IMPACT OF LIFESTYLE FACTORS ON SCREENING-DETECTED COLORECTAL NEOPLASIA

Background and aims: The detection and removal of precancerous lesions through colorectal cancer (CRC) screening, and the intervention on modifiable risk factors for CRC - such as smoking habits, physical activity, red meat consumption and alcohol intake - represent the two possible ways for reducing CRC incidence and mortality. The aim of this project was to investigate whether lifestyle factors, gender, family history and daily low-dose Aspirin use are important factors in predicting endoscopy findings at a first round screening level and whether they can have a significant impact on the natural history of the disease in screened patients during their follow-up (second round screening level). Patients and methods: Me and my work team identified and selected a study population of 870 men and women of age 50-74 years who underwent a screening colonoscopy at the European Institute of Oncology (IEO) between the years 2007-2009 after a positive Fecal Occult Blood Test (FOBT+). We set up a telephone questionnaire in order to retrieve information on smoking habits, BMI, physical activity, diet, alcohol consumption, family history and usage of low-dose Aspirin at the time of the first colonoscopy. All patients were then interviewed by me by telephone. Ninety-five individuals were not interviewed for various reasons, making the final population size n=775. Patients who could answer the questionnaire were similar to the unreached individuals in terms of outcome of the first colonoscopy. Results: At first colonoscopy, we observed 415 patients presenting with a high-risk neoplasia (i.e. 3 or more adenomas or at least one adenoma bigger than 10 mm / with villous component / with high-grade dysplasia or invasive tumor). At the univariate analysis, gender, family history, physical activity, smoking habits, alcohol intake, fruit and vegetable intake and daily low-dose Aspirin were associated with the prevalence of high-risk neoplasia. Using a \u201cSpike at zero function\u201d, we showed that light drinkers (<5 grams per day) seemed to have a lower risk of high-risk neoplasia compared to non-drinkers. We concluded that a proportion of non-drinkers might avoid alcohol because of some health conditions linked to the endpoint of interest. At a multivariable level, all those factors remained statistically significantly associated with the outcome of interest. We therefore combined the information of lifestyle factors, gender, family history and daily low-dose Aspirin use to obtain a reliable individual risk score (i.e. linear predictor) and build a nomogram. The second colonoscopy visit date was fixed in advanced at the time of first colonoscopy, based on the outcome of the first colonoscopy, following a typical example of Doctor\u2019s care scheme of examinations. After adjusting for the severity of the outcome of the first colonoscopy and for the time from first to second colonoscopy, we obtained a statistically significant association between the linear predictor and the risk of high-risk neoplasia detected at the second colonoscopy. We then applied homogeneous Markov Models to simultaneously model the disease process over time. The effect of the linear predictor on the transitions \u2013 from one disease stage to the other \u2013 resulted statistically significant. Moreover, as the linear predictor increased, the probability of getting better decreased. In other words, the worse the lifestyle, the lower the probability for the intestinal mucosa to heal. On the other hand, the estimated parameter for the effect of linear predictor on the aggravation transition resulted positive: the worse the lifestyle, the higher the probability to find new high-risk polyps. Conclusions: Lifestyle should be considered in the planning of population CRC screenings, because the identification of different risk groups can lead to more tailored screening policies, and accordingly to more efficient and cost-effective interventions

Smoking as a cofactor for causation of chronic pancreatitis: a meta-analysis.

OBJECTIVES: To assess the evidence for tobacco smoking as a risk factor for the causation of chronic pancreatitis. METHODS: We performed a meta-analysis with random-effects models to estimate pooled relative risks (RRs) of chronic pancreatitis for current, former, and ever smokers, in comparison to never smokers. We also performed dose-response, heterogeneity, publication bias, and sensitivity analyses. RESULTS: Ten case-control studies and 2 cohort studies that evaluated, overall, 1705 patients with chronic pancreatitis satisfied the inclusion criteria. When contrasted to never smokers, the pooled risk estimates for current smokers was 2.8 (95% confidence interval [CI], 1.8-4.2) overall and 2.5 (95% CI, 1.3-4.6) when data were adjusted for alcohol consumption. A dose-response effect of tobacco use on the risk was ascertained: the RR for subjects smoking less than 1 pack per day was 2.4 (95% CI, 0.9-6.6) and increased to 3.3 (95% CI, 1.4-7.9) in those smoking 1 or more packs per day. The risk diminished significantly after smoking cessation, as the RR estimate for former smokers dropped to a value of 1.4 (95% CI, 1.1-1.9). CONCLUSIONS: Tobacco smoking may enhance the risk of developing chronic pancreatitis. Recommendation for smoking cessation, besides alcohol abstinence, should be incorporated in the management of patients with chronic pancreatitis

