rubrica

Registri di patologia

  • Emanuele Crocetti1

  1. UO Epidemiologia clinica e descrittiva, ISPO Firenze
Emanuele Crocetti -

Ricerca bibliografica periodo dal 1 aprile 2013 – 15 giugno 2013

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Stringa: (("registries"[MeSH Terms] OR "registries"[All Fields] OR "registry"[All Fields]) OR ("registries"[MeSH Terms] OR "registries"[All Fields])) AND (("italy"[MeSH Terms] OR "italy"[All Fields]) OR italian[All Fields]) AND "humans"[MeSH Terms] AND ("2013/04/01"[PDat] : "2013/06/15"[PDat])

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1. Gotti D, Danesi M, Calabresi A, Ferraresi A, Albini L, Donato F, Castelli F, Scalzini A, Quiros-Roldan E; Brescia HIV Cancer Study Group. Clinical characteristics, incidence, and risk factors of HIV-related Hodgkin lymphoma in the era of combination antiretroviral therapy. AIDS Patient Care STDS. 2013 May;27(5):259-65. doi: 10.1089/apc.2012.0424. Epub 2013 Apr 21.
Collaborators: Casari S, Castelnuovo F, Cattaneo C, Festa A, Magoni M, Paraninfo C, Re A, Scarcella C, Torti C. University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy. daria.gotti@gmail.com

Abstract HIV-infected patients are at increased risk for developing HIV-related Hodgkin lymphoma (HIV-HL) despite the success of combination antiretroviral therapy (cART). To study the incidence of HIV-HL in HIV-patients with respect to the general population of Brescia, Italy, we conducted a single-center cohort study of HIV-patients followed from 1999 to 2009. The incidence of HIV-HL was compared to the incidence in the general population of Brescia using standardized incidence ratios (SIRs). Poisson analysis was used to study the association between covariates and HL. A total of 5085 HIV-patients were observed among 30,946 person-years; 30 patients developed HIV-HL. The incidence rate was 9.9 (95% confidence interval [CI], 6.7-14.1) per 10,000 person-years of follow-up. HL was substantially more frequent in HIV-patients than in the general population living in the same district area [standardized incidence rate, SIR=21.8 (95% CI, 15.33-31)]. The risk of HIV-HL tended to increase with lowering CD4+ cell counts at time of HL diagnosis [adjusted incidence relative risk (IRR) for CD4 cell count<50 cells/μL: 41.70, p<0.001]. HL risk had been elevated during the 6 months after combination antiretroviral therapy (cART) initiation (IRR: 26.65, p<0.001). Twenty-two HIV-HL cases were matched to 3280 controls. In the year preceding HIV-HL diagnosis the mean change in CD4+ cell counts between cases and controls was significantly different (-99 cells/μL for cases vs. +37 cells/μL for controls, p<0.0001). Compared with the general population, HIV-infected patients showed an increased risk for developing HL. The risk of HIV-HL increased significantly in the first months after cART initiation.

2. Malandrino P, Pellegriti G, Attard M, Violi MA, Giordano C, Sciacca L, Regalbuto C, Squatrito S, Vigneri R. Papillary thyroid microcarcinomas: a comparative study of the characteristics and risk factors at presentation in two cancer registries. J Clin Endocrinol Metab. 2013 Apr;98(4):1427-34. doi: 10.1210/jc.2012-3728. Epub 2013 Mar 12.
Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy. p.malandrino@unict.it Comment in J Clin Endocrinol Metab. 2013 Apr;98(4):1391-3.

