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Biomedical subjects

E Crocetti

Publications and source records attributed to E Crocetti.

At least 37 records · Page 2Linked to original sources
PubMed2002

Time trends in cancer incidence and mortality in central Italy.

Time trends in cancer incidence and mortality represent an essential tool for monitoring the changes in population lifestyle and in the environmental risks and the effectiveness of the health system on cancer control in a specific area. During 1985-1997 82 506 malignant tumours were diagnosed in the Tuscany Cancer Registry, central Italy (about 1 200 000 inhabitants) and 54 979 cancer deaths registered in the period 1985-1999 by the Regional Mortality Registry were analysed. A statistically significant decrease in incidence was evidenced for stomach and gallbladder in both sexes, and for oesophagus, larynx and lung among males. Significant increases were documented for melanomas of the skin, kidney and non-Hodgkin's lymphoma in both sexes for colon, prostate and Kaposi's sarcoma among males and for breast, thyroid and multiple myeloma among females. Mortality decreased significantly for stomach and thyroid in both sexes and for oral cavity and pharynx, oesophagus, rectum, larynx, lung, bone, prostate, testis and Hodgkin's disease among males and colon, gallbladder and breast among females. Mortality increased for soft tissue, brain and multiple myeloma. In conclusion, most of these data can be explained as the effect of the modifications that occurred in smoking habits between the sexes and as the consequence of the primary and secondary prevention activities that are ongoing in the area.

Adolescent↗
PubMed2002

Transperineal sonography guided biopsy of the prostate: critical review of 1107 cases.

PURPOSE: To assess the predictive value for a positive biopsy of different indicators (rectal examination, transrectal ultrasonography, total PSA, PSA density). MATERIAL AND METHODS: Positive predictive value was assessed on 1107 consecutive US-guided transperineal biopsies performed from 1991 to 2001 (cancer=344, dysplasia (PIN)=64, atypical hyperplasia=4, benign hyperplasia=686, inadequate=9) with univariate and multivariate analysis. RESULTS: Increasing age (chi square for trend 52.2, p <0.001), positive rectal examination (chi square 233, df=1, p<0.001) or ultrasonography (chi square 191, df=1, p<0.001), total PSA (chi square for trend 68.9, p<0.001) and PSA density (cutoff 0.15, chi square 104, df=1, p<0.001; cutoff 0.20, chi square 104, df=1, p<0,001) were all significantly associated to the likelihood of a positive biopsy outcome. Multivariate analysis stresses the independent role of Psa density over total PSA. If the parameters studied had determined the biopsy, spared benign biopsies [positive rectal examination=505 (66%), positive ultrasonography=467 (61%), PSA>4=124 (16%), PSA>10=159 (74%), PSA density >0,15=426 (62%), PSA density >0.20=517 (75%)] would not have justified the amount of delayed cancer biopsies [positive rectal examination=103 (29%), positive ultrasonography=55 (15%), PSA>4=42 (12%), PSA>10=569 (46%), PSA density >0,15=73 (25%), PSA density >0,20=107 (37%)]. CONCLUSIONS: The parameters currently available prior to biopsy, if used alone, allow no reliable prediction of biopsy outcome. Positive predictive value, particularly for PSA density, allows a better evaluation of biopsy indication, particularly for random sextant biopsies in the 4-10 ng/ml PSA range, which are frequently negative.

Adult↗
PubMed2001

Non-Hodgkin lymphoma among young adults with and without AIDS in Italy.

To compare the presentation and prognosis of non-Hodgkin lymphoma (NHL) in people with AIDS (PWA) and in the general Italian population, a record linkage study was carried out. The fraction of NHLs attributable to HIV/AIDS was also estimated. Information from the National AIDS Registry (RAIDS) was linked with records from 13 cancer registries (CR), covering about 15% of the Italian population. During the period 1985--94, among PWA ages 15--49, 136 NHLs were identified (8% of all NHLs) and were compared with 1,481 concurrent incident NHL cases of the same age group among non-PWA. Percentages above 13% of all NHLs were registered in the northern areas of Genoa and Varese, i.e., the most heavily affected by the AIDS epidemic. Between 1 year prior to and 3.5 years after AIDS diagnosis, PWA showed an overall standardised incidence ratio (SIR) for NHL of 302. SIR was particularly high (394) within 3 months after AIDS diagnosis and subsequently declined to 170. SIR was somewhat higher in females (428) than in males (280) but similar among intravenous-drug users (299) and other HIV-transmission groups (309). High-grade NHL, particularly immunoblastic and Burkitt's lymphoma, were twice as frequent among PWA than non-PWA. Conversely, low-grade NHL were less frequent. Except for the high proportion of brain localisation, no clear difference emerged in the pattern of NHL presentation site in PWA compared with non-PWA. At variance with NHL in the general population, among PWA histological grade had little impact on survival, which overall appeared to be very poor (2-year survival: 10%; 95% confidence interval: 3%--17%). Our present linkage of RAIDS and CRs represents an efficient tool for the surveillance of trends in incidence and survival of NHL among PWA in Italy.

