rubrica

Registri di patologia

  • Emanuele Crocetti1

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

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Ricerca bibliografica periodo dal 1 novembre – 15 gennaio 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 ("2012/11/01"[PDat] : "2013/01/15"[PDat])
1. Rugge M, Zaninotto G, Parente P, Zanatta L, Cavallin F, Germanà B, Macrì E, Galliani E, Iuzzolino P, Ferrara F, Marin R, Nisi E, Iaderosa G, Deboni M, Bellumat A, Valiante F, Florea G, Della Libera D, Benini M, Bortesi L, Meggio A, Zorzi MG, Depretis G, Miori G, Morelli L, Cataudella G, D’amore E, Franceschetti I, Bozzola L, Paternello E, Antonini C, Di Mario F, Dal Bò N, Furlanetto A, Norberto L, Polese L, Iommarini S, Farinati F, Battaglia G, Diamantis G, Realdon S, Guido E, Mastropaolo G, Canova D, Guerini A, Franceschi M, Zirillo M. Barrett's esophagus and adenocarcinoma risk: the experience of the North-Eastern Italian Registry (EBRA). Ann Surg. 2012 Nov;256(5):788-94; discussion 794-5. doi: 10.1097/SLA.0b013e3182737a7e.
Department of Pathology, University of Padova, Padua, Italy.

Abstract
OBJECTIVE: To establish the incidence and risk factors for progression to high-grade intraepithelial neoplasia (HG-IEN) or Barrett's esophageal adenocarcinoma (BAc) in a prospective cohort of patients with esophageal intestinal metaplasia [(BE)].
BACKGROUND: BE is associated with an increased risk of BAc unless cases are detected early by surveillance. No consistent data are available on the prevalence of BE-related cancer, the ideal surveillance schedule, or the risk factors for cancer.
METHODS: In 2003, a regional registry of BE patients was created in north-east Italy, establishing the related diagnostic criteria (endoscopic landmarks, biopsy protocol, histological classification) and timing of follow-up (tailored to histology) and recording patient outcomes. Thirteen centers were involved and audited yearly. The probability of progression to HG-IEN/BAc was calculated using the Kaplan-Meier method; the Cox regression model was used to calculate the risk of progression.
RESULTS: HG-IEN (10 cases) and EAc (7 cases) detected at the index endoscopy or in the first year of follow-up were considered to be cases of preexisting disease and excluded; 841 patients with at least 2 endoscopies {median, 3 [interquartile range (IQR): 2-4); median follow-up = 44.6 [IQR: 24.7-60.5] months; total 3083 patient-years} formed the study group [male/female = 646/195; median age, 60 (IQR: 51-68) years]. Twenty-two patients progressed to HG-IEN or BAc (incidence: 0.72 per 100 patient-years) after a median of 40.2 (26.9-50.4) months. At multivariate analysis, endoscopic abnormalities, that is, ulceration or nodularity (P = 0.0002; relative risk [RR] = 7.6; 95% confidence interval, 2.63-21.9), LG-IEN (P = 0.02, RR = 3.7; 95% confidence interval, 1.22-11.43), and BE length (P = 0.01; RR = 1.16; 95% confidence interval, 1.03-1.30) were associated with BE progression. Among the LG-IEN patients, the incidence of HG-IEN/EAc was 3.17 patient-years, that is, 6 times higher than in BE patients without LG-IEN.
CONCLUSIONS: These results suggest that in the absence of intraepithelial neoplastic changes, BE carries a low risk of progression to HG-IEN/BAc, and strict surveillance (or ablative therapy) is advisable in cases with endoscopic abnormalities, LG-IEN or long BE segments.

2. D'Onofrio A, Messina A, Lorusso R, Alfieri OR, Fusari M, Rubino P, Rinaldi M, Di Bartolomeo R, Glauber M, Troise G, Gerosa G. Sutureless aortic valve replacement as an alternative treatment for patients belonging to the "gray zone" between transcatheter aortic valve implantation and conventional surgery: a propensity-matched, multicenter analysis. J Thorac Cardiovasc Surg. 2012 Nov;144(5):1010-6. doi: 10.1016/j.jtcvs.2012.07.040. Epub 2012 Sep 10.
Division of Cardiac Surgery, University of Padova, Padova, Italy. adonofrio@hotmail.it Comment in J Thorac Cardiovasc Surg. 2012 Nov;144(5):1016-8.

