The application of different correlation coefficients to assess the reproducibility of a food frequency questionnaire

We computed four different correlation coefficients to investigate the degree of reproducibility of the weekly consumption of 77 food items or groups of foods and of seven summary questions from a food frequency questionnaire developed in Italy for a case-control study on cancers of the breast and digestive tract. The questionnaire had been administered twice to 452 Italian men and women. These included Pearson correlation coefficients (a) using the weekly frequencies of consumption without any transformation (P1); (b) after applying the transformation log (x + 1) (P2); (c) after applying the transformation log (x + 0.01) (P3); and (d) the Spearman correlation coefficient (SP). The mean values were 0.55 for P1, 0.59 for P2, 0.56 for P3 and 0.59 for SP. All coefficients were positively correlated, although to variable extents: the Spearman correlation coefficient between P2 and SP was 0.92, and that between P1 and P3 was 0.53. Differences between the four coefficients were more marked for food items with a lower kappa statistic and lower intraclass correlation, ie for those items with more severe reproducibility problems. Thus, a single correlation coefficient may not be enough to detect zones of the distribution of a food item where misclassification problems are more severe. The correlation coefficients used to investigate reproducibility should therefore be chosen on the basis of subsequent data analyses.

Prognostic factors and survival in non-Hodgkin's lymphomas: the experience of the Istituto Oncologico Romagnolo (IOR)

In an attempt to evaluate natural history, prognostic factors and survival, the data of 340 patients with NHL were collected. 267 patients were evaluable for the analysis of prognostic factors and survival. The tumor samples were reviewed and reclassified according to the Kiel classification. At completion, 180 patients were affected by low-grade (LG)-NHL and 87 patients had high-grade (HG)-NHL. Numerous potential prognostic factors were analysed in univariate and multivariate analyses. Globally 154 patients (57.4%) obtained complete remission (CR) and 65 patients (24.3%) partial remission (PR). The response rate was similar in LG and HG-NHL groups. 5-years survival was 52% for all patients (53% in LG-NHL and 44% in HG-NHL). Median survival was 62 months in LG-NHL and 38 months in HG-NHL (p = n.s.). At the univariate analysis overall survival (OS) in LG-NHL was favourably influenced by age < 65 years (p = 0.004), performance status > 80 (p < 0.02), early clinical stage (p < 0.001), absence of systemic symptoms (p < 0.001), low serum LDH (p < 0.001) and achievement of CR (p < 0.001), while in the HG-NHL only by age (p = 0.005) and achievement of CR (p < 0.001). The multivariate analysis showed early clinical stage, low serum LDH, absence of systemic symptoms and achievement of CR as independent prognostic factors in LG-NHL and only achievement of CR in HG-NHL.(ABSTRACT TRUNCATED AT 250 WORDS)

Do Italian small cell lung cancer (SCLC) specialists share a common language? An analysis based on 549 questionnaires

Different specialists are involved in the treatment of SCLC: medical oncologists, pneumologists, radiotherapists, and thoracic surgeons; only in large institutions the therapeutic policy is the result of a multidisciplinary approach. In order to investigate the opinions of the Italian physicians about the state of the art in the diagnosis and treatment of SCLC, 2369 questionnaires have been sent to an equal number of specialists. Each questionnaire contained 16 topics addressing what we consider major open questions. The analysis is based on 549 interpretable questionnaires received back (23.1%). The general attitude of responding physicians is quite pessimistic on the present state of the art; the large majority considering insufficient the current knowledge of both clinical and basic research. Some differences have been registered, among different specialists, regarding the role of surgery and radiation therapy in prolonging the expected survival; while a nearly unanimous consensus has been reached on the role of radiation therapy for local control. Optimism merges about the possibilities of ameliorating the survival in the next decades: 48% have confidence in new drugs, 45% in the development of integrated modalities, and 41% in the application of basic research.

Clinical prediction of survival is more accurate than the Karnofsky performance status in estimating life span of terminally ill cancer patients

Predicting the survival of terminally ill cancer patients can help in informing patients and their families, in programming therapy and assistance models, and in utilising existing resources correctly. Clinical prediction of survival (CPS) and Karnofsky performance status (KPS) are two factors which have already been described in the literature. The aim of our study was to verify their respective predictive value with regard to actual survival. In our study of 100 consecutive patients, the CPS obtained a higher prediction accuracy than that reported previously (correlation coefficient with actual survival = 0.51) and than that obtained with KPS alone (correlation coefficient = 0.37). The median difference between predicted and expected survival was only 1 week. The resultant predictivity could be further improved by integrating other prognostic factors studied in larger prospective, multicentric studies.

