Delphi initiative for early-onset colorectal cancer (DIRECt). International Management Guidelines.

BACKGROUND AND AIMS: Patients with early-onset colorectal cancer (eoCRC) are managed according to guidelines that are not age-specific. A multidisciplinary international group (DIRECt), comprised of 69 experts, was convened to develop the first evidence-based consensus recommendations for eoCRC. METHODS: After reviewing the published literature, a Delphi methodology was employed to draft and respond to clinically relevant questions. Each statement underwent 3 rounds of voting and reached a consensus level of agreement of ≥80%. RESULTS: The DIRECt group produced 31 statements in 7 areas of interest: diagnosis, risk factors, genetics, pathology-oncology, endoscopy, therapy, and supportive care. There was strong consensus that all individuals younger than 50 should undergo CRC risk stratification and prompt symptom assessment. All newly diagnosed eoCRC patients should receive germline genetic testing, ideally before surgery. Based on current evidence, endoscopic, surgical, and oncologic treatment of eoCRC should not differ from later onset CRC, except for individuals with pathogenic or likely pathogenic germline variants. The evidence on chemotherapy is not sufficient to recommend changes to established therapeutic protocols. Fertility preservation and sexual health are important to address in eoCRC survivors.The DIRECt group highlighted areas with knowledge gaps that should be prioritized in future research efforts, including age at first screening for the general population, use of fecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for eoCRC patients. CONCLUSIONS: The DIRECt group produced the first consensus recommendations on eoCRC. All statements should be considered together with the accompanying comments and literature reviews. We highlighted areas where research should be prioritized. These guidelines represent a useful tool for clinicians caring for patients with eoCRC

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Methods to study the deprivation and its relationships with cancer incidence in a local area [Metodi per lo studio della deprivazione e le sue relazioni con l\u2019incidenza del cancro in un\u2019area locale].

Abstract Aim: This study was aimed at finding the best method to describe the relationships between cancer incidence and deprivation of population at a local level (the Genoa province). Methods: The population was clustered using the National Deprivation Index (NDI) and the Genoa Deprivation Index (GDI), both using data drawn from the 2001 Census, either at municipality or at district levels. The NDI and GDI used were drawn from the NDI 2001 and the Liguria Region Deprivation Index 2001 (LRDI), re-parameterised on the values of areas pertaining to the Genoa province considering the quintiles of the population. In the building of both original indexes five traits representing the multi-dimensionality of the social and material deprivation concept were selected, but each one resulted composed by quite opposite variables. The derived indexes were applied to clustering Genoa province population computing for each cluster the cancer incidence occurrence in the period 1999-2003. For the five deprivation clusters of population, individuated aggregating the 91 areas of the province on the basis of the two indexes, the Standardised Incidence Ratios (SIR) were computed for all malignant cancers combined (skin carcinomas excluded) and 35 sites. The observed SIR and their 95% confidence intervals were calculated by gender and age (all ages, 0-64 years and 65+ years). To evaluate if deprivation influenced the incidence, an analysis was conducted between SIR group variances. Results: From the application of the GDI, many significant associations between cancer incidence and deprivation surfaced, particularly for women. However, the NDI did not correctly identify the main part of the negative linear trends whereas the GDI did so. The lacking of statistical significance in all cancers combined distribution by GDI in men was mainly explained by the opposite trends in lung and prostate cancers, while in women the breast negative trend was balanced by a major number of different sites. Conclusions: Although the GDI cannot be considered a \u201cpure\u201d deprivation index, it does seem to be useful for public health purposes due to its capability of discriminating SE clusters in a fairly homogenous population, like the Liguria one

Incidenza delle neoplasie per caratteristiche di deprivazione socio-economica delle aree di residenza.

cancer incidence - deprivatio

Deprivation and cancer incidence in a de-industrialised and highly ageing area. [Deprivazione e incidenza di cancro in un\u2019area ex-industriale a forte invecchiamento].

