistent circumstantial evidences were obtained that the organised screening programme brought about a 40% reduction in annual CC incidence after 10 years.

Survival after the diagnosis of breast or colorectal cancer in the GAZA Strip from 2005 to 2014

Background

Within a dramatic socio-political context, cancer represents a growing health burden in the Gaza Strip. We investigated the survival experience of people diagnosed with breast (BC) or colorectal (CRC) cancer from 2005 to 2014.

Methods

Data included 1360 BC cases (median age 55.1 years) and 722 CRC cases (median age: 59.5 years; 52.5% men) recorded by the Gaza Cancer Registry according to a standard protocol. Clinical information was available for cases diagnosed in 2005–2006 only. Survival probabilities were estimated by Kaplan-Meyer method, while hazard ratios (HRs) and 95% confidence intervals (CI), adjusted for age and sex, were computed to assess factors associated with the risk of death.

Results

Five-year survival was 65.1% for women with BC and 50.2% for patients with CRC. Advanced age (> 65 years), stage, and grade increased the death risk. Full access to therapies was associated with a reduced risk of death as compared with patients who had limited access (HR = 0.26, 95% CI:0.13–0.51 for BC; and HR = 0.11, 95% CI:0.04–0.31 for CRC).

Conclusion(s)

The 5-year survival after BC or CRC in the Gaza Strip was in line with estimates from surrounding Arab countries, but it was much lower than in developed Mediterranean countries (e.g., in Italy or in Jewish people in Israel).

[TNM Classification of malignant tumours - Eighth edition: which news?]

The eighth edition of TNM classification of malignant tumours has been published by the Union for International Cancer Control in January 2017. As for the previous editions - from the third on - it has been translated into Italian and recently published in our Country. This article explains the main changes from the previous edition: new classifications, some major revisions of cancer staging rules, the introduction of a grid of prognostic factors for each neoplasia and the addition of two chapters. These two chapters are about the essential TNM and the paediatric tumours, and have been developed in order to facilitate the use of data by Cancer Registries.

The impact of overdiagnosis on thyroid cancer epidemic in Italy,1998-2012

AIMS

In Italy, incidence rates of thyroid cancer (TC) are among the highest worldwide with substantial intracountry heterogeneity. The aim of the study was to examine time trends of TC incidence in Italy and to estimate the proportion of TC cases potentially attributable to overdiagnosis.

METHODS

Data on TC cases reported to Italian cancer registries during 1998-2012 aged <85 years were included. Age-standardised incidence rates (ASR) were computed by sex, period, and histology. TC overdiagnosis was estimated by sex, period, age, and Italian region.

RESULTS

In Italy between 1998-2002 and 2008-2012, TC ASR increased of 74% in women (from 16.2 to 28.2/100,000) and of 90% in men (from 5.3 to 10.1/100,000). ASR increases were nearly exclusively due to papillary TC (+91% in women, +120% in men). In both sexes, more than three-fold differences emerged between regions with highest and lowest ASR. Among TC cases diagnosed in 1998-2012 in Italy, we estimated that overdiagnosis accounted for 75% of cases in women and 63% in men and increased over the study period leading to overdiagnosis of 79% in women and 67% in men in 2008-2012. Notably, overdiagnosis was over 80% among women aged <55 years, and substantial variations were documented across Italian regions, in both genders.

CONCLUSION(S)

Incidence rates of TC are steadily increasing in Italy and largely due to overdiagnosis. These findings call for an update of thyroid gland examination practices in the asymptomatic general population, at national and regional levels.

Clinical Usefulness of Estrogen Receptor Immunocytochemistry in Human Breast Cancer

We assessed the reliability of the immunocytochemical assay of estrogen receptor (ER-ICA) as a marker of clinical outcome. Relapse-free interval (RFI) and overall survival (OS) according to ER-ICA status were retrospectively evaluated on a series of 210 patients who had undergone surgery for primary breast cancer between January 1985 and December 1988. ER assay by the dextran-coated charcoal method (DCC) was also performed in 189 tumors. A significant positive correlation was found between the DCC and ER-ICA assays, with an overall agreement of 79 %. ER-ICA status showed a prognostic predictive power with respect to OS and RFI in the whole series of patients and in the subset of node-positive patients. It was also a marker of outcome with respect to OS in the subsets of node-negative patients and patients with tumors ≤ 2 cm in diameter. Moreover, the predictive value of the ER-ICA assay was higher than that of the DCC assay in the present study. These findings emphasize the clinical usefulness of the ER-ICA assay as a measure for prognosis.