Abstract CONTEXT: Papillary thyroid microcarcinoma (PTMC) is an indolent neoplasia, often asymptomatic and discovered incidentally. Some PTMCs, however, exhibit a more aggressive behavior, frequently recur, and can even cause cancer-related death. OBJECTIVE: The aim of this study was to evaluate the prevalence of PTMCs and the associated risk factors at presentation in 2 thyroid cancer registries from areas with different genetic and environmental characteristics. DESIGN AND PATIENTS: We conducted a retrospective, observational study of all incident cases of PTMCs recorded over a 5-year period in the Sicilian Regional Registry for Thyroid Cancer (SRRTC) and in the Surveillance Epidemiology and End Results (SEER) US registry. SETTING: The study took place at an academic hospital. RESULTS: The incidence of PTMCs was much higher in Sicily (1777 PTMC diagnosed in 2002-2006; age-standardized incidence rate for the world population [ASRw] = 5.8 per 100 000) than in the United States (14 423 PTMC in the period 2004-2008; ASRw = 2.9 per 100 000). Within the SRRTC, a significantly higher incidence was observed in the volcanic area (ASRw = 10.4 vs 4.6 in the rest of Sicily). In Sicily, the female to male ratio was higher, and PTMC patients were younger. In both registries, a significant inverse correlation was observed between age and tumor size. Young patients (≤45 y) exhibited a higher frequency of nodal metastases. CONCLUSIONS: PTMC incidence is twice as high in Sicily compared with the United States, and within Sicily, the incidence is twice as high in the volcanic area. In young patients, PTMCs are larger at presentation and exhibit more risk factors. In both registries, more than 35% of PTMCs exhibited 2 or more risk factors, suggesting that they may require surgery and follow-up similar to that of larger carcinomas.

3. Cecchi E, Parodi G, Giglioli C, Passantino S, Bandinelli B, Liotta AA, Bellandi B, Cioni G, Costanzo M, Abbate R, Gensini GF, Antoniucci D, Mannini L. Stress-induced hyperviscosity in the pathophysiology of takotsubo cardiomyopathy. Am J Cardiol. 2013 May 15;111(10):1523-9. doi: 10.1016/j.amjcard.2013.01.304.
Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. emanuelececchi@virgilio.it

Abstract Takotsubo cardiomyopathy (TC) is characterized by transient hypokinesis of the left ventricular apex or midventricular segments with coronary arteries without significant stenosis. It is often associated with emotional or physical stress; however, its pathophysiology is still unclear. In the present study, we analyzed the alterations in blood viscosity and markers of endothelial damage induced by sympathetic stimulation in patients with previous TC. Seventeen women (mean age 71 years) with previous TC, included and investigated in the TC Tuscany Registry, were compared to a control group of 8 age- and risk factor-matched women with chest pain and coronary arteries free of stenosis. All subjects underwent the cold pressor test (CPT). Before and after the CPT, the hemorheologic parameters (whole blood viscosity at 0.512 s(-1) and 94.5 s(-1), plasma viscosity, erythrocyte deformability index, and erythrocyte aggregation), catecholamines, plasminogen activator inhibitor-1 (PAI-1), and von Willebrand factor levels were assessed. The patients with TC had significantly greater baseline PAI-1 levels (p <0.01) and lower erythrocyte deformability index values (p <0.01). After CPT, both the patients with TC and the controls had a significant increase in several hemorheologic parameters, catecholamines, and von Willebrand factor levels and a decrease in erythrocyte deformability index. However, the PAI-1 levels were significantly increased only in the patients with TC. Compared to the controls, the patients with TC had significantly greater values of whole blood viscosity at 94.5 s(-1) (p <0.05), PAI-1 (p <0.01), von Willebrand factor (p <0.05) and lower erythrocyte deformability index values (p <0.01) after CPT. In conclusion, the results of the present study suggest that in patients with TC, the alterations in erythrocyte membranes and endothelial integrity induced by catecholaminergic storm could determine microvascular hypoperfusion, possibly favoring the occurrence of left ventricular ballooning.

4. Visco C, Moretta F, Falisi E, Facco M, Maura F, Novella E, Nichele I, Finotto S, Giaretta I, Ave E, Perbellini O, Guercini N, Scupoli MT, Trentin L, Trimarco V, Neri A, Semenzato G, Rodeghiero F, Pizzolo G, Ambrosetti A. Double productive immunoglobulin sequence rearrangements in patients with chronic lymphocytic leukemia. Am J Hematol. 2013 Apr;88(4):277-82. doi: 10.1002/ajh.23396. Epub 2013 Feb 28.
Department of Hematology S. Bortolo Hospital, Vicenza, Italy. carlovisco@hotmail.com