Abstract
OBJECTIVE: The aim of this propensity-matched, multicenter study was to compare early clinical and echocardiographic outcomes of patients undergoing transapical aortic valve implantation (TA-TAVI) versus patients undergoing sutureless aortic valve replacement (SU-AVR) for severe symptomatic aortic valve stenosis.
METHODS: We reviewed 468 TA-TAVIs performed in 20 centers from April 2008 to May 2011, and 51 SU-AVRs performed in 3 centers from March to September 2011. Based on a propensity score analysis, 2 groups with 38 matched pairs were created. Variables used in the propensity analysis were age, sex, body surface area, New York Heart Association class, logistic EuroSCORE, peripheral vascular disease, chronic obstructive pulmonary disease, aortic valve area, mitral regurgitation, and left ventricular ejection fraction.
RESULTS: Preoperative characteristics of the 2 groups were comparable. Hospital mortality was 5.3% and 0% in the TA-TAVI and SU-AVR groups, respectively (P = .49). We did not observe stroke or acute myocardial infarction in the 2 groups. Permanent pacemaker implantation was needed in 2 patients of each group (5.3%, P = 1.0). Dialysis was required in 2 patients (5.3%) in the SU-AVR group and in 1 patient (2.7%) in the TA-TAVI group (P = 1.0). Predischarge echocardiographic data showed that the incidence of paravalvular leak (at least mild) was greater in the TA-TAVI group (44.7% vs 15.8%, P = .001), but there were no differences in terms of mean transprosthetic gradient (10.3 ± 5 mm Hg vs 11 ± 3.7 mm Hg, P = .59).
CONCLUSIONS: This preliminary experience showed that, in patients at high risk for conventional surgery, SU-AVR is as safe and effective as TA-TAVI and that it is associated with a lower rate of postprocedural paravalvular leak.

3. Capodanno D, Caggegi A, Capranzano P, Milino V, Chisari A, Mangiameli A, Monaco S, Barrano G, Di Salvo ME, Tamburino C. Comparative one-year effectiveness of percutaneous coronary intervention versus coronary artery bypass grafting in patients <75 versus ≥75 years with unprotected left main disease (from the CUSTOMIZE Registry). Am J Cardiol. 2012 Nov 15;110(10):1452-8. doi: 10.1016/j.amjcard.2012.07.005. Epub 2012 Jul 30.
Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy; Excellence Through Newest Advances Foundation, Catania, Italy. dcapodanno@gmail.com

Abstract There is a lack of knowledge on the interaction between age and left main coronary artery revascularization. The aim of this study was to investigate the comparative effectiveness of percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG) in patients with left main coronary artery disease aged <75 versus ≥75 years. Of a total of 894 patients included, 692 (77.4%) were aged <75 years and 202 (23.6%) ≥75 years. PCI was found to be significantly different from CABG with respect to the composite of major adverse cardiac events at 1-year follow-up in patients aged <75 years (15.5% vs 8.5%, p = 0.01) but not in those aged ≥75 years (16.4% vs 13.9%, p = 0.65). This finding was consistent after statistical adjustment for baseline confounders in the 2 groups (adjusted hazard ratio [AHR] 2.2, 95% confidence interval 1.2 to 4.1, p = 0.016 in younger patients; AHR 0.9, 95% confidence interval 0.3 to 3.0, p = 0.88 in older patients). In the 2 groups, PCI and CABG showed similar adjusted risks for all-cause death, cardiac death, and myocardial infarction. Target lesion revascularization occurred more frequently in patients aged <75 years treated with PCI compared to CABG (AHR 5.1, 95% confidence interval 1.9 to 13.6, p = 0.001) but not in those aged ≥75 years. A significant interaction between age and treatment with regard to major adverse cardiac events was identified (adjusted p for interaction = 0.034). In conclusion, compared to younger patients, elderly patients with left main disease are likely to derive the maximal gain from a less invasive procedure such as PCI.

4. Ceresini G, Corcione L, Michiara M, Sgargi P, Teresi G, Gilli A, Usberti E, Silini E, Ceda GP. Thyroid cancer incidence by histological type and related variants in a mildly iodine-deficient area of Northern Italy, 1998 to 2009. Cancer. 2012 Nov 15;118(22):5473-80. doi: 10.1002/cncr.27591. Epub 2012 Apr 19.
Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, Endocrine Unit, University of Parma, Parma, Italy. ceresini@unipr.it