Immunohistochemical Expression of c-erbB-2 in Human Breast Cancer by Monoclonal Antibody: Correlation with Lymph Node and Er Status

c-erbB-2 Protein expression was investigated in a series of fifty primary breast cancers by means of a specific monoclonal antibody and immunocytochemistry. Specific staining was observed at the plasma membrane level of neoplastic cells, according to the reported localization of c-erbB-2 protein. Sixty-four percent of tumors scored positive, with a variable amount of stained cells. The rate of protein expression was found to exceed the reported gene amplification. No relationship was observed between c-erbB-2 protein staining and age, meno pausal status or histologic subtypes. An inverse association was found between c'erbB-2 protein staining and estrogen receptor content of tumors, assayed by immunocytochemistry. A positive relationship was observed between c-erbB-2 protein expression and presence of axillary node metastasis. These findings suggest that c-erbB-2 protein expression is a marker of tumor aggressiveness and that its prognostic power deserves further investigation both in node-positive and node-negative patients.

Characteristics of people living in Italy after a cancer diagnosis in 2010 and projections to 2020

BACKGROUND

Estimates of cancer prevalence are widely based on limited duration, often including patients living after a cancer diagnosis made in the previous 5 years and less frequently on complete prevalence (i.e., including all patients regardless of the time elapsed since diagnosis). This study aims to provide estimates of complete cancer prevalence in Italy by sex, age, and time since diagnosis for all cancers combined, and for selected cancer types. Projections were made up to 2020, overall and by time since diagnosis.

METHODS

Data were from 27 Italian population-based cancer registries, covering 32% of the Italian population, able to provide at least 7 years of registration as of December 2009 and follow-up of vital status as of December 2013. The data were used to compute the limited-duration prevalence, in order to estimate the complete prevalence by means of the COMPREV software.

RESULTS

In 2010, 2,637,975 persons were estimated to live in Italy after a cancer diagnosis, 1.2 million men and 1.4 million women, or 4.6% of the Italian population. A quarter of male prevalent cases had prostate cancer (n = 305,044), while 42% of prevalent women had breast cancer (n = 604,841). More than 1.5 million people (2.7% of Italians) were alive since 5 or more years after diagnosis and 20% since ≥15 years. It is projected that, in 2020 in Italy, there will be 3.6 million prevalent cancer cases (+ 37% vs 2010). The largest 10-year increases are foreseen for prostate (+ 85%) and for thyroid cancers (+ 79%), and for long-term survivors diagnosed since 20 or more years (+ 45%). Among the population aged ≥75 years, 22% will have had a previous cancer diagnosis.

CONCLUSIONS

The number of persons living after a cancer diagnosis is estimated to rise of approximately 3% per year in Italy. The availability of detailed estimates and projections of the complete prevalence are intended to help the implementation of guidelines aimed to enhance the long-term follow-up of cancer survivors and to contribute their rehabilitation needs.

The Burden of Rare Cancers in Italy: The Surveillance of Rare Cancers in Italy (RITA) Project

Aims and background

The project Surveillance of rare cancers in Italy (RITA) provides, for the first time, estimates of the burden of rare cancers in Italy based on the list of rare cancers proposed in collaboration with the European project Surveillance of Rare Cancers in Europe (RARECARE).

Methods

RITA analyzed data from Italian population-based cancer registries (CR). The period of diagnosis was 1988 to 2002, and vital status information was available up to December 31, 2003. Incidence rates were estimated for the period 1995–2002, survival for the years 2000–2002 (with the period method of Brenner), and complete prevalence at January 1, 2003.

Results

Rare cancers are those with an incidence <6/100,000/year. In Italy, every year there are 60,000 new diagnoses of rare cancers corresponding to 15% of all new cancer diagnoses. Five-year relative survival was on the average worse for rare cancers (53%) than for common cancers (73%). A total of 770,000 patients were living in Italy in 2008 with a diagnosis of a rare cancer, 22% of the total cancer prevalence.

Conclusions

Our estimates constitute a useful base for further research and support the idea that rare cancers are a public health problem that deserves attention. Centers of expertise for rare cancers that pool cases, expertise and resources could ensure an adequate clinical management for these diseases. Our data also showed that cancer registries are suitable sources of data to estimate incidence, prevalence and survival for rare cancers and should continue to monitoring rare cancers in Italy.

Strong Seasonality in the Diagnosis of Skin Melanoma in Italy: The Italian Network of Cancer Registries (AIRTUM) Study

Aim

To evaluate seasonality in the diagnosis of cutaneous melanoma in Italy.

Methods

A total of 16,284 invasive (and 1,235 in situ) cutaneous melanomas incident from 1978 to 2002 in 14 cancer registries belonging to the Italian Network of Cancer Registries (AIRTUM) was analyzed. We used the Walter and Elwood test to evaluate seasonality. The monthly distribution of diagnosis was evaluated for sex, skin site, melanoma morphology and period of diagnosis.