Abstract The immunoglobulin heavy chain variable (IGHV) gene mutational status represents a major prognostic marker in chronic lymphocytic leukemia (CLL). Usually, the prognostic implications of IGHV gene analysis can be reliably ascertained but, occasionally, double productive rearrangements have been detected. Clinical presentation and biological features of such cases are unknown. Sixty patients with morphologically and phenotypically monoclonal CLL but double productive IGHV rearrangements were retrospectively identified by mRNA analysis from three Hematology Institutions. Clinical and biological features and survival of these 60 patients were compared with a control group of patients with CLL and single IGHV rearrangement. A prospective registry was used to assess the epidemiology of double productive IGHV among incidental patients with CLL. Using standard criteria to define IGHV-mutated (M) or unmutated (U) cases, 39 of the 60 patients (65%) with double productive IGHV rearrangement had concordant status (23 MM, 16 UU), while 21 (35%) had discordant IGHV status. As compared with M patients, the MM ones had lower CD38 expression, more favorable cytogenetics and more indolent clinical behavior. Cases with UU had similar characteristics of U patients. Discordant cases presented with adverse prognostic features and had an aggressive clinical behavior requiring early treatment, similar to U patients. The prevalence of double IGHV was 3.1%. Patients with CLL with double concordant mutational status (MM or UU) have a clinical course similar to that of the corresponding single IGHV status, while those exhibiting discordant status represent a high risk population. This may help correct stratification within clinical trials.

5. Olivieri A, Corbetta C, Weber G, Vigone MC, Fazzini C, Medda E; Italian Study Group for Congenital Hypothyroidism. Congenital hypothyroidism due to defects of thyroid development and mild increase of TSH at screening: data from the Italian National Registry of infants with congenital hypothyroidism. J Clin Endocrinol Metab. 2013 Apr;98(4):1403-8. doi: 10.1210/jc.2012-3273. Epub 2013 Feb 26.
Collaborators: Angeloni U, Antonozzi I, Baserga M, Bernasconi S, Bona G, Bucci I, Calaciura F, Caldarera R, Camilot M, Cappa M, Caruso U, Casini M, Cassio A, Cavallo L, Cesaretti G, Chiarelli F, Ciannamea B, Ciatti R, Cicciò M, Cordova R, Correra A, Costa P, De Santis C, Di Maio S, Gallicchio G, Gastaldi R, Grasso G, Gurrado R, Lelli A, Leonardi D, Loche S, Lorini R, Manente G, Monaco F, Minelli G, Narducci P, Oggiano N, Pagliardini S, Parlato G, Pasquini E, Pinchera A, Pizzolante M, Radetti G, Righetti F, Rizzo A, Saggese G, Sala D, Salerno C, Sava L, Scognamiglio D, Stoppioni V, Tonacchera M, Vigneri R, Vignola G, De Luca F. Metabolism and Endocrinology, Istituto Superiore di Sanità, Viale Regina Elena, Rome, Italy. antonella.olivieri@iss.it

Abstract CONTEXT: Over the years lower TSH cutoffs have been adopted in some screening programs for congenital hypothyroidism (CH) worldwide. This has resulted in a progressive increase in detecting additional mild forms of the disease, essentially with normally located and shaped thyroid. However, the question of whether such additional mild CH cases can benefit from detection by newborn screening and early thyroid hormone treatment is still open. OBJECTIVE: The aim of this study was to estimate the frequency of cases with mild increase of TSH at screening in the Italian population of babies with permanent CH and to characterize these babies in terms of diagnosis classification and neonatal features. METHODS: Data recorded in the Italian National Registry of infants with CH were analyzed. RESULTS: Between 2000 and 2006, 17 of the 25 Italian screening centers adopted a TSH cutoff at screening of <15.0 μU/mL. It was found that 21.6% of babies with permanent CH had TSH at screening of 15.0 μU/mL or less, whereas this percentage was 54% in infants with transient hypothyroidism. Among the babies with permanent CH and mild increase of TSH at screening (≤15 μU/mL), 19.6% had thyroid dysgenesis with serum TSH levels at confirmation of the diagnosis ranging from 9.9 to 708 μU/mL. These babies would have been missed at screening if the cutoff had been higher. CONCLUSIONS: Lowering TSH cutoff in our country has enabled us to detect additional cases of permanent CH, a number of which had defects of thyroid development and severe hypothyroidism at confirmation of the diagnosis.