Iterative use of a priori exposure matrices to improve the characterization of chemical exposures in agricultural work studies

To assess pesticide exposures of agricultural workers, a priori exposure matrices based on "circumstantial determinants" of pesticide use were incorporated into the questionnaire of a case-referent study. Circumstantial determinants (crops cultivated, their surface areas and crop infestations) were recalled more frequently than specific chemicals. After the matrices were applied, the proportion of missing values fell from 44 to 9% for specific chemicals, from 97 to 17% for the dose for each treatment, and from 80 to 16% for number of treatments per year in a random sample of 40 questionnaires. The number of workers changed from 19 to 30 for parathion use, from 4 to 10 for mancozeb use, and from 4 to 12 for DDT (dichlorodiphenyltrichloroethane) use when the matrix was applied. The matrix enabled exposure levels to be assigned in each case. Provided that the matrix used is valid, this approach could increase the efficiency of case-referent studies on agricultural exposure to chemicals.

A prognostic score for patients resected for gastric cancer

This paper describes the construction, validation and use of a simple prognostic score suitable for predicting survival of patients undergoing a curative gastric resection. Using death from all causes as outcome, the prognostic significance of age, sex, tumour site, stage of disease (nodal status and wall invasion), surgical treatment and histological type was investigated in a set of 213 patients recruited in a multi-centre clinical trial. A Weibull multiple regression model was adopted to evaluate the joint effect of these variables on survival. From a full model, containing all the variables, a final parsimonious model was obtained by means of a backward selection procedure. The prognostic score is based on the final model, including four variables which are easily detected in every institution: age, wall invasion, site of tumour, and nodal status. Three groups of patients with different probabilities of surviving 5 years from surgery were identified: group I (survival probability > or = 70%), group II (30%-69%) and group III (< 30%). The prognostic score, obtained from the multicentre trial patients, was tested on a set of 135 consecutive patients in an independent institution, confirming its reliability in predicting survival. The score system presented can supply a simple tool for classifying patients radically operated for gastric cancer into three well discriminated groups from the prognostic point of view.

Cell kinetics and prognosis in gastric cancer

METHODS

The potential proliferative activity of primary gastric cancer was determined using the in vitro tritiated thymidine labeling index (LI) technique.

RESULTS

The proliferative rate had a wide range (0.1-28.4%) with a median value of 9.3%. The cell kinetics of the primary tumor were not related to clinicopathologic features, such as the patient's age and sex or the tumor's histologic type and stage. The contribution of cell kinetics to prognosis was investigated in a series of 28 patients (median follow-up, 34 months). The 3-year survival rate was 50% for patients with slowly proliferating tumors compared with only 13% for those with rapidly proliferating tumors. Moreover, in patients with high-LI tumors, the risk of death was more than sixfold greater than for those with low-LI tumors.

CONCLUSIONS

These data suggest that cell kinetic studies might be an important discriminant to predict prognosis in gastric cancer.

Reproducibility of an Italian food frequency questionnaire for cancer studies: results for specific food items

To evaluate the reproducibility of a quantitative food frequency questionnaire (FFQ) used in a case-control study on cancer of the breast, ovary and digestive tract, we compared the result of a 98-item questionnaire administered twice at an interval of 3-10 months (median = 5.4 months) to 452 volunteers (144 males and 308 females, median age = 50 years) from three Italian provinces (Pordenone, Genoa and Forlí). Spearman correlation coefficients (r) for intake frequency of 87 dietary items ranged from 0.35 ("chicken or turkey, boiled") to 0.84 ("wine"). Most coefficients were between 0.60 and 0.80, only two being below 0.40 and five equal or above 0.80 (mean r = 0.59). The concordance of the two measurements tended to be somewhat better for alcoholic and non-alcoholic beverages, bread, cereals and first courses, fruits and summary questions at the end of each section of the questionnaire than for side dishes, sweets and desserts. Also, the reproducibility of 11 subjective questions, such as those concerning the amount of fat in seasoning and the intake of garlic or salt, seemed to be high. Age, sex, educational level of the volunteers and interval between the two FFQ did not have a large or systematic impact on the concordance of the two measurements. In conclusion, the present study has shown a good level of reproducibility of our questionnaire and has provided a few important hints on ways of improving the description of various food items.

Hepatocellular carcinoma. Prognostic factors and survival analysis in 135 Italian patients

This is a retrospective study to evaluate the history of hepatocellular carcinoma and find the relationship between clinical, biochemical and ultrasonographic features and survival in Italian patients. In 135 consecutive patients median follow-up was 16 months (range 1-66 months) and median survival from the time of diagnosis was 12 months. Univariate analysis showed that individual variables associated with significantly decreased survival included: absence of therapy, Okuda's Stage III, Child-Pugh's Class C, alpha-fetoprotein greater than 400 ng/ml, presence of symptoms, moderate or severe ascites, tumor involving both lobes, mixed internal echo pattern, and multinodular or massive type. Multiple regression analysis (Cox model) revealed that the mixed internal echo pattern of hepatocellular carcinoma, the presence of moderate or severe ascites and Okuda's Stage III were independent predictors of high risk of death. These data can help in selecting patients whose probability of survival is considered high enough to undergo treatment and may be useful for stratifying patients in randomized controlled trials.