Results

The overall monthly diagnosis of invasive melanoma showed a statistically significant excess around the month of June. The same pattern was present for males and females, across age-groups and periods of time. All skin sites showed a cycling trend, melanoma of the head and neck peaked around April, all the others peaked around June. As regards morphologic types, a cyclic trend was evident for superficial-spreading melanomas (peak around July), for not-specified melanomas (June) and for other histotypes (June). Diagnosis of in situ melanoma peaked in September.

Conclusions

The present study showed that also in Italy melanoma diagnosis has a seasonal trend, with the peak in early summer. It seemed that summer UV exposure, acting both as a late promoter of malignant melanoma development and also increasing the visibility of pigmented skin lesion, may be relevant to explain such a peak.

Estimates of cancer burden in Italy

Aims and background

This paper presents updated estimates of the incidence, prevalence and mortality of stomach, colorectal, lung, breast, uterine cervix and prostate cancer and skin melanoma in the Italian population. In particular, point estimates for 2012 and time trends from 1970 to 2015 will be provided.

Methods

The presented figures were obtained by summing up the regional epidemiological indicator estimates presented in the other papers of this monographic issue, which were derived by applying the MIAMOD statistical back-calculation method to cancer registries survival data and official mortality rates.

Results

Our findings indicate that breast, colon-rectum and prostate will be the cancer sites with the highest incidence rates in the forthcoming years. The incidence rates still tend to increase for breast, male colorectal cancer and female lung cancer as well as for skin melanoma. By contrast, the incidence of stomach cancer, cervical cancer and male lung cancer, by far the most common tumor sites up to the early 1990s, will continue to decrease. The mortality estimates showed a decreasing trend for all considered cancers with the only exception of lung cancer in women.

Conclusion

These results point to the need to reinforce prevention activities by developing more effective preventive measures for population groups at risk. There is also a need to support timely and continuous cancer surveillance in the Italian population through cancer registries in order to monitor the spread of the cancer risk and to evaluate the impact of prevention policies and therapeutic advances.

Estimated and Observed Cancer Incidence in Italy: A Validation Study

Aims and background

The study aimed to validate model-based incidence estimates by means of observed incidence rates provided by Italian cancer registries, for five major cancer sites (stomach, colon and rectum, lung, breast and prostate cancers) and for all cancers together.

Methods

Recent incidence rates observed by Italian population-based cancer registries were extracted from the data base of the Italian Association of Cancer Registries. Regional estimates of incidence rates for the same cancers were obtained by the MIAMOD method. Observed and estimated crude incidence rates and incidence trends were compared for the period of diagnosis 1985-2000. Eight Italian cancer registries and seven regions were selected for the analysis since they had incidence data available during the entire selected period.

Results and conclusions

An excellent agreement between estimated and observed crude incidence rates was found for all single cancer sites, regarding absolute incidence levels and time trends. A partial exception was breast, where empirical data showed a sudden increase in the last three years of observation, perhaps due to organized screenings in some Italian regions, and not captured by statistical models. Substantial underestimation of model-based incidence rates was found for all cancers combined, where the difference tended to increase with calendar year, up to a maximum of 20% in recent years. The greatest part of the discrepancy can be attributed to multiple cancers, which were included in cancer registries statistics but were not accounted for in MIAMOD estimates.

Impact of socioeconomic status and district of residence on cutaneous malignant melanoma prognosis: a survival study on incident cases between 1991 and 2011 in the province of Ferrara, northern Italy

The aim of this study was to analyse the impact of socioeconomic status (SES) on the prognosis of patients with invasive malignant melanoma (MM) incident from 1991 to 2011 in the province of Ferrara, northern Italy. A total of 750 patients provided by the Area Vasta Emilia Centrale Cancer Registry were included in this retrospective cohort study. Prognosis was analysed in terms of overall survival and specific survival. The study determinants were the patients' SES and district of residence. The confounding effect of sex, age, period and TNM stage at diagnosis was evaluated. In the study population, neither overall survival nor specific survival showed significant differences among different layers of SES and districts of residence. The risk for death from MM was lower for the female sex [hazard risk (HR)=0.68, 95% confidence interval (CI): 0.50-0.94] and for diagnoses made in the most recent period (2005-2011: HR=0.56, 95% CI: 0.36-0.89 with respect to 1991-1997). A worse prognosis was observed in patients older than 70 years at the time of diagnosis (HR=2.33, 95% CI: 1.39-3.91 with respect to the <40-year age group) and in patients with more than pT1 tumours (up to 20 times for pT4 tumours). SES and district of residence did not constitute prognostic factors for MM patients residing in the province of Ferrara. Homogeneity in MM staging, treatment and follow-up strategies due to the relatively small extent of the study area and the presence of a single university hospital of reference, as well as less marked social and economic differences among the study patients in comparison with other previously analysed populations, may account for this finding.