6. Grasso C, Capodanno D, Scandura S, Cannata S, Immè S, Mangiafico S, Pistritto A, Ministeri M, Barbanti M, Caggegi A, Chiarandà M, Dipasqua F, Giaquinta S, Occhipinti M, Ussia G, Tamburino C. One- and twelve-month safety and efficacy outcomes of patients undergoing edge-to-edge percutaneous mitral valve repair (from the GRASP Registry). Am J Cardiol. 2013 May 15;111(10):1482-7. doi: 10.1016/j.amjcard.2013.01.300. Epub 2013 Feb 20.
Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.

Abstract The aim of this study was to report on the 30-day and 1-year outcomes of percutaneous mitral valve repair with the MitraClip technique in patients with grade ≥3+ mitral regurgitation (MR) at high risk for conventional surgical therapy enrolled in the prospective Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation (GRASP) registry. Acute device success was defined as residual MR ≤2+ after clip implantation. The primary safety end point was the rate of major adverse events at 30 days. The primary efficacy end point was freedom from death, surgery for mitral valve dysfunction, or grade ≥3+ MR at 30 days and 1 year. A total of 117 patients were treated. Eighty-nine patients (76%) presented with functional MR and 28 patients (24%) with organic MR. Acute device success was observed in all patients. Device implantation time significantly diminished with experience and varied significantly between cases with 1 versus ≥2 clips. No procedural mortality was recorded. Major adverse events occurred in 4 patients at 30 days (4.3%). Deterioration to MR ≥3+ was recorded in 25% of patients with degenerative MR and 7% of those with functional MR at 1 year. No surgery for mitral valve dysfunction occurred within 1 year. Freedom from death, surgery for mitral valve dysfunction, or grade ≥3+ MR was 96.4% and 75.8% at 30 days and 1 year, respectively. No significant differences were noted in the primary efficacy end point between patients with degenerative MR and those with functional MR. In conclusion, percutaneous mitral valve repair with the MitraClip technique was shown to be safe and reasonably effective in 117 patients from a real-world setting.

7. Pulli R, Dorigo W, Castelli P, Dorrucci V, Ferilli F, De Blasis G, Monaca V, Vecchiati E, Benincasa A, Pratesi C. A multicentric experience with open surgical repair and endovascular exclusion of popliteal artery aneurysms. Eur J Vasc Endovasc Surg. 2013 Apr;45(4):357-63. doi: 10.1016/j.ejvs.2013.01.012. Epub 2013 Feb 4.
Department of Vascular Surgery, University of Florence, Firenze, Italy.

Abstract INTRODUCTION: The aim of this study was to analyse early and follow-up results of the treatment of popliteal artery aneurysms (PAAs) performed with open surgical repair or with endovascular exclusion with endografts in a multicentric retrospective registry involving seven Italian vascular centres. MATERIALS AND METHODS: We retrospectively collected data concerning 178 open surgical interventions (OR group) and 134 endovascular exclusions (ER group) for PAAs performed between January 2000 and December 2011. Early and follow-up results were analysed in terms of mortality, graft patency, reintervention and limb preservation. RESULTS: OR patients were more frequently symptomatic (64%, 115 cases) than patients in the ER group (34%, 51 cases; p < 0.001), had more frequently acute limb ischaemia (23% and 6.5%, respectively; p < 0.001) and had more frequently a run-off score <2 (39% and 26%, respectively, p = 0.03). In the OR group there were no perioperative deaths; six thromboses (3.3%) and one amputation occurred. In the ER group mortality was 1.5%; 13 thromboses (9.7%) and one amputation (0.5%) occurred. Mean duration of follow-up was 30.6 ± 27.5 months. In the OR group primary and secondary patency, freedom from reintervention and limb preservation rates at 48 months were 63.5% (standard error (SE) 0.05), 76.5% (SE 0.05), 72.5% (SE 0.06) and 89.7% (SE 0.05), respectively. The corresponding figures in the ER group were 73.4% (SE 0.04), 85% (SE 0.04), 75% (SE 0.04) and 97% (SE 0.04), respectively. CONCLUSIONS: In this large multicentric retrospective registry, open and endovascular treatment of PAAs are used in different patients with regard to clinical and anatomical characteristics. Both treatments are feasible and safe, providing satisfactory early and long-term results.