Adolescent↗
PubMed2001

Measuring interval cancers in population-based screening using different assays of fecal occult blood testing: the District of Florence experience.

The fecal occult blood test (FOBT) has demonstrated its efficacy in reducing mortality from colorectal cancer (CRC). The guaiac-based FOBT has been criticized for its low sensitivity. In this study, two different assays for FOBT (guaiac or an immunochemical test based on reversed passive hemagglutination [RPHA]) were tested for comparison within a population-based screening program for colorectal cancer in the province of Florence (Italy). The proportional incidence method was used to calculate sensitivity for both FOBTs, according to rank of screening (first or repeat), age at entry (two groups of 50 to 59 and 60 to 70 years old) and lesion site (colon or rectum). When comparing FOBTs, the sensitivity multivariate Poisson regression was used to adjust for other variables. The sensitivity after the first 2 years was 50% (95% confidence interval [CI] 34% to 63%) for the guaiac test versus 82% (95% CI 67% to 92%) for RPHA. At multivariate analysis the risk of developing an interval cancer after a guaiac test is almost 3 times that after RPHA (rate ratio = 2.64; 95% CI 1.3 to 5.4). Our study confirms that RPHA is more sensitive than the guaiac test. The assumption that FOBT screening for CRC has to be based on a guaiac test should be reconsidered, and RPHA should be recommended as the standard FOBT for screening purposes.

Aged↗
PubMed2001

Long-term prognosis of gastric cancer in a European country: a population-based study in Florence (Italy). 10-year survival of cases diagnosed in 1985-1987.

This paper analysed, in a population-based series of 1976 gastric cancers diagnosed in Florence (Italy), from 1985 to 1987, the relationship between prognostic variables (demographic, clinical and pathological) and 10-year survival rates. Gastric cancer was mostly detected in elderly patients (mean age: 70.5 years) and at advanced stages (i.e. approximately 50% of the patients could not undergo radical surgery). Ten-year observed survival was 12.1% (95% confidence interval (CI): 10.6-13.6%) for the whole series and 20.8% (95% CI: 18.3-23.3%) for resected cases; relative survival was, respectively, 20.9% (95% CI: 18.4-23.4%) and 32.0% (95% CI: 28.1-35.9%). Ten-year relative survival was 86% for stage IA (95% CI: 73-99%) and 67% for stage IB (95% CI: 52-82%). Multivariate analysis showed a significantly better prognosis in females and a significantly worse prognosis in patients aged 65 years or more (reference: < or = 59 years). In addition, an independent prognostic effect was observed for pT in the resected cases (reference: pT3; pT1: RR = 0.47, 95% CI: 0.34-0.64; pT2 = 0.71, 95% CI: 0.58-0.87; pT4: RR = 2.02, 95% CI: 1.49-2.75), pN (reference: pN0; pN1: RR = 2.13, 95% CI: 1.70-2.68; pN2-3: RR = 3.14, 95% CI: 2.42-4.07; pN+ no. nodes involved unspecified: RR = 4.26, 95% CI: 3.11-5.83) and surgical margin involvement (reference: not involved; involved: RR = 1.36, 95% CI: 1.08-1.72). In addition, the stage, after adjustment for age, gender and surgical margin involvement, showed a strong independent prognostic value (reference: stage II; IA: RR=0.37, 95% CI: 0.25-0.57; IB: RR=0.70, 95% CI: 0.50-0.98; IIIA: RR = 1.80, 95% CI: 1.40-2.33; IIIB: RR = 2.82, 95% CI: 2.14-3.72; IV: RR = 3.29, 95% CI: 2.36-4.59). In conclusion, on the basis of a large population-based series, our results confirm the prognostic effect on long-term gastric cancer survival of pathological and demographic variables. In addition, the study shows that Italy had a relatively good, long-term survival when diagnosis was performed at early stages. However, only a few cases were diagnosed at stages when cure by radical surgery is more likely (i.e. stage I accounted for approximately 20% of the resected cases and less than 10% of all incident cases).