Nationwide analysis of open groin hernia repairs in Italy from 2015 to 2020

Introduction: Inguinal hernia repair is one of the most commonly performed operations in general surgery. A total of 130.000 inguinal hernia repairs are performed yearly in Italy, and approximately 20 million inguinal hernias are treated worldwide annually. This report represents the trend analysis in inguinal hernia repair in Italy from a nationwide dataset for the 6-year period from 2015 to 2020. Materials and methods: Based on regional hospital discharge records, all the inguinal hernia repairs performed in public and private hospitals in Italy between 2015 and 2020 were reviewed based on diagnosis and procedure codes. For the aim of this study, data from the AgeNas (The National Agency for Regional Health Services) data source were analyzed. Results: Elective inguinal hernia repairs outnumbered urgent operations over the 6-year study period, ranging from 122,737 operations in 2015 to 65,780 in 2020 as absolute numbers, and from 87.96 to 83.3% of total procedures in 2019 and 2020 respectively, with an annual change ranging from - 66.58%, between 2020 and 2019, to - 2.49%, between 2019 and 2018 (mean = - 18.74%; CI =- 46.7%-9.22%; p &lt; 0.0001). Conclusions: This large-scale review of groin hernia data from a nationwide Italian dataset provides a unique opportunity to obtain a snapshot of open groin hernia repair activity. More specifically, there is a trend to perform more elective than urgent procedures and there is a steady decrease in the amount of open hernia repairs in favor to laparoscopy

Reproductive factors and risk of melanoma : a population-based cohort study

Background The association between reproductive factors and risk of cutaneous melanoma (CM) is unclear. We investigated this issue in the Norwegian Women and Cancer cohort study. Objectives To examine the association between the reproductive factors age at menarche, menstrual cycle length, parity, age at first and last birth, menopausal status, breastfeeding duration and length of ovulatory life, and CM risk, overall and by histological subtypes and anatomical site. Methods We followed 165 712 women aged 30-75 years at inclusion from 1991-2007 to the end of 2015. Multivariable Cox regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Results The mean age at cohort enrolment was 49 years. During a median follow-up of 18 years, 1347 cases of CM were identified. No reproductive factors were clearly associated with CM risk. When stratifying by histological subtype we observed significant heterogeneity (P = 0 center dot 01) in the effect of length of ovulatory life on the risk of superficial spreading melanoma (HR 1 center dot 02, 95% CI 1 center dot 01-1 center dot 04 per year increase) and nodular melanoma (HR 0 center dot 97, 95% CI 0 center dot 94-1 center dot 01 per year increase). When stratifying by anatomical site, menopausal status (HR 0 center dot 54, 95% CI 0 center dot 31-0 center dot 92, postmenopausal vs. premenopausal) and menstrual cycle length (HR 1 center dot 07, 95% CI 1 center dot 01-1 center dot 13, per day increase) were associated with CM of the trunk, and significant heterogeneity between anatomical sites was observed for menopausal status (P = 0 center dot 04). Conclusions In this large population-based Norwegian cohort study, we did not find convincing evidence of an association between reproductive factors and risk of CM.Peer reviewe

Analysis of local and regional recurrences in breast cancer after conservative surgery

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Case mix at the European Institute of Oncology: first report of the Tumour Registry, 2000–2002

Introduction: An institutional and centralized hospital-based tumour registry (TR) is the ideal supporting tool for the organization and management of clinical data in a comprehensive cancer centre. The purpose of this paper is to describe the development of the TR at the European Institute of Oncology (IEO) in Milan, Italy, from its origin to its current applications. Material and methods: After a series of meetings with members of administrative, clinical, research and informatics departments, the TR was activated in March 2006 with the aim to collect data on all the individuals referring to the Institute, with or at risk of developing a tumour. It was implemented on an Oracle\u2122-based interface. A minimum data set of variables was defined and data collection was divided into four forms, which together gather all the relevant data on patients, tumours, treatments and subsequent events. Results: After a 6-month pilot period, which involved the training of the tumour registrars, adjustments to the structure of the registry, development of data quality control procedure and finalization of the operative protocol, from September 2006 the data collection has been fully operative. Five registrars have been chronologically entering data of all individuals who visited the IEO for the first time since 1st January 2000. As of March 2009, data on 69,637 individuals and 43,567 tumours has been reviewed, recoded and registered in the TR. Twenty-two percent of the tumours (n=9,578) were first invasive primaries, diagnosed and treated in IEO; the most common sites were breast (n=4,972), lung (n=627), intestines (n=479) and prostate (n=376). Conclusion: The IEO TR has been proven functional and reliable in monitoring the activity of the Hospital, allowing extraction of data from any subpopulation with characteristics of interest. The structured and centralized TR represents an important tool for our research-oriented Institution

Intensified ChlVPP/ABVVP chemotherapy regimen and pegfilgrastim support in advanced Hodgkin lymphoma

We present feasibility, toxicity and efficacy results of an intensified six-cycle ChlVPP/ABVVP regimen in advanced Hodgkin lymphoma (HL). From February 2004 to August 2007, 82 consecutive eligible patients were enrolled. According to the Hasenclever index, 64 patients (78%) were considered at low risk, 15 (18%) at intermediate and 3 (4%) at high risk. The most relevant toxicity was haematological: grade 3–4 neutropenia occurred in 32% of patients, grade 3–4 anaemia in 26% of patients. Severe infections and febrile neutropenia were observed in 8% of patients. With a median follow-up of 35 months (range 12–55), the three-year freedom from treatment failure (FFTF) and overall survival (OS) were 75% (95% CI 65%–86%) and 94% (95% CI 87%–99%), respectively. The intensified ChlVPP/ABVVP regimen in advanced HL is effective, does not seem to differ from standard regimens in terms of FFTF and OS and showed a favourable toxicity profile

Clinical outcome of circulating tumor cells in metastatic castration-resistant prostate cancer patients treated with docetaxel: long-term prospective single-centre study

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