8. Caldarella A, Buzzoni C, Crocetti E, Bianchi S, Vezzosi V, Apicella P, Biancalani M, Giannini A, Urso C, Zolfanelli F, Paci E. Invasive breast cancer: a significant correlation between histological types and molecular subgroups. J Cancer Res Clin Oncol. 2013 Apr;139(4):617-23. doi: 10.1007/s00432-012-1365-1. Epub 2012 Dec 27.
Clinical and Descriptive Epidemiology Unit, Institute for Study and Cancer Prevention (ISPO), Via delle Oblate 2, 50141 Florence, Italy. a.caldarella@ispo.toscana.it

Abstract INTRODUCTION: The special types of breast cancer seem to have not only distinct morphological features but also distinct biological features. MATERIALS AND METHODS: Women diagnosed with a first primary invasive breast cancer in the 2004-2005 period were identified through Tuscan Cancer Registry. Information on age, tumor size, lymph node status, histological type and grade, hormonal receptors, HER2 immunohistochemical expression were collected. Five subtypes were defined: luminal A, luminal B HER2+, luminal B HER2-, triple negative, and HER2 positive. The association between the histological type and molecular subgroups was assessed by a Fisher's exact test, and a multinomial logistic regression model was used. RESULTS: Out of 1,487 patients, 34 % were luminal A subtype, 25 % luminal B HER2-, 11 % luminal B HER2+, 19 % triple negative, and 10.2 % HER2+; 58.5 % of cancers were ductal NOS types. With luminal A as reference, histological types distribution was significantly different between the subgroups. Mucinous, tubular, and cribriform histotypes were found among luminal A cancers more than in other subgroups; all medullary carcinomas were triple negative cancers. Pathological stage at diagnosis was more advanced, and histological grade was lower among subgroups other than luminal A. CONCLUSIONS: Significant association between breast cancer histotypes and molecular subgroups was found.

Breve commento a cura di E. Crocetti
Questo lavoro di Caldarella et al che abbiamo condotto sui dati del Registro Tumori Toscano, analizza, per una casistica di popolazione di 1487 tumori della mammella femminile, l’associazione fra istologia e tipizzazione biologica. L’aspetto più interessante, a mio vedere, è lo spunto per la riflessione sul confronto fra due sistemi classificativi della diagnosi oncologica rappresentativi di due epoche storiche diverse, quella della classificazione basata sull’aspetto cellulare e quella più attuale della caratterizzazione biologica tramite marker. L’oncologia attualmente valorizza molto le informazioni veicolate dalla biologia, che definiscono classi prognostiche indipendenti anche dallo stadio della malattia. Quindi con la classificazione biologica, almeno per il tumore della mammella, si ottiene la caratterizzazione del tumore, la sua prognosi e si indirizza la terapia. Ma allora l’istologia è superata? Dal lavoro di Caldarella et al. vengono evidenziate alcune relazioni che indicano la presenza di differenze biologiche all’interno dei diversi gruppi morfologici, ad esempio che tutte le forme midollari sono triplo negative (ER-, PgR-, HER2-), il che fa pensare alla possibilità di livelli diversi di caratterizzazione. Lo sviluppo delle conoscenze verso una sempre maggiore capacità di differenziare gruppi di pazienti che in passato erano considerati omogenei e che quindi indirizzano verso una personalizzazione della malattia e del trattamento è oggi su base biologica. Pertanto questo sviluppo determinerà presumibilmente, almeno per alcune sedi neoplastiche, una flessione della rilevanza della caratterizzazione istologica rispetto al pattern biologico e clinico costruito da un pannello di marcatori.