Adult↗
PubMed2001

Multiple primary cancer incidence in Italy.

Data collected from eleven Italian population-based cancer registries (overall population 7,200,000 inhabitants) were used to compute the incidence of second independent cancers (MP) in a cohort of cancer patients aged 15 years or more. Overall, 240111 patients have been followed for 544438 person-years during which 8766 second primary cancers were diagnosed leading to an observed to expected ratio (SIR) of MP of 1.08 (95% Confidence Interval (CI): 1.05-1.12). Restricting the analysis to metachronous cancers, there were 6974 second primary cancers diagnosed among 198303 patients during 508,648 person-years with an SIR of 0.93 (95% CI: 0.90-0.96). According to the time since first cancer diagnosis, the SIR was significantly higher than expected during the first 2 months, then the overall risk was slightly lower than 1 up to 10 years after diagnosis. No differences were observed according to gender. The SIR significantly differed among the age groups with consistent excess risks in subjects younger than 65 years in comparison with older ones. Overall, significantly elevated SIR for metachronous cancers were evidenced for oral cavity and pharynx, larynx, connective, skin non-melanoma, ovary and kidney cancers. For each cancer site, the site-specific risk of further MP has been evaluated. The identification of strong site-specific associations may be useful for clinicians when following-up patients.

Adolescent↗
PubMed2001

Effectiveness of influenza vaccination in the elderly in a community in Italy.

OBJECTIVES: Assess the effectiveness of influenza vaccination in reducing hospitalization due to pneumonia and influenza among elderly subjects in a community in central Italy. Estimate the hospitalization fraction preventable by extending the vaccination program. METHODS: Case-control study. Cases were subjects aged 65+ at hospital admission (1 December 1994-31 March 1995). For each case two population controls were randomly chosen, matched by sex, age and residence. Variables of interest were recorded through a postal questionnaire and telephone interview. A matched-set analysis was carried out adjusting for concomitant chronic diseases, education, type of home heating, and smoking habits. The preventable fraction of hospitalization was computed through the application of the attributable risk estimate. The setting was 33 municipalities in central Italy including 169,370 residents aged 65 years or more. RESULTS: Two hundred and seventy-five cases 550 controls were analyzed. Influenza vaccination was effective in preventing 33% of hospitalization due to pneumonia/influenza. The fraction of hospital admissions preventable by extending the vaccination was 17%. When the analysis was limited to self-respondents to the questionnaire (excluding next-of-kin) and to pneumonia/influenza as primary discharge diagnosis, protection from hospitalization by vaccination almost reached 50%, a better result in comparison with most case-control studies. CONCLUSIONS: Influenza vaccination was shown to be successful in reducing hospital admissions due to pneumonia and influenza. A large number of hospitalizations could be reduced extending the vaccination campaign.

Age Factors↗
PubMed2001

Incidence of second cancers among women with in situ carcinoma of the breast.

A population-based cohort of 371 women with carcinoma in situ (CIS) of the breast, collected by the Tuscany Cancer Registry, has been analysed for further invasive cancers. All cases, diagnosed between 1985 and 1997, have been followed up to the end of 1997. During 1707 person-years of follow-up, 27 further invasive cancers were diagnosed while 13.7 were expected (Observed/Expected=2.0, P<0.05). The relative risk for invasive breast cancers was 3.7 (P<0.05). According to the surgical treatment for CIS and the site of further invasive breast cancer, no side specific difference was evident. No significant increase was evident for other cancer sites; only non-melanomatous skin cancers occurred more frequently than expected (O/E=4.2). The cumulative risk of developing an invasive cancer after CIS was 13.2% at 10 years. There were also two deaths due to breast cancer (O/E=8.3; P<0.05) corresponding to a cumulative mortality risk of 2% at 10 years. We have quantified the risk of developing an invasive breast cancer among women with CIS of the breast as four times that of the general population.