Abstract Aims: The analysis by tumor site, age groups and gender of the 1999-2003 cancer incidence in Genoa province population clusters in relationships with the socio-economic (SE) deprivation, evaluating if the observed associations confirmed the literature. Methods: The SIR of all malignant cancers (but not melanoma skin cancers) and 35 sites were computed by deprivation cluster, gender and age groups (all ages, 0-64, 65+ years), evaluating the variance in SIR among groups. The SE clusters were individuated by the Genoa Deprivation Index (GDI), derived from the re-parameterisation of the LRDI (Liguria Region Deprivation Index) inside the territorial limits of Genoa province. Results: All malignant cancers combined showed no association with deprivation in both sexes due to a balance of positive and negative observed associations. Increasing trend at decreasing deprivation (linear negative associations) regarded colon, melanoma, skin carcinomas, breast, prostate, meningioma and myelodysplastic syndromes, while the opposite (linear positive associations) were observed for oropharynx, oesophagus, stomach, rectum, liver, lung, mesothelioma, uterine corpus, testis, kidney, brain, Hodgkin\u2019s and non-Hodgkin\u2019s lymphomas and myeloma. Conclusions: The combined effects of population ageing, de-industrialisation and increasing role of touristic activities in Liguria induced a situation forerunner of the possible post-industrial Western countries development outcomes. Our study confirmed some known associations between deprivation and cancer incidence occurrence: both the positive with smoke- and alcohol-consumption (oropharynx, oesophagus, lung) and infectious risks (rectum, liver) and the negative ones with diet, obesity and sedentariness (colon, breast, prostate) and sun recreational exposure (skin carcinomas, melanoma). Also the controversial evidences regarding brain and haematological tumours seemed confirmed. From the future experiences of re-allocation of resources on the Genoa territory could derive input on readjustment policies on social and health resources redistribution at national level

Estimates of cancer burden in Liguria.

Aims and background. The regional health care system of Liguria caters for a resident population which is among the oldest in Europe. One population-based cancer registry is present in the region, providing incidence and survival data for the Genoa province (covering 55% of the regional population). This paper will estimate the incidence, prevalence and mortality in the Liguria region for cancers of the lung, breast, prostate, colon-rectum, stomach and uterine cervix and melanoma of the skin in 1970-2015. Methods. The estimated figures were obtained by applying the MIAMOD method. Starting from mortality and survival data, incidence and prevalence were derived using a statistical back-calculation approach. Survival was modeled on the basis of published data from the Italian cancer registries. The MIAMOD method was applied also to estimate the colorectal cancer incidence, mortality and prevalence rates in the Ligurian provinces in the period 1988-2015. Results. In 2012 about 1,500 new cases of breast cancer were expected in Ligurian women. The estimates for the other cancer sites were considerably lower, ranging from 839 (colon-rectum) to 54 (cervix). In men about 1,400 new cases were estimated for prostate cancer, while the incidence for the other sites ranged from 1,118 (colon-rectum) to 208 (skin melanoma). The breast cancer prevalence rate was more than 10 times the incidence rate in women, and the lung cancer prevalence rate was more than double the incidence rate in both sexes. Mortality rates were highest for lung cancer in men and breast cancer in women; the lowest rates were estimated for melanoma and cancer of the uterine cervix. Conclusion. In Liguria a large portion of the health expenditure has been devoted to diagnostic and therapeutic resources. This may have contributed to the reduction of mortality rates and to the improvement of cancer survival. This phenomenon, added to population aging, will inflate the cancer prevalence. One of the major challenges for the Liguria region is to face the increasing demand for oncology services

Hodgkin's disease in 63 intravenous drug users infected with human immunodeficiency virus

Sixty-three cases of Hodgkin's disease in intravenous drug users (IVDUs) have been collected by the Italian Cooperative Group on AIDS-Related Tumors (GICAT). In most patients (74%) the histological pattern was that of mixed cellularity and lymphocyte depletion. In 39% of patients the initial symptom was a persistent lymph node enlargement due to persistent generalized lymphadenopathy (PGL). Unusual presentations included Waldeyer's ring, skin, meninges, colon, and pleura. After MOPP alternated or followed by ABVD, MOPP alone, or ABVD alone, 15 of 32 patients (47%) had a complete remission (CR) and 15 of 32 (47%) had a partial remission (PR). The median duration of CR was 14 months, while the median survival of patients with CR has not been reached; the median survival of patients treated with chemotherapy who had CD4 levels at presentation greater than or equal to 400/mm3 was significantly superior to that of those who had CD4 less than 400/mm3. The overall median survival was only 14 months. Forty-four percent of patients receiving chemotherapy, with or without radiotherapy, developed opportunistic as well as nonopportunistic infections. Lethal hepatic toxicity was observed in one patient. Among IVDUs, unusual presentations of Hodgkin's disease occurred at a lower rate than was previously reported for homosexuals. Complete remissions could be achieved in almost half the patients, but non opportunistic infections, in addition to parenchymal function impairment due to drug abuse, may limit treatment administration in IVDUs