9. Baili P, Hoekstra-Weebers J, Van Hoof E, Bartsch HH, Travado L, Garami M, Di Salvo F, Micheli A, Veerus P; EUROCHIP-3 Working group on Cancer Rehabilitation. Cancer rehabilitation indicators for Europe. Eur J Cancer. 2013 Apr;49(6):1356-64. doi: 10.1016/j.ejca.2012.10.028. Epub 2012 Dec 10.
Collaborators: Denz H, Andritsch E, Van Hoof E, Watts C, Yordanov N, Nestoros S, Svestkova O, Johansen C, Veerus P, Samson M, Brechot JM, Rautalahti M, Pylkkanen L, Garami M, Bartsch H, Vadalouca A, Grassi L, Amati C, Casella I, Sant M, Murray D, Vetra A, Vaitekunaite N, Scharpantgen A, Micallef R, Hoekstra Weebers J, Bielska-Lasota M, Halik R, Travado L, Portugal C, Nicula F, Csaba DL, Ferro T, Bonfill X, Margulies A, Sadovska O, Ondrusova M, Jelenc M, Zakotnik B, Hellbom M, Hubbard G, Gail E, Turpenney J, Cavanagh S. Descriptive Studies and Health Planning Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", via Venezian 1, 20133 Milan, Italy. lifetable@istitutotumori.mi.it

Abstract Little is known of cancer rehabilitation needs in Europe. EUROCHIP-3 organised a group of experts to propose a list of population-based indicators used for describing cancer rehabilitation across Europe. The aim of this study is to present and discuss these indicators. A EUROCHIP-3 expert panel reached agreement on two types of indicators. (a) Cancer prevalence indicators. These were proposed as a means of characterising the burden of cancer rehabilitation needs by time from diagnosis and patient health status. These indicators can be estimated from cancer registry data or by collecting data on follow-up and treatments for samples of cases archived in cancer registries. (b) Indicators of rehabilitation success. These include: return to work, quality of life, and satisfaction of specific rehabilitation needs. Studies can be performed to estimate these indicators in individual countries, but to obtain comparable data across European countries it will be necessary to administer a questionnaire to randomly selected samples of patients from population-based cancer registry databases. However, three factors complicate questionnaire studies: patients may not be aware that they have cancer; incomplete participation in surveys could lead to bias; and national confidentiality laws in some cases prohibit cancer registries from approaching patients. Although these studies are expensive and difficult to perform, but as the number of cancer survivors increases, it is important to document their needs in order to provide information on cancer control.

10. Goffredo P, Sosa JA, Roman SA. Malignant pheochromocytoma and paraganglioma: a population level analysis of long-term survival over two decades. J Surg Oncol. 2013 May;107(6):659-64. doi: 10.1002/jso.23297. Epub 2012 Dec 11.
Department of Surgery, Milano-Bicocca University, Monza, Italy.

Abstract BACKGROUND AND OBJECTIVES: Pheochromocytoma (PHEO) and paraganglioma (PGL) are rare tumors. Aims of this study were to describe and to compare demographic, clinical, pathologic, and survival characteristics of malignant PHEO and PGL. METHODS: Patients were identified in SEER, 1988-2009. Analyses included chi-square, ANOVA, Kaplan-Meier, and Cox proportional hazard regression. RESULTS: Gender distribution and mean age were similar for PHEO and PGL. Surgery was performed in 74.3% of PHEO and 78.9% of PGL; external beam radiation was administered in 8.0% of PHEO and 28.1% of PGL (P < 0.001). Compared to PGL, PHEO were larger (mean size 7.7 vs. 4.5 cm PGL, P = 0.001) and more were SEER-staged as localized (17.3% vs. 49.6%, respectively, P < 0.001). PGLs were more often located in the trunk than in the head/neck (53.8% vs. 38.0%, P < 0.001). PHEO had lower overall and disease-specific survival than PGL (54.0% and 73.5% vs. 73.3% and 80.5% for PGL, respectively, P < 0.001 and P = 0.118). Independent factors associated with mortality for PHEO included not undergoing surgery and metastases at diagnosis; for PGL, these were age 61-75 years, size ≥5 cm, and presenting with metastases. CONCLUSIONS: Malignant PHEO has a more aggressive course than malignant PGL; long-term survival has not improved over the last two decades. Multi-institutional efforts should be pursued to seek novel treatments.