[Extension of the target age range of mammography screening programme and governance of mammography practice in the Emilia-Romagna Region (Northern Italy)]

"OBJECTIVES: to evaluate the effectiveness of the regional law No.1035 enacted in 2009 by the local government of the Emilia- Romagna Region (Northern Italy) with the purpose of revising the rules of access to breast-care services. The law dictated the extension of the organised mammography screening programme to women aged 45-49 and 70-74 years in order to decrease their spontaneous screening rates and, thus, the waiting times for the access to diagnostic mammography by women of all ages.

DESIGN

study of time trends (joinpoint regression analysis and before/ after analysis) in annual percent mammography rates and in waiting times for access to clinical radiology facilities (2006-2014) among resident women. The information was taken from the regional Department of Health.

SETTING

public and accredited private radiology facilities.

MAIN OUTCOME MEASURES

age-specific and waiting-time-specific (months) percent rates of organised screening mammography, spontaneous screening mammography, and diagnostic mammography.

RESULTS

following the regional law No.1035, screening rates among women aged 45-49 and 70-74 years reached levels comparable to those attained by women aged 50-69 years. Spontaneous screening rates dropped and waiting times for spontaneous screening mammography (women aged 40-44 years) were cut. For diagnostic mammography, the rates remained stable, except for a decrease among women aged 35-39 and 45-49 years, and waiting times decreased in a constant manner over the study period.

CONCLUSIONS

the above-mentioned law met most of its goals. Comprehensive programmes regulating mammography practice at the population level can be effective."

Interpretation of colposcopy in population-based cervical screening services in north-eastern Italy: an online interregional agreement study

OBJECTIVE

An innovative web-based colposcopy quality assurance programme was implemented in population-based cervical screening services in three north-eastern Italian administrative regions with different colposcopists' training background. In this study, the levels of intra- and interregional intercolposcopist diagnostic agreement were evaluated.

STUDY DESIGN

Of the 158 registered colposcopists, 125 accessed the website of the programme, logged-in, viewed a posted set of 50 digital colpophotographs selected by an expert steering committee, and classified them for the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy. Anonymous data were downloaded and analysed using the crude, or observed, proportion of agreement and the kappa coefficient.

RESULTS

There were 113 eligible colposcopists. Overall, crude agreement on the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy was 0.72, 0.72, and 0.87, with kappa values of 0.60, 0.36, and 0.69, respectively. The homologous kappa values were 0.61, 0.41, and 0.69 in one region, 0.57, 0.36, and 0.69 in another, and 0.66, 0.38, and 0.74 in the third. Total intra- and interregional agreement were nearly identical, with kappa values of 0.59 and 0.60 for the colposcopic impression, 0.38 and 0.35 for the visibility of the squamocolumnar junction, and 0.69 and 0.69 for the need for biopsy. The width of 95% confidence intervals around the above kappa values was ≤0.01.

CONCLUSIONS

The levels of agreement varied between moderate and substantial both within and between regions. Regional differences in training background had minor effects. The interpretation of colposcopy is potentially well-reproducible.

Routine mini-laparoscopic cholecystectomy: Outcome in 200 patients

INTRODUCTION

In order to improve the outcome of classical laparoscopic cholecystectomy (CLC), surgeons have attempted to minimize tissue trauma. The aim of this study is to describe the technique of mini-laparoscopic cholecystectomy (MLC) and to report the outcome of this approach when used as a routine procedure.

METHODS

Since January 2012, all consecutive patients undergoing MLC were included in this study. Operative and perioperative data were prospectively collected. Additionally, cost analysis was performed.

RESULTS

From 2012 to 2015, 200 MLC were performed (F/M: 132/68, mean age 45±16 years). Mean operative duration was 97±32min for the first 50 patients and 75±25min for the subsequent 150 patients (P<0.0001). Modifications in the number or size of trocars were necessary in nine of the first 50 procedures and in seven of the subsequent 150 procedures (P=0.003). Perioperative morbidity included gallbladder perforation (n=28) or moderate (<50mL) bleeding (n=6). Postoperative morbidity was 4%. The mean global cost for a MLC procedure was 1757±1855 euros. This cost decreased from 2946±3115 euros in the first 50 patients to 1390±1278 euros in the subsequent 150 patients (P=0.001).

CONCLUSION

Mini-laparoscopy can be used for routine elective cholecystectomy. This approach is associated with low morbidity and good cosmetic results.