Journal Article↗
PubMed2001

An application of the two-source capture-recapture method to estimate the completeness of the Tuscany Cancer Registry, Italy.

The purpose of this study was to apply a two-way capture-recapture method to estimate the Tuscany Cancer Registry completeness, taking into account the presence of dependence between sources. Cases incident during 1995-1996 were flagged according to three sources of information: clinical notes, pathological reports and death certificates. For each group of cases notified by one source the dependence between the other two has been quantified and the completeness has been estimated by a two-way capture-recapture method. When only two (or substantially two) sources are dependent on each other it is possible to correct for it by pooling the two sources in a single group and comparing it with the remainder source by a two-way capture-recapture method. The capture-recapture method has been applied to the overall 12 387 incident cases and to 1569 female breast and 1443 lung cancer cases. After correction for the greatest dependence among the three couples of sources of information, the estimates of completeness were 97.4% for the whole case series, 88.7% for female breast and 99.6% for lung cancer. With the limit of multiple strong dependence between sources, the two-way capture-recapture method seems a simple and useful tool for estimating the completeness of cancer registration.

Female↗
PubMed2001

Net survival: comparison between relative and cause-specific survival estimates.

This paper presents a comparison between cause-specific survival and relative survival calculated according to the Hakulinen method. The data are from the Tuscany Cancer Registry and we analysed the following cancer sites: stomach, colon, rectum, cervix and corpus uteri, female breast and skin melanoma. When cause-specific survival was calculated including among the deceased only those subjects whose death certificate reported strictly the same neoplasm as cause of death (three digits ICD-9), very good agreement between the two methods was found for stomach, lung, and skin melanoma and a good agreement was found for female breast. For cancer of the colon and rectum, in order to obtain similar estimates, deaths coded as caused by cancer in other sites of the large bowel and partially the not specified intestine had to be included. For cancer of the cervix and corpus uteri, in order to obtain similar estimates, but with cause-specific remaining higher than the relative estimates, deaths coded as not specified uteri cancer had to be included. In conclusion, cause-specific survival may be used also with overall mortality data, providing the death causes by cancers most susceptible to misclassification are to be included. However, using cause-specific survival creates some difficulties in comparative studies due to the different reliability of mortality data and to the different criteria used to identify the main cause of death.

Cause of Death↗
PubMed2001

Coding criteria of bladder cancer: effects on estimating survival.

The aim of this study is to evaluate the consistency between routine methods for coding urinary bladder tumours in eight Italian cancer registries and the European Network of cancer registries (ENCR) criteria. Furthermore, it aims to evaluating the impact of the discordance on survival data. Eight cancer registries took part in the study: Ferrara, Florence, Macerata, Ragusa, Romagna, Sassari, Turin and Varese. The first 100 cases of neoplasm of the urinary bladder incident in the years 1993-1994 were identified from the files of each registry. The original pathology reports were made available. A working group considered eligible to the study 699 cases of microscopically confirmed transitional carcinoma (ICD-O morphology code 812-813). Using the ENCR criteria, each of these was classified according to morphology code (8120 vs. 8130) and behaviour (1/ uncertain, /2 non-invasive, 3/ invasive). Information of tumour behaviour was classified as follows: (i) present, when expressly stated in the original report, (ii) deducible, when not expressly stated but suggested by the pathologist's description, and (iii) absent, when impossible to determine on the basis of the original pathology report. The working group classification of tumour behaviour and the classification of the registry of origin were compared. There was a full concordance in the case of complete agreement on the morphology code, and partial concordance when only the invasive or non-invasive behaviour code was agreed upon. As much as 92.5% cases were microscopically confirmed. Tumour behaviour was expressly stated in the original report of 69.2% cases, not stated but suggested by the pathologist's description in 21.2% cases, and impossible to determine in 9.6%. Agreement between the panel and the registry of origin was complete in 71.2% cases and partial in 12.3% while there was a complete discordance in 16.5% cases. The panel interpreted as non-invasive 111 cases coded as invasive by the registry of origin. Conversely, it was estimated that 24% cases included in incidence data were non-invasive. This article discusses the impact of misclassification on survival data.

Female↗