11. Allemani C, Minicozzi P, Berrino F, Bastiaannet E, Gavin A, Galceran J, Ameijide A, Siesling S, Mangone L, Ardanaz E, Hédelin G, Mateos A, Micheli A, Sant M; EUROCARE Working Group. Predictions of survival up to 10 years after diagnosis for European women with breast cancer in 2000-2002. Int J Cancer. 2013 May 15;132(10):2404-12. doi: 10.1002/ijc.27895. Epub 2012 Nov 7.
Analytical Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. claudia.allemani@lshtm.ac.uk

Abstract Few studies have addressed longer-term survival for breast cancer in European women. We have made predictions of 10-year survival for European women diagnosed with breast cancer in 2000-2002. Data for 114,312 adult women (15-99 years) diagnosed with a first primary malignant cancer of the breast during 2000-2002 were collected in the EUROCARE-4 study from 24 population-based cancer registries in 14 European countries. We estimated relative survival at 1, 5, and 10 years after diagnosis for women who were alive at some point during 2000-2002, using the period approach. We also estimated 10-year survival conditional on survival to 1 and 5 years after diagnosis. Ten-year survival exceeded 70% in most regions, but was only 54% in Eastern Europe, with the highest value in Northern Europe (about 75%). Ten-year survival conditional on survival for 1 year was 2-6% higher than 10-year survival in all European regions, and geographic differences were smaller. Ten-year survival for women who survived at least 5 years was 88% overall, with the lowest figure in Eastern Europe (79%) and the highest in the UK (91%). Women aged 50-69 years had higher overall survival than older and younger women (79%). Six cancer registries had adequate information on stage at diagnosis; in these jurisdictions, 10-year survival was 89% for local, 62% for regional and 10% for metastatic disease. Data on stage are not collected routinely or consistently, yet these data are essential for meaningful comparison of population-based survival, which provides vital information for improving breast cancer control.

12. Marengoni A, Nobili A, Romano V, Tettamanti M, Pasina L, Djade S, Corrao S, Salerno F, Iorio A, Marcucci M, Mannucci PM; SIMI Investigators. Adverse clinical events and mortality during hospitalization and 3 months after discharge in cognitively impaired elderly patients.
J Gerontol A Biol Sci Med Sci. 2013 Apr;68(4):419-25. doi: 10.1093/gerona/gls181. Epub 2012 Sep 12. Geriatric Unit, Spedali Civili, Department of Medical and Surgery Sciences, University of Brescia, Italy. alessandra.marengoni@ki.se

Abstract BACKGROUND: Controversial findings are reported on hospital outcome in cognitively impaired patients. The aim of this study was to explore mortality risk according to cognitive status during hospitalization and after 3 months in elderly patients. METHODS: Sixty-six internal medicine and geriatric wards in Italy participated in the "Registry Politerapie SIMI (REPOSI)" during 2010. Of the 1,380 in-patients, aged 65 and older enrolled, 1,201 were included. Cognition was evaluated with the Short Blessed Test (SBT). Logistic regression was used to evaluate the association of questionable and impaired cognition (according to SBT cutoff points) with mortality during hospitalization and at follow-up. Morbidity, function, and adverse events during hospitalization were covariates. RESULTS: Four hundred and twenty-one participants were classified as normal, 219 questionable, and 561 cognitively impaired. Forty-nine patients died during hospitalization and 70 during follow-up. Sixty-seven point three percent versus 32.7% (p < .001) of patients who died during hospitalization and 54.3% versus 45.7% (p < .001) during follow-up had at least one adverse event. After multiadjustment, impaired cognition was associated with in-hospital mortality (odds ratio [OR] = 3.1; 95% confidence interval [CI] = 1.1-8.6) but not with mortality at follow-up. Increase severity of cognitive impairment was associated with higher odds of mortality (from 2.7 in those with moderate impairment to 4.2 in those with severe impairment). After stratification for adverse clinical events, impaired cognition resulted associated with mortality only in patients having at least one event. CONCLUSION: Elderly patients with cognitive impairment are more likely to die during hospitalization with a severity-dependent association. Adverse events may represent an important target of prevention due to their high association with mortality and cognitive impairment.

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