In vitro potentiation by lonidamine of the cytotoxic effect of adriamycin on primary and established breast cancer cell lines

Lonidamine is a new potential chemotherapeutic agent, relatively non-toxic, that can positively modulate the efficacy of several antineoplastic drugs. We evaluated the response of two established human breast cancer cell lines (MCF-7 and BRC-230) and of 20 primary breast cancer cell lines to lonidamine, either alone or in combination with adriamycin, the drug most widely used in the management of breast cancer. Different schedules were tested by varying either concentration of the drugs (LND: 10-150 micrograms/ml; ADM: 0.10-0.15 micrograms/ml), or time of exposure (1-96 hours), or sequence of administration (ADM-->LND; LND-->ADM; ADM+LND). Our results indicate slight sensitivity of the cell lines to lonidamine when used alone, whereas an increase of efficacy was noted when lonidamine was added for at least 24 hours after a 4 hour exposure to adriamycin. Such efficacy was significantly greater than that expected from an additive effect between the two drugs. We conclude that lonidamine, when given according to an appropriate schedule, enhances, in vitro, the efficacy of adriamycin. A correct employment of lonidamine in the management of breast cancer might therefore potentiate the therapeutic effect of adriamycin.

Clinical and laboratory evaluation of the myeloprotective effect of medroxyprogesterone acetate in head and neck cancer

The action of high-dose medroxyprogesterone acetate (MPA) was studied by analysing the behaviour of colony-forming-unit granulocyte-macrophage (CFU-GM) during chemotherapy. 21 non-pretreated men with locally advanced carcinoma of the head and neck were randomised into two arms: A (11 patients) received three alternating cycles of cisplatin, 5-fluorouracil (CF)/cisplatin, methotrexate, bleomycin, vincristine and then CF every 4 weeks and B (10 patients) were treated with the same schedule plus 1000 mg per day of MPA. MPA was administered 14 days before the start of chemotherapy (day 0) and continued daily up to the 90th day. Bone marrow was harvested in arm A on days 0, +14 and +90, and in B, also on day -14. There was diverse CFU-GM behaviour in the two arms on the 14th day. These data support the hypothesis that the myeloprotective effect of MPA is due to induction of a mitotic rest in the stem cells, which protects them from drug action.

[Value of the in situ hybridization technique in the diagnosis of human papilloma virus infections of the uterine cervix. Correlations between the human papilloma virus type and the morphological features]

Clinico-pathologic, epidemiologic and molecular analytic studies have shown that: i) the squamous cancer of the uterine cervix derives from intraepithelial lesions with different degrees of atypia; ii) human papillomavirus (HPV) can play a fundamental role in the progression of these lesions. We have examined 219 uterine cervix biopsies by means of the in situ hybridization technique (ISH) using biotinylated probes for 6/11, 16/18 and 31/35/51 HPV strains. The histologic lesions were as follows: 104 (49.7%) focal koilocytotic lesions 26 (11.8%) low grade intraepithelial lesions (SIL) 45 (20.5%) high grade intraepithelial lesions (SIL) 18 (8.2%) condylomata acuminata 21 (9.8%) invasive cancers. The percentage of the positivity found in the whole material examined is 14.1%. In particular, none of the 109 cases of focal koilocytotic lesions was positive, whereas the 28.1% of the remaining 110 biopsies turned out to contain HPV. We hypothesize that our small percentage of positivity in preinvasive and invasive lesions of the uterine cervix can be due to the fact that the HPV is not the only cancerogenic factor involved, although the possibility of a low sensitivity of the technique cannot completely be excluded.

Cell kinetics and hormonal features in relation to pathological stage in breast cancer

Proliferative activity (expressed as 3H-thymidine labeling index, 3H-TdR LI) was evaluated on a series of 281 primary tumors recruited in two years in 6 different institutions from central Italy. 3H-TdR LI proved to be low in intraductal, or well and moderately differentiated, or hormone receptor positive tumors. Conversely, no relation was observed between 3H-TdR LI and menopause, tumor size, or lymph node involvement. An inverse relation was observed between 3H-TdR LI and hormone receptor content. Specific patterns of 3H-TdR LI value and ER content association were observed as a function of menopause, lymph nodal status, and degree of lymph nodal involvement.