Abstract
BACKGROUND: The incidence of thyroid cancer is increasing in several countries. However, the issue of whether this applies to all different histological types and related variants is poorly addressed.
METHODS: All incident thyroid cancers diagnosed between 1998 and 2009 in a mildly iodine-deficient area in northern Italy were derived from a population-based tumor registry. Stage of disease, size of the tumor, focality, and histological variants were recorded from a review of pathology reports and slides. The mean annual increase (MAI) of the standardized incidence rate was calculated over the entire 12-year period of observation and a standardized rate ratio was evaluated to compare the mean standardized incidence between 2 periods of 6 years each (1998-2003 vs 2004-2009).
RESULTS: In total, 980 cases were considered. An increase in the incidence trend for all thyroid tumors was demonstrated; the increase was found to be continuous from 1998 to 2002 but not afterward. The cancer incidence increased in both male and female subjects. Papillary thyroid carcinoma (PTC), the follicular variant of PTC, the tall cell variant of PTC (TCV-PTC), and Hurthle cell carcinoma (HC) showed the most relevant changes in incidence whereas follicular carcinoma was not found to be significantly affected. TCV-PTC was the only histological type to demonstrated a significant (P < .01) proportional increase in the second 6-year period of observation. Only TCV-PTC and HC were found to display a significant MAI after 2002.
CONCLUSIONS: The incidence of thyroid cancer has increased within the last decade, an increase that is accounted for mostly by differentiated tumors. The most significant increases were documented for aggressive variants of basic histotypes.

Breve commento a cura di E. Crocetti
La letteratura italiana relativa all’incremento nel tempo dell’incidenza del tumore tiroideo si arricchisce di questo nuovo e interessante contributo. L’incremento nel tempo che il tumore della tiroide presenta anche nel nostro Paese è stato associato a diverse possibili spiegazioni, dal fall-out di Chernobyl nel 1986, alla presenza di sostanze chimiche specifiche del suolo vulcanico, alla carenza di iodio e al ruolo di una sempre più diffusa diagnostica ecografica e di una più aggressiva diagnosi delle lesioni nodulari tiroidee, per citare le principali. Un gruppo di colleghi parmensi ha condotto questo studio basato sui dati del locale registro tumori analizzando 980 casi diagnosticati nel periodo 1998-2009.
Gli autori hanno evidenziato un incremento dell’incidenza complessiva e nei due sessi, dal 1998 fino al 2002 ed un andamento piatto in anni più recenti. L’articolo affronta una valutazione per due periodi, 1998-2002 e 2003-2009, per sesso, TNM, dimensioni, età e per tipi istologici. Nonostante la casistica risulti nelle analisi per sottogruppi rappresentata da poche decine di casi o per alcune modalità addirittura da pochi casi per periodo, alcuni risultati appaiono interessanti. Fra questi si segnala l’analisi per morfologia che mostra, accanto all’incremento della forma più frequente, quella papillare (44% del totale) e la crescita della variante follicolare del papillare (31%), anche la crescita di varianti dal comportamento più aggressivo come la variante a cellule alte del papillare (7%) e il tumore a cellule di Hurtle (4%).
L’incremento in termini di tasso di incidenza anche di forme morfologiche ad andamento aggressivo (che aumentano nell’intero periodo studiato) sarebbe, secondo gli Autori, in contrasto con l’ipotesi che lega la crescita del numero delle nuove diagnosi tiroidee prevalentemente con l’incremento dell’intensità diagnostica e con il conseguente contributo della sovra diagnosi.

5. Rinaldi C, Savignano C, Pasca S, Sperotto A, Patriarca F, Isola M, Fanin R, De Angelis V. Efficacy and safety of peripheral blood stem cell mobilization and collection: a single-center experience in 190 allogeneic donors. Transfusion. 2012 Nov;52(11):2387-94. doi: 10.1111/j.1537-2995.2012.03619.x. Epub 2012 Mar 27.
Transfusion Medicine Department and the Clinic of Haematology, University Hospital of Udine, and the Department of Statistics, University of Udine, Udine, Italy.

Abstract
BACKGROUND: In the past two decades peripheral blood stem cells (PBSCs) have increasingly replaced marrow as stem cells source for allogeneic transplantation. The PBSC donation initially applied only to related donors; later, due to the safety of the procedure, it was extended to unrelated donors.
STUDY DESIGN AND METHODS: We have retrospectively collected data regarding mobilization, collection, and short- and long-term follow-up of 190 consecutive donors, 174 related and 16 unrelated. All donors followed a standard protocol for mobilization and underwent at least one PBSC collection. Follow-up in related donors was performed every 4 months in the first year and then annually, with no time limits, while unrelated donors were monitored for 10 years.
RESULTS: All 190 donors completed the established mobilization protocol. The mobilizing capacity was significantly greater in males and in donors less than 60 years old. No case of major toxicity by granulocyte-colony-stimulating factor was found, nor thromboembolic events. The total dose of CD34+/recipient (median 5.8×10(6)/kg recipient/body weight) was statistically correlated with age, CD34+ before and after mobilization, and collection efficiency. Compliance to follow-up was 66%, with a significant difference between related and unrelated (63% vs. 100%, p=0.03). During follow-up no significant abnormalities in hematologic variables or hematologic malignancies were reported.
CONCLUSION: Our study allowed us to define the PBSC donation as "a safe procedure for the donors," with short- and long-term effects limited to a small percentage of donors and "effective for the recipient," due to the dose of collected CD34+, adequate for transplantation in almost all recipients.

6. Vitellaro M, Ferrari A, Trencheva K, Sala P, Massimino M, Piva L, Bertario L. Is laparoscopic surgery an option to support prophylactic colectomy in adolescent patients with Familial Adenomatous Polyposis (FAP)? Pediatr Blood Cancer. 2012 Dec 15;59(7):1223-8. doi: 10.1002/pbc.24113. Epub 2012 Feb 29.
Colorectal Cancer Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. marco.vitellaro@istitutotumori.mi.it

Abstract
BACKGROUND: Prophylactic surgery is still considered the standard treatment for patients with Familial Adenomatous Polyposis (FAP). Laparoscopic (Lap) surgery has been introduced as an alternative approach. The aim was to evaluate the feasibility and short- to long-term outcomes after prophylactic FAP surgery in adolescent.
PROCEDURES: A retrospective review of a database of adolescent patients with FAP identified through the Hereditary Colorectal Tumor Registry in a single Institution between 2005 and 2011. Patients underwent Lap total colectomy (TC) with ileo-rectal anastomosis (IRA) or proctocolectomy (PC) with ileal-pouch anal anastomosis (IPAA). The main outcomes were: Hospital stay, postoperative complications, desmoid tumor rates, tumor recurrence, long-term complications.
RESULTS: Sixteen consecutive patients with median age 16 (range 13-19) and median BMI 22 (17-29) underwent surgery. [correction made here after initial online publication]. Of them 14 patients had LAP TC with IRA and 2 had PC with IPAA. Operative time (median, range) was TC/IRA 270 (210-330) minutes; PC/IPAA 370 (360-380) minutes. Length of extraction site was cm (median, range) 6(5-8). Lymph Node harvest (median, range) 81 (32-139). Postoperative stay days (median, range) were 6 (4-24). Five patients (31.2%) showed dysplasia on the pathological report and 3 of them showed severe dysplasia. Median follow-up time (FU) was 39 months, range (10-82). The anastomotic leak rate for 30 days was 2 (12.5%). Pouch failure was 0. Post-surgical desmoid tumors rate was 1 (6.2%) and there was no tumor recurrence. Anastomotic stricture, SBO and mortality were zero.
CONCLUSIONS: Lap approach is feasible and shows acceptable postoperative outcomes. Lap surgery can be an appealing alternative for prophylactic surgery in adolescent FAP patients. Pediatr Blood Cancer 2012; 59: 1223-1228. © 2012 Wiley Periodicals, Inc.

7. Pizzi C, De Stavola BL, Pearce N, Lazzarato F, Ghiotti P, Merletti F, Richiardi L. Selection bias and patterns of confounding in cohort studies: the case of the NINFEA web-based birth cohort. J Epidemiol Community Health. 2012 Nov;66(11):976-81. doi: 10.1136/jech-2011-200065. Epub 2011 Dec 6.
Cancer Epidemiology Unit, CeRMS and CPO-Piemonte, University of Turin, Via Santena 7, Turin 10126, Italy. costanza.pizzi@lshtm.ac.uk

Abstract
BACKGROUND: Several studies have examined the effects of sample selection on the exposure-outcome association estimates in cohort studies, but the reasons why this selection may induce bias have not been fully explored.
AIMS: To investigate how sample selection of the web-based NINFEA birth cohort may change the confounding patterns present in the source population.
METHODS: The characteristics of the NINFEA participants (n=1105) were compared with those of the wider source population-the Piedmont Birth Registry (PBR)-(n=36 092), and the association of two exposures (parity and educational level) with two outcomes (low birth weight and birth by caesarean section), while controlling for other risk factors, was studied. Specifically the associations among measured risk factors within each dataset were examined and the exposure-outcome estimates compared in terms of relative ORs.
RESULTS: The associations of educational level with the other risk factors (alcohol consumption, folic acid intake, maternal age, pregnancy weight gain, previous miscarriages) partly differed between PBR and NINFEA. This was not observed for parity. Overall, the exposure-outcome estimates derived from NINFEA only differed moderately from those obtained in PBR, with relative ORs ranging between 0.74 and 1.03.
CONCLUSIONS: Sample selection in cohort studies may alter the confounding patterns originally present in the general population. However, this does not necessarily introduce selection bias in the exposure-outcome estimates, as sample selection may reduce some of the residual confounding present in